Hemorrhoids

WHAT ARE THEY?
Hemorrhoids are enlarged and inflamed veins in the lower rectum and anus, which sometimes occur outside the anus and can be seen (external type); at other times they occur inside the rectum and cannot be seen (internal type).
WHAT CAUSES THEM?
There are many contributing factors related to hemorrhoids: straining to have a bowel movement; passing hard, dry stools (constipation); sitting for long periods of time; having frequent diarrhea stools, and pregnancy (the pressure it puts on the bowel). Others include diet, overuse of laxatives, inflammation or infection of the rectal area, heredity and other conditions of the rectum. Hemorrhoids are a very common problem. It is not known exactly how many people have them, because often they do not cause symptoms. We do know that people between the ages of 20 and 50 experience the largest number of symptoms from hemorrhoids.
WHAT ARE THE COMMON SYMPTOMS?
Pain, itching, and bleeding are common symptoms. Hemorrhoids inside the rectal opening are usually painless, but often bleed and cause a feeling of fullness. This may result in an urge to have a bowel movement even when there is no stool present. Straining to have a bowel movement can aggravate the problem. Bleeding from internal hemorrhoids usually occurs at the end of the bowel movement. You may notice that the stool is streaked with blood, blood may drip into the toilet bowl, or it will appear on the toilet paper when you wipe. Rectal bleeding can be a signal of a more severe problem and should be evaluated. Other symptoms include increased moisture or itching around the rectum, or finding a small bulge that is very tender to the touch outside the rectum.
ARE THEY CONTAGIOUS?
No.
HOW LONG WILL THEY LAST?
Hemorrhoids tend to stay with you, but they may not cause you difficulty. An internal hemorrhoid can remain without symptoms for a long time. Bleeding and extension of internal hemorrhoids through the anus are the most common symptoms. This is known as prolapse. When the hemorrhoids develop a blood clot, known as thrombosis, the condition is more serious and needs evaluation. Thrombosis will usually be signaled by a significant increase in discomfort.
HOW ARE THEY TREATED?
Treatment for this problem consists of two important parts: (1) what you can do, and (2) what your health care provider can do.
What Can You Do?

• Put an ice bag on the rectal area to help relieve acute pain. Some people find that the tanic acid from a warm, wet tea bag applied to the area is soothing. Others use compresses containing witch hazel applied to the area for 10 to 15 minutes three or four times a day.
• A 10 to 15 minute soak in a warm bath three or four times a day may relieve the pain and swelling for some people.
• Lying on your stomach or side instead of sitting may lessen the discomfort.
• If you must sit try using a “donut pillow”. This will help take some of the direct pressure off the rectal area.
• Keep the rectal area clean to help relieve the itching.
• Do not wipe yourself vigorously. Patting with toilet paper will help. Using moistened toilet paper or baby-wipes after a bowel movement can protect the skin from further irritation.
• Avoid scratching. This will make the problem worse.
• Avoid anti-itching creams or lotions with an ingredient that has "-caine" in its name. These products have a local anesthetic in them and, if used too often, can cause further irritation.
• It is recommended that you consult with a physician prior to using any suppository-type product.

What Can Your Health Care Provider Do?

• Your health care provider will examine your rectal area and may recommend several alternatives. Prescription creams and suppositories are available for pain and swelling.
• Your provider may also recommend a stool softener or a high-fiber, anti-constipation diet. All of these are available over the counter. The dietary fiber should be between 20 and 35 grams a day. For more information on high fiber diets please read the McKinley Health Center handout “High Fiber.”
• If hemorrhoids persist or are particularly troublesome, a more active type of treatment may be necessary. This may include injection with a special chemical to shrink them, or they may be destroyed by a freezing technique called cryosurgery. Another method is surgical removal. These procedures will probably be referred to a colon-rectal specialist.
• In cases where bleeding is persistent, the doctor may want to examine the lower part of the intestine visually, using a technique called sigmoidoscopy. This procedure takes only a few minutes and involves inserting a type of lighted scope into the rectum to view the intestinal lining and hemorrhoid areas.

CAN YOU PREVENT THEM?
Yes, maybe. Because constipation is the most frequent cause of rectal problems, it is necessary to avoid constipation by eating a diet filled with high-fiber foods every day. Fiber adds bulk and moisture to the stool, and it speeds movement through the bowel. Foods that are rich in fiber are whole grain breads and cereals, fresh or cooked fruits and vegetables, beans and nuts. You also need to drink adequate amounts of water each day. People who suffer from hemorrhoids should decrease or eliminate alcohol and caffeine, because they can cause small, dry stools. By using good toilet habits you can help prevent hemorrhoids. Avoid straining, putting off the urge to go, and using laxatives or enemas. Do not strain or sit on the toilet for long periods of time. Many people think that they must have a bowel movement every day. Daily bowel movements are not necessary. A healthy bowel movement should happen naturally, within several minutes, and with little or no effort on your part. Also, avoid heavy lifting, which puts pressure on the anal opening.
FOLLOW-UP
Follow-up with your health care provider as recommended.
REMEMBERNotify your health care provider if you have any of the following symptoms:

• Severe, acute bleeding that you cannot control
• Bleeding that lasts more than a week
• Severe pain lasting more than a few hours

Hemorrhoids, protocol

What are hemorrhoids?Almost everyone is bothered at some time or another by hemorrhoids. Reports suggest that 50 percent of the U.S. population - both men and women - have hemorrhoids by age 50. The term refers to a condition that occurs when veins around the anus (external hemorrhoids) or just inside the anus (internal hemorrhoids) become distended and inflamed. They can cause a number of symptoms - usually just irritating, not dangerous, and treatable at home - but sometimes they can become infected or bleed heavily, prompting urgent intervention and even surgery.

What are the symptoms of hemorrhoids?
Depending on whether they are internal or external, these inflamed veins can cause itching, rectal bleeding, and pain that can sometimes be severe. The classic symptom of internal hemorrhoids is rectal bleeding. Most often it is usually noticed as bright red streaks on toilet paper, but blood can also be found on the stool, underwear or in the toilet bowl. Internal hemorrhoids can sometimes bulge outside of the anus, rarely leading to the formation of a blood clot.

External hemorrhoids are more frequently associated with pain, and if irritated from straining or excessive rubbing or cleaning, may also itch and bleed. Blood clots - also known as thrombosed hemorrhoids - are more commonly formed in external hemorrhoids. They can often feel like a hard, painful grapelike lump on the anus, and sometimes need to be removed surgically.

What are the causes?
The most common causes of hemorrhoids are prolonged sitting, straining at stool, constipation, and irritants in the diet, including strong spices such as red pepper and mustard, and drinks such as coffee, decaffeinated coffee, and alcohol. Stress can cause hemorrhoids, as can pregnancy (due to pressure of the fetus in the abdomen, as well as hormonal changes that cause blood vessels to enlarge - these hemorrhoids usually disappear after delivery). Obesity, chronic diarrhea and anal intercourse can also lead to hemorrhoids.

What is the conventional treatment?
If natural remedies (see below) don’t improve constipation , you can help lessen pressure and straining with bowel movements by taking an over-the-counter stool softener such as docusate sodium (Colace).

An effective natural treatment for symptomatic hemorrhoids often recommended in conventional settings is the sitz bath: sit in a bathtub with enough warm water to cover the anal area for fifteen minutes several times a day. 

Application

 of warm compresses for 10 minutes at a time throughout the day can also offer similar relief. Local heat increases blood flow to the area, promoting healing.

Most hemorrhoids disappear on their own after a few days, some however, may become thrombosed and require surgical intervention to remove clotted blood; still others can persist becoming hard and painful. These may require more invasive treatment. One method is ligation, in which a rubber band is placed around the base of the hemorrhoid. The band cuts off blood circulation and, as a result, the hemorrhoid withers away within days. Another method is sclerotherapy - injection of a chemical solution around the blood vessel to shrink it. A third technique relies on infrared coagulation to destroy the hemorrhoid by burning. And lastly, a surgical procedure known as hemorrhoidectomy is occasionally recommended for extensive or severe hemorrhoids to completely remove them. All of these are last resorts for persistent or severe cases that do not respond to simpler methods.

What therapies does Dr. Weil recommend for hemorrhoids?

• Dietary changes: To prevent hemorrhoids as well as treat them, you should increase the amount of fiber in your diet in order to relieve constipation (and consequent straining, which increases pressure in the veins surrounding the anus). You can do this by eating plenty of fruits, vegetables and whole grains. If that's not possible, take psyllium seed husks, in any of the forms available in drugstores and health-food stores. Drink lots of water, more than you think you need. Yet another healthy option is freshly ground flaxseed, a great source of both soluble and insoluble fiber in addition to omega-3 fatty acids and lignans. Flax helps promote bowel motility as well as softening stool. Try 1-2 tbsp daily with food. Avoid dietary irritants as much as possible.
• Exercise: Regular exercise promotes bowel function and health.
• Supplements: Triphala, a combination of three bowel tonifying herbs from the Ayurvedic tradition, is another excellent bowel regulator. You can buy it in capsules in health food stores. Follow the dosage and directions on the label. If you can tolerate it, try taking one teaspoon of liquid aloe vera after meals.
• Also: Apply aloe vera gel to the anal area frequently; it feels good and promotes healing. Avoid tobacco use in all forms. Instead of dry toilet paper, use compresses of witch hazel (which acts as an astringent) to clean the anal area after bowel movements. You can get medicated witch hazel pads and towelettes at most drugstores.

Finally, many over-the-counter products are sold for symptomatic relief of hemorrhoids. Dr. Weil recommends avoiding those containing benzocaine or other topical anesthetics. Although it may contribute to the loss of marine species, preparation H is safe; it is an unlikely but effective combination of a yeast culture and shark liver extract.

Natural Remedies For Hemorrhoids: Home Treatment For Bleeding Piles

Hemorrhoids (or piles) are the anal veins that have become engorged and swollen. Hemorrhoids cause immense pain, rectal bleeding, burning, itching, inflammation, irritation and sometimes prolapse of the rectal tissue.

There are a host of causative factors for hemorrhoids, the commonest being, chronic constipation, excessive straining at stool, pregnancy, chronic diarrhea, and diarrhea alternating with constipation, a diet that is lacking ion fiber and anal intercourse.

Hemorrhoids Home Remedy

The following are very effective home remedies for piles / hemorrhoids:

• Baking soda: apply some baking soda around the anus; it helps manage itching associated with hemorrhoids.
  Onion and honey: grate an onion and add a spoon of honey, place this over a cotton padand apply on the hemorrhoids for 2 hours.
• Vitamin E: applying vitamin E oil to the anal area affords immense pain relief.
• Aloe Vera gel: soothes the pain and inflammation that occurs in piles.
• Dried mango seed is an amazing home remedy for bleeding and painful hemorrhoids. Take about 2 grams of powdered mango seed along with honey. It helps improve bowel movement, prevents constipation and reduces pressure on the piles.

Natural Remedies For Hemorrhoids Or Piles

Follow these simple and easy to do measures and dietary changes to mange piles successfully:

• Check constipation.
  Drink lots of water every day, and make sure you have foods that supply generous doses of dietary fiber. These add bulk to the stool and aid in easy and smooth passage of the feces; thereby cutting the risk of painful hemorrhoids. Steer clear of aerated drinks,caffeine and alcohol.
• Do away with oily food, refined and processed food, and junk food from the daily diet. Opt for nutritious and wholesome options such as whole wheat, oats, fresh vegetables and fruits, dates, dried figs and nuts.
• Do not indiscriminately use laxatives.
• Avoid lifting heavy weights and avoid sitting / standing for prolonged periods of time.
• Apply Witch hazel to the hemorrhoids affected area using a toilet paper. Witch Hazel is known to be a natural astringent that reduces inflammation, swelling, pain and discomfort.

Bleeding Piles Home Treatment

• Witch hazel, aloe vera or apple cider vinegar application to the bleeding hemorrhoid stops the bleeding immediately and prevents infection from occuring.
• Applying an ice pack to the anus helps allay pain, swelling and swiftly and effectively.
• Homeopathy drugs are known to afford wonderful respite from piles. Consulting a practitioner is recommended.
• Use disposable baby wipes to clean after a bowel movement; they are gentler than the toilet paper and prevent bleeding.
• Sit on a hemorrhoid cushion; it relieves pressure on the hemorrhoids and consequently checks bleeding.

Read more on Hemorrhoids Treatments

• Rinse affected area with Apple Cider Vinegar and warm water several times a day.
• For external hemorrhoids, smooth on Linseed Oil several times a day. If the piles are internal, take a teaspoon of Linseed Oil several times a day.
• Apply Borax and water mixed to piles. You could also try sitting on a cloth saturated with this solution.
• An enema of Whole Flaxseed is very soothing. Apply when liquid is warm, not hot.
• You can apply chopped Garlic in the rectal area and rest several hours then rinse clean; finish with an application of Almond Oil.
• One internal treatment is to take teaspoons of Molasses and butter right before going to bed; take hot.
• External application of Aloe Vera Juice helps reduce inflammation and brings cooling relief.
• Sit in a warm bath of Chamomile Tea followed by an application of pure Petroleum Jel.

Some more external 

applications

1) Yarrow Herb
2) Witch Hazel
3) Weak warm bath in Epsom Salts
4) Sage and Garden Parsley Tea bath
5) Pumpkin Seed Oil, Fireweed Oil, Horsemint Oil, and Linseed Oil mixed together and applied several times a day.
6) An application of Olive Oil several times a day.

Does Alcohol Causes Hemorrhoids and Home Remedies for Its Treatments

 Hemorrhoids also known as piles, are inflamed and swollen veins found in the lower rectum and in the anus. A number of factors can cause it. In some instances, it may also be related to alcohol consumption.

• As a person gets older, they become more susceptible to developing hemorrhoids.
• By age 50, it is estimated that about half of the adult population would have experienced signs of hemorrhoids
• They can either be internal or external with external piles causing the most irritation
• It can be treated with medication, lifestyle changes and sometimes with surgery
• Although alcohol does not directly cause hemorrhoids, they can help aggravate the situation

Does Alcohol Cause Hemorrhoids?

No.

Drinking alcohol alone will not cause hemorrhoids. However, it can affect the other factors causing the condition. This leads to an aggravation of symptoms, recurrence, and trouble healing.

Alcohol and Piles Correlation

Too much alcohol in the diet can worsen a case of hemorrhoids. This is mainly because:

• Alcohol in the body draws water out of the cells and leads to dehydration
• This can lead to harder stools and constipation is one of the precipitating factors of the condition
• Constipation leads to an increased amount of straining, which also aggravates piles
• People who want to have their hemorrhoids treated and keep them from reoccurring should stop taking alcoholic beverages.

In addition to alcohol, hemorrhoids may also be aggravated by increased caffeine intake as it can also dehydrate the body.

Causes of Hemorrhoids

Here are some of the common causes of piles

• Straining with bowel movements – can irritate the veins of the rectum
• Long periods of sitting on the toilet – this causes an increase of pressure on the rectal area
• Chronic Diarrhea/Constipation
• Pregnancy
• Obesity
• Anal  Intercourse

In addition to those factors, some studies have shown that hemorrhoids may also be an inherited condition.

Home Remedies and Lifestyle Treatments

• Avoid alcohol and caffeine-rich foods and drinks
• Drink a lot of water – this helps to keep hydrated and avoid constipation
• Prepare a Sitz Bath – regular soaking in a sitz bath can help to relieve itching and irritation
• Cold and Warm Compresses – These can help to reduce the swelling and control the pain, doctors may also prescribe pain relievers
• Avoid using dry toilet paper – moist towelettes can helps to keep the anal area clean better than dry toilet paper
• Keep the anal area clean by regular bathing

How to Get Rid of Hemorrhoids Naturally

Hemorrhoids can be a real pain in the butt, quite literally, and one of the best things that you can know are how to treat them in the comfort of your own home without having to take that embarrassing trip to the doctor. It really shouldn't be that embarrassing. Think about it, doctors look at this kind of thing, and worse, every day. Follow this guide for remedies that you can try at home.

Method 1 of 3: Know the Causes & Symptoms

1. 
   1
   Understand what causes hemorrhoids. Hemorrhoids are swollen veins in the anal region. These are caused by increased pressure in the abdomen. Straining while going to the bathroom, sitting for long periods of time, obesity, and pregnancy can all lead to hemorrhoids developing. Never strain to have a bowel movement for more than 10-15 seconds. Pause for at least a minute before straining again, if the first effort was unsuccessful.^[1]
   • Hemorrhoids are more prevalent at older ages due to weakened tissue in the anal area.
   Ad
2. 
   2
   Understand the symptoms of hemorrhoids. Hemorrhoids can cause bleedingduring bowel movements, itching and irritation, general pain, and swelling in the anal region.
   • Any significant bleeding that does not abate after trying remedies at homerequires a prompt visit to a doctor.

Method 2 of 3: Use Home Remedies

1. 
   1
   Soak regularly. Soak your inflamed area in warm water for about 15 minutes, three or four times a day. Gently dry by patting with a soft towel or with a hair dryer.
2. 
   2
   Keep it clean. Bathe or shower at least once a day, and clean the inflamed area with warm water. Use a hand sprayer. Soap may cause irritation and is not absolutely required. Gently dry by patting with a soft towel or with a hair dryer.
3. 
   3
   Apply a cold pack. Ice packs or cold compresses will help to reduce swelling and irritation. If that doesn't help, hot packs sometimes work as well.
4. 
   4
   Avoid dry toilet paper. Dry, rough toilet paper can inflame and cause more irritation. Use only premium, fluffy, soft TP and moist towelettes that don’t contain fragrances or alcohol. Hold the paper or towelette in place a few moments to allow it to absorb any residue.
5. 
   5
   Apply apple cider vinegar. Apple cider vinegar helps to reduce the swelling and irritation of both internal and external hemorrhoids. When purchasing apple cider vinegar, be sure to get unfiltered, unpasteurized vinegar, as it is much more potent and effective.
   • For external hemorrhoids, first gently clean the inflamed area. Apply a small amount of vinegar to a cotton ball, and then gently press the ball up against the inflamed area. Expect to feel some stinging, but it will pass in a few moments and you should feel relief from the itching and irritation. Repeat a few times a day until the swelling decreases.
   • For internal hemorrhoids, ingest a teaspoon of vinegar along with a glass of waterat least twice a day. Be sure to drink water when drinking vinegar to help balance the acidity in your stomach. Add honey to help lessen the taste of the vinegar

Method 3 of 3: Prevent Hemorrhoids

1. 
   1
   Change your diet. Eat foods that are high in fiber. This includes more fruits, vegetables, and whole grains. This will lead to softer stool, which will cause less strain and therefore less irritation.
   • Slowly add more fiber to your diet to avoid producing excess gas.
2. 
   2
   Supplement your fiber intake. If you still aren’t consuming enough fiber, even after changing your diet, consider adding fiber supplements to your routine. Fiber supplements will help to increase the softness of your stool, although they will tend to increase gas.
3. 
   3
   Drink lots of water. Drink at least six glasses of water each day to help keep your stool soft. Alcohol has a negative effect, so try to avoid it.
   • Drink at least eight glasses of water a day when taking supplements to avoid constipation.
4. 
   4
   Stay active. A regular exercise routine will help to relieve strain on the veins. This strain is especially apparent if you have been standing or sitting for long periods of time. Exercise to break up the constant strain.
   • Excess weight has a negative effect on hemorrhoids, so exercise is a multi-benefit solution.
5. 
   5
   Go immediately. As soon as you feel the need to go to the bathroom, do it. If you wait and the need passes, your stool will most likely become drier and harder to pass.
6. 
   6
   Avoid tight clothing in the summer months. Tight clothing will cause sweating and this can lead to irritation and inflammation. Wearing nylon and other such materials can prove to be bad for the skin as they can encourage sweating and do not have the absorbency needed to take the sweat away from the perirectal skin.

Hemorrhoids and what to do about them

A few simple strategies can help ease the pain and trouble associated with these bothersome bulging blood vessels.

Many women have a passing encounter with hemorrhoids during pregnancy. But by midlife, hemorrhoids often become an ongoing complaint. By age 50, about half the population has experienced one or more of the classic symptoms, which include rectal pain, itching, bleeding, and possibly prolapse (hemorrhoids that protrude through the anal canal). Although hemorrhoids are rarely dangerous, they can be a recurrent and painful intrusion. Fortunately, there’s a lot we can do about them.

Anatomy of hemorrhoids Hemorrhoids are distended blood vessels that form either externally (around the anus) or internally (in the lower rectum).

What are hemorrhoids?

In one sense, everyone has hemorrhoids, the pillow-like clusters of veins that lie just beneath the mucous membranes lining the lowest part of the rectum and the anus. The condition most of us call hemorrhoids (or piles) develops when those veins become swollen and distended, like varicose veins in the legs. Because the blood vessels involved must continually battle gravity to get blood back up to the heart, some people believe hemorrhoids are part of the price we pay for being upright creatures.

There are two kinds of hemorrhoids: internal ones, which occur in the lower rectum, and external hemorrhoids, which develop under the skin around the anus. External hemorrhoids are the most uncomfortable, because the overlying skin becomes irritated and erodes. If a blood clot forms inside an external hemorrhoid, the pain can be sudden and severe. You might feel or see a lump around the anus. The clot usually dissolves, leaving excess skin (a skin tag), which may itch or become irritated.

Internal hemorrhoids are typically painless, even when they produce bleeding. You might, for example, see bright red blood on the toilet paper or dripping into the toilet bowl. Internal hemorrhoids may also prolapse, or extend beyond the anus, causing several potential problems. When a hemorrhoid protrudes, it can collect small amounts of mucus and microscopic stool particles that may cause an irritation called pruritus ani. Wiping constantly to try to relieve the itching can worsen the problem.

What causes hemorrhoids?

Experts are divided on exactly what causes hemorrhoids, but probably several mechanisms are at work. Traditionally, hemorrhoids are associated with chronic constipation, straining during bowel movements, and prolonged sitting on the toilet — all of which interfere with blood flow to and from the area, causing it to pool and enlarge the vessels. This also explains why hemorrhoids are common during pregnancy, when the enlarging uterus presses on the veins.

More recent studies show that patients with hemorrhoids tend to have a higher resting anal canal tone — that is, the smooth muscle of the anal canal tends to be tighter than average (even when not straining). Constipation adds to these troubles, because straining during a bowel movement increases pressure in the anal canal and pushes the hemorrhoids against the sphincter muscle. Finally, the connective tissues that support and hold hemorrhoids in place can weaken with age, causing hemorrhoids to bulge and prolapse.

Hemorrhoids can usually be diagnosed from a simple medical history and physical exam. External hemorrhoids are generally apparent, especially if a blood clot has formed. Your clinician may perform a digital rectal exam to check for blood in the stool. She or he may also examine the anal canal with an anoscope, a short plastic tube inserted into the rectum with illumination. If there’s evidence of rectal bleeding or microscopic blood in the stool, flexible sigmoidoscopy or colonoscopy may be performed to rule out other causes of bleeding, such as colorectal polyps or cancer, especially in women over age 50

.Diagnosing hemorrhoids

Home treatment

Most hemorrhoid symptoms improve dramatically with simple, at-home measures. To avoid occasional flare-ups, try the following.

Get more fiber. Add more fiber to your diet from food, a fiber supplement (such as Metamucil, Citrucel, or Fiber Con), or both. Along with adequate fluid, fiber softens stools and makes them easier to pass, reducing pressure on hemorrhoids. High-fiber foods include broccoli, beans, wheat and oat bran, whole-grain foods, and fresh fruit. Fiber supplements help decrease hemorrhoidal bleeding, inflammation, and enlargement. They may also reduce irritation from small bits of stool that are trapped around the blood vessels. Some women find that boosting fiber causes bloating or gas. Start slowly, and gradually increase your intake to 25–30 grams of fiber per day. Also, increase your fluid intake.

Exercise. Moderate aerobic exercise, such as brisk walking 20–30 minutes a day, can help stimulate bowel function.

Take time. When you feel the urge to defecate, go to the bathroom immediately; don’t wait until a more convenient time. Stool can back up, leading to increased pressure and straining. Also, schedule a set time each day, such as after a meal, to sit on the toilet for a few minutes. This can help you establish a regular bowel habit.

Sitz. A sitz bath is a warm water bath for the buttocks and hips (the name comes from the German “sitzen,” meaning “to sit”). It can relieve itching, irritation, and spasms of the sphincter muscle. Pharmacies sell small plastic tubs that fit over a toilet seat, or you can sit in a regular bathtub with a few inches of warm water. Most experts recommend a 20-minute sitz bath after each bowel movement and two or three times a day in addition. Take care to gently pat the anal area dry afterward; do not rub or wipe hard. You can also use a hair dryer to dry the area.

Seek topical relief. Over-the-counter hemorrhoid creams containing a local anesthetic can temporarily soothe pain. Creams and suppositories containing hydrocortisone are also effective, but don’t use them for more than a week at a time, because they can cause the skin to atrophy. Witch hazel wipes (Tucks) are soothing and have no harmfu l effects. A small ice pack placed against the anal area for a few minutes can also help reduce pain and swelling. Finally, sitting on a cushion rather than a hard surface helps reduce the swelling of existing hemorrhoids and prevents the formation of new ones.

Treat the clot. When an external hemorrhoid forms a blood clot, the pain can be excruciating. If the clot has been present for longer than two days, apply home treatments for the symptoms while waiting for it to go away on its own. If the clot is more recent, the hemorrhoid can be surgically removed or the clot withdrawn from the vein in a minor office procedure performed by a surgeon.

Some hemorrhoids can’t be managed with conservative treatments alone, either because symptoms persist or because an internal hemorrhoid has prolapsed. Fortunately, a number of minimally invasive treatments are available that are less painful than traditional hemorrhoid removal (hemorrhoidectomy) and allow a quicker recovery. These procedures are generally performed in a surgeon’s office or as outpatient surgery in a hospital.

Procedures to treat hemorrhoids

Rubber band ligation To perform a rubber band ligation, the clinician places a ligator over the hemorrhoid to position a rubber band around its base.

Band it. The most commonly used hemorrhoid procedure in the United States is rubber band ligation, in which a small elastic band is placed around the base of a hemorrhoid (see bow to the right). The band causes the hemorrhoid to shrink and the surrounding tissue to scar as it heals, holding the hemorrhoid in place. It takes two to four procedures, done six to eight weeks apart, to completely eliminate the hemorrhoid. Complications, which are rare, include mild pain or tightness (usually relieved with a sitz bath), bleeding, and infection. Other office procedures include laser or infrared coagulation, sclerotherapy, and cryosurgery. They all work on the same principle as rubber band ligation but are not quite as effective in preventing recurrence. Side effects and recurrence vary with the procedure, so consult your physician about what’s best for your situation.

Hemorrhoidectomy. You may need surgery if you have large protruding hemorrhoids, persistently symptomatic external hemorrhoids, or internal hemorrhoids that return despite rubber band ligation. In a traditional hemorrhoidectomy, a narrow incision is made around both external and internal hemorrhoid tissue and the offending blood vessels are removed. This procedure cures 95% of cases and has a low complication rate — plus a well-deserved reputation for being painful. The procedure doesn’t involve an overnight hospital stay, but it does require general anesthesia, and most patients need narcotic analgesics afterward. Patients can usually return to work after 7–10 days. Despite the drawbacks, many people are pleased to have a definitive solution to their hemorrhoids.

Staples. A newer alternative to traditional hemorrhoidectomy is called stapled hemorrhoidopexy. This procedure treats bleeding or prolapsed internal hemorrhoids. The surgeon uses a stapling device to anchor the hemorrhoids in their normal position. Like traditional hemorrhoid removal, stapled hemorrhoidopexy is performed under general anesthesia as day surgery, but it’s less painful and recovery is quicker. It’s more painful than rubber band ligation and has more minor side effects, but it only needs to be done once; the hemorrhoids are also much less likely to return. Research is now under way comparing stapled hemorrhoidopexy with rubber band ligation and hemorrhoidectomy as a first-line treatment for internal hemorrhoids.

(This article was first printed in the July, 2004 issue of the Harvard Women’s Health Watch. For more information or to order, please go to http://health.harvard.edu/women.)

Harvard Women's Health Watch Harvard Women’s Health Watch – the monthly newsletter that focuses on the special health concerns of women, with expert information and advice from the specialists at Harvard Medical School. Read more »