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