Hemorrhoids are swollen veins in the anus. To some degree, everybody has them and they are a normal part of human anatomy. They are usually not symptomatic, and actually help in preventing leakage of gas or stool from the anus. It is when hemorrhoids become symptomatic that they need to be treated. Common symptoms include:
- Anal masses
- Anal leakage or soiling
Hemorrhoids are not cancer but symptoms of conditions other than hemorrhoids (including cancer) may mimic hemorrhoids, so it is important to have an evaluation by a physician. Hemorrhoids are often caused by pressure due to straining, pregnancy, or other factors. Hemorroidectomy is surgery to remove hemorrhoids. Not all hemorrhoids require surgical intervention, or are treated the same. Treatment options are dependent upon the underlying problem causing the hemorrhoids.
Hemorrhoids can be internal or external:
- Internal hemorrhoids can occur in clusters around the anal canal wall. While usually painless, the may prolapse (protrude), bleed or discharge mucus. They occur above the level of nerve endings so they typically do not cause pain. They may cause an anal mass if they prolapsed. Internal hemorrhoids are classified by degrees I-IV, defined and treated by the degree of prolapsed.
- External hemorrhoids are at the anal opening. They become problematic when they thrombose (form a blood clot). This may appear as a hard bluish lump that may cause severe pain. External hemorrhoids occur below the nerve endings; therefore treatment can be painful. They may accompany internal hemorrhoids.
Prevention of Hemorrhoids
Finding the cause of your hemorrhoids is the first step to preventing them. It is much easier to prevent them that to treat them. Inability to rectify what is causing your hemorrhoids makes it much more likely that they will recur.
- Coughing, diarrhea and constipation are the main culprits in the formation of hemorrhoids.
- If your job requires you to spend most of the seated, try to stand and walk five minutes for every hour and frequently shift position to alleviate pressure on the rectal area.
- Always exhale as you strain or lift. Don’t hold your breath.
- Do not delay or try to prevent a bowel movement when the urge is present.
- Regular exercise can help stimulate the bowels to move.
- Moistened tissues such as baby wipes are less irritating than using dry toilet paper after bowel movements.
- Keep the rectal area dry.
- Do not read or linger while on the toilet. If bowel movements take longer than five minutes, you are too constipated.
Prevention of hard stools and constipation is paramount in the prevention of hemorrhoids. To have soft, regular bowel movements:
- Drink at least 8 tall glasses of water a day.
- Maintain a high fiber diet. Fiber passes into the colon and can result in larger, bulkier stool, which is soft and easier to pass. If you gradually work up to three fiber servings a day, you will find you can tolerate the fiber much better.
- Avoid narcotics as these medications increase constipation.
Sometimes a laxative is needed to stimulate more frequent bowel movements, but they are not a good long-term solution as it can damage the nerves of the colon. Do not take any laxative product for more than seven days in a row.
A bowel retraining program can be implemented to severe constipation. This includes a diet high in roughage (bran, leafy vegetables), six ounces of prune or apricot juice each morning, two large servings of stewed fruit each day, one heaping tablespoon of psyllium fiber twice a day. After a normal breakfast, set aside 15 minutes to sit on the toilet without straining to have a bowel movement. If no bowel movement occurs by the third day, you may use an enema and repeat this process.
Non-Surgical Treatment of Hemorrhoids
Once hemorrhoids develop, non-surgical treatment includes relieving symptoms such as burning, pain and itching, as well as shrinking the hemorrhoids.
Sitz baths are very useful in the treatment of hemorrhoids. You should soak the rectal area in hot water in a shallow bath for 20 minutes three to four times a day. This helps clean and relax the area.
There are also topical medications that are used for aching, burning and itching.
Surgical Removal of Hemorrhoids (Hemorrhoidectomy)
- Numbing the hemorrhoid with local anesthetic
- Making a small incision to remove the blood clot; or
- Removal of the hemorrhoid
Removal of internal hemorrhoids may include:
- Banding-placing tight elastic bands around the base of the hemorrhoid to cut off the blood supply, causing it to fall off within a week.
- Infrared coagulation – a small probe is used to expose the hemorrhoid to short bursts of infrared light, sealing off the blood vessel causing it to shrink. Healing takes a week or two.
- Stapled Hemorrhoidopexy(PPH) – is a newer technique to reduce hemorrhoidal tissue prolapse with the use of a circular stapling device. This device excises a segment of the prolapsed anal mucosa, allowing the remaining hemorrhoidal tissue to be stapled, thereby restoring the hemorrhoidal tissue back to its correct anatomical position. PPH offers patients treatment of their hemorrhoids with lee pain and quicker recovery times than other types of hemorrhoid surgery. PPH must be performed by a surgeon skilled in this technique.
- Transanal Hemorrhoidal Dearterialization (THD) is an effective minimally invasive surgical procedure for treating internal hemorrhoids. This surgery involves the use of a special proctoscope coupled with a Doppler transducer to allow for successful, targeted ligation of the arteries supplying blood to the hemorrhoids. This newer technique results in significantly less postoperative pain for patients.
- Traditional Hemorrhoidectomy - is a surgery to remove hemorrhoids. You will be given general anesthesia or spinal anesthesia so that you will not feel pain. Incisions are made in the tissue around the hemorrhoid. The swollen vein inside the hemorrhoid is tied off to prevent bleeding, and the hemorrhoid is removed. The surgical area may be sewn closed or left open. Medicated gauze covers the wound.