The majority of patients who have an anal or rectal problem come to the office and refer to the problem as “hemorrhoids”. Many other conditions may cause the same symptoms, but here is some information on true hemorrhoids.
WHAT ARE HEMORRHOIDS?
Hemorrhoids are bulging, enlarged blood vessels around and in the anus. They may be external and covered with loose skin, or internal and covered with “mucosa”, the red, moist lining of the inside portion of the anus. As the vessels enlarge, the skin is stretched and thinned. Hemorrhoids may also be “mixed”, which means they are both internal and external.
WHAT ARE THE SYMPTOMS OF HEMORRHOIDS?
Swelling or protrusion of excess skin around the anus.
Itching or irritation.
Difficulty getting clean after bowel movement.
Protrusion (prolapse) of internal tissue to the outside during bowel movements. This may require manual pressure to push back inside.
Bleeding associated with bowel movements.
Anal Pain: This occurs only in certain situations, like sudden development of an external blood clot (thrombosed external hemorrhoid) .
SYMPTOMS NOT LIKELY TO BE HEMORRHOIDS
These can be signs of a much more serious process, and require medical attention.
Blood mixed with stool
Difficulty passing the stool
Change in bowel habits
WHAT CAUSES HEMORRHOIDS?
We are not really sure, but these factors may contribute:
Long term constipation or diarrhea
Straining and pushing to have a bowel movement
Sitting on the toilet for prolonged periods
Dry, hard stool
THROMBOSED EXTERNAL HEMORRHOID-a special case
A firm, painful lump consisting of a clot covered by thin anal skin can suddenly develop, even in a person who has had no previous symptoms or protrusion. It is usually round or oval, ranging from pea-size to robin’s egg size. It may rupture and bleed, resulting in relief. Warm soaks and over the counter ointments may help with pain. If early in the course, it may be removed in the office under local anesthesia, with immediate relief and healing within a few days.
TREATMENT OF HEMORRHOIDS
Treament is based on the type of hemorrhoids and the symptoms. We all benefit from a more plant-based diet, whole grains and dietary fiber, and exercise. I usually recommend supplementation with Psyllium fiber, in powder form, before recommending more invasive procedures
External hemorrhoids- Avoid overly aggressive hygiene, soaps and steroid ointments. These can be removed, but often come back with time
Internal hemorrhoids- For bleeding or protrusion, I may recommend Rubber Band Ligation. With this office procedure, a tiny rubber band is applied to the INTERNAL hemorrhoid, cutting off its blood supply. The hemorrhoid and the band fall off in several days,
and the wound heals. Multiple bandings may be required.
Other techniques include injection sclerotherapy, infra red coagulation and stapling, but rubber band ligation is my preferred treatment.
If fiber and rubber banding have failed, or if the external part of the hemorrhoid is very large and bothersome, Hemorrhoidectomy may be performed to remove the tissue causing symptoms. This is done with an anesthetic. Depending on how much tissue is involved, 2-7 days off work may be needed.
The symptoms I have described for hemorrhoids are very similar to the signs and symptoms of other colorectal diseases, such as cancer. All symptoms should be evaluated by a physician trained in treatment of these diseases. In addition, colorectal cancer screening is recommended for ALL individuals over the age of 50.