Thousands of people develop this condition every single day, but luckily most treatments can be conducted right at home. Hemorrhoids are enlarged veins located in the lower part of the rectum and the anus. They become swollen because of increased pressure within them, usually due to straining at stools and during pregnancy. Internal Hemorrhoids are located in the inside lining of the rectum and cannot be felt. They are usually painless and make their presence known by causing bleeding with a bowel movement. Internal Hemorrhoids can prolapsed or protrude through the anus. External Hemorrhoids are alocated underneath the skin that surrounds the anus. They can be felt when they swell and may cause itching or pain with a bowel movement, as well as bleeding. A thromboses external hemorrhoid occurs when blood within the vein clots, and can cause significant pain.
Causes of Hemorrhoids
Hemorrhoids are associated with Constipation and straining at bowel movements. Pregnancy is also associated with hemorrhoids. These conditions lead to increased pressure within the hemorrhoidal veins causing them to swell. Other conditions, for example chronic liver disease, may also cause increased venous pressure and may be associated with hemorrhoid formation. Hemorrhoids are very common and are estimated to occur in up to one-half of the population by age 50.
Symptoms of Hemorrhoids
The most common symptom and sign from hemorrhoids is painless bleeding. There may be bright red blood on the outside of the stools, on the toilet paper, or dripping into the toilet. The bleeding usually is self-limiting. Bleeding with a bowel movement is never normal and should prompt a visit to a health care practitioner. While hemorrhoids are the most common cause of bleeding with a bowel movement, there may be other reasons to have bleeding including inflammatory bowel disease, infection, and tumors.
Types of Hemorrhoids
- Prolapsed Internal Hemorrhoids
Prolapse of an internal hemorrhoid occurs when the internal hemorrhoids swell and extend from their location in the rectum through the anus. A prolapsed internal hemorrhoid:
- can be felt as a lump outside the anus;
- can be gently pushed back through the anus, this may resolve the problem of prolapse but does not fix the hemorrhoid itself;
- may enlarge and swell even more if they cannot be pushed back;
- May become entrapped, which requires medical attention.
- Thrombosed External Hemorrhoids
Thrombosed External Hemorrhoids are a painful condition. These occur when a blood clot develops in the hemorrhoid causing swelling and inflammation.
- When a blood clot occurs in a hemorrhoid, the hemorrhoid will become even more swollen. This swelling leads to increased pain.
- The pain is usually worse with bowel movements and may increase with sitting.
- Thrombosed External Hemorrhoids often need medical care and treatment.
Diagnosis of Hemorrhoids
Diagnosis of hemorrhoids is usually made by history and physical examination by the health care practitioner. Depending upon the situation, past medical history, medications and stability of the patient, treatment may follow with no further testing. Inspection of the anus and a digital rectal examination are often performed. Sometimes anoscopy may be required.
Treatment of Hemorrhoids
Self-Care at Home
Symptomatic treatment for hemorrhoids can be done at home.
- Warm Sitz Baths
- Sitting in a few inches of warm water three times a day for 15-20 minutes may help decrease the inflammation of the hemorrhoids. It is important to dry off the anal area completely after each Sitz bath to minimize irritation of the skin surrounding the anus.
- Dietary Changes
- Increased fluid intake and dietary fiber (roughage) will decrease the potential for constipation and lessen the pressure on the rectum and anus during a bowel movement, minimizing further swelling, discomfort, and bleeding. Dietary fiber supplements may also help bulk up the stools
- Stool Softeners
- Stool softeners may help but once hemorrhoids are present, liquid stools may cause inflammation and infection of the anus. Your health care practitioner and pharmacist are good resources to discuss their use.
- Activity Suggestions
- Individuals with hemorrhoids should not sit for long periods of time and may benefit from sitting on an air or rubber donut available at most local pharmacies.
- Exercise is helpful in relieving constipation and in decreasing pressure on the hemorrhoidal veins. Individuals should be encouraged to have a bowel movement as soon as possible after the urge arises. Once that urge passes, stools can become constipated and straining with a bowel movement may occur.
Treatment of Hemorrhoids
Prolapsed Internal Hemorrhoids
- Most prolapsed internal hemorrhoids can be pushed back into the anus
- If the hemorrhoids remain swollen and trapped outside the anus and nothing is done about it, the hemorrhoid tissue may not receive enough blood and can become infected. In such situations, surgery may be required to resolve the problem.
- Thrombosed external hemorrhoids can be painful and are associated with a hard lump that is felt at the anus and cannot be pushed back inside. Most often the clot within the hemorrhoid will need to be removed with a small incision.
- After local anesthetic is placed under the skin surrounding the hemorrhoid, a scalpel is used to cut into the area and the clot is removed. There is almost instant relief of the sharp pain but a dull ache may continue.
- There may be some mild bleeding from the hemorrhoid for a couple of days. Sitz baths and over-the-counter pain medications may be recommended.
- The use of a rubber or air rubber donut may help with the pain as well. Preventing constipation is also a priority.
- For Best Toilet Health: Squat Or Sit? (npr.org)