Hemorrhoids

What are hemorrhoids?
Hemorrhoids occur when are blood vessels normally present in and around the anus and lower rectum can become greatly swollen and painful. due to stretching under pressure. These are fairly common in Both men and women can develop hemorrhoids. , and about 50% of people have hemorrhoids by time they reach age 50. Hemorrhoids are also They are more prevalent in pregnant women due to the pressure of the fetus in the abdomen, as well as hormonal changes, which can cause these vessels to enlarge into hemorrhoids. The process of childbirth also puts severe stress of these vessels. Pregnancy and childbirth increase the risk.
Hemorrhoids are either internal (inside the anus) or external (under the skin around the anus).

What are the symptoms of hemorrhoids?
The following are the most common symptoms of hemorrhoids. However, each individual may experience symptoms differently. Symptoms may include:

• Bright red blood present on the stool, toilet paper, or in the toilet bowl
• Irritation and pain around the anus
• Swelling or a hard lump around the anus
• Itching

The symptoms of hemorrhoids may resemble other medical conditions or problems. Always consult your physician for a diagnosis.
Key Points:
– Hemorrhoids occur when blood vessels in the anus or lower rectum become swollen
– They occur in both men and women; pregnancy and childbirth increase the risk
– Symptoms include pain and irritation around the rectum, swelling around the anus, blood in stools or on toilet paper, and itching

What are the causes and risk factors for hemorrhoids?
Hemorrhoids may develop as a result of repeated straining during bowel movements, pregnancy, advanced age, heredity, and chronic constipation or diarrhea.

Causes and risk factors include:
– Pregnancy and childbirth
– Chronic constipation or diarrhea
– Straining during bowel movements
– Advancing age
– Heredity

How are hemorrhoids diagnosed?
The presence of blood in the stool can be indicative of other digestive disorders, including colorectal cancer, so thorough evaluation and proper diagnosis is important.

Diagnosing hemorrhoids may include:

• Physical examination (to examine the anus and rectum and look for swollen blood vessels that indicate hemorrhoids)
• Digital rectum examination (DRE) - the physician inserts a gloved, lubricated finger into the rectum to check for abnormalities
• Tests that help visualize hemorrhoids:
• Proctoscopy - a lighted tube, which allows the physician to completely examine the entire rectum, is inserted into the anus.
• Anoscopy - a hollow, lighted tube useful for viewing internal hemorrhoids is inserted into the anus.
• Sigmoidoscopy - a diagnostic procedure that allows the physician to examine the inside of a portion of the large intestine, and is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.
• Colonoscopy - a procedure that allows the physician to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the physician to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.

Key points:
– Causes and risk factors for hemorrhoids include chronic constipation or diarrhea, straining during bowel movements, pregnancy and childbirth, and heridity
– During diagnosis, a thorough examination and tests to rule out other digestive disorder is important
– Diagnosis includes examination, and various tests to help the doctor visualize the hemorrhoids


How are they treated?
Specific treatment for hemorrhoids will be determined by your physician, based on your:

• tolerance of specific medicines, procedures, or therapies
• age, overall health, and medical history
• extent of condition
• expectations for the course of the condition
• opinion or preference

Medical treatment of hemorrhoids is aimed at relieving Medications to relieve symptoms and may include: the following:

• Sitting in plain, warm water in the tub several times a day
• Application of ice packs to reduce swelling
• Hemorrhoidal creams or suppositories

Your physician may also recommend increasing both Preventive measures include increased dietary fiber and fluids, and stool softeners. or laxatives to soften stools and reduce constipation. A softer stool lessens pressure on hemorrhoids caused by straining. Good sources of fiber include fruits, vegetables, and whole grains. Bulk stool softeners or Fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel) may also be recommended.

In some cases, it is necessary to treat hemorrhoids surgically. Several surgical techniques are used to remove or reduce internal and external hemorrhoids. These include the following:

Surgery or procedures are sometimes necessary to remove or shrink hemorrhoids. Options include:

• Hemorrhoidectomy - surgical procedure which permanently removes the to remove hemorrhoids.
• Rubber band ligation - a rubber band is placed around the base of the hemorrhoid inside the rectum to cut off circulation to and shrink the hemorrhoids. The hemorrhoid then gradually shrinks and withers away within a few days.
• Sclerotherapy - a chemical solution is injected around the blood vessel to shrink hemorrhoids.
• Electrical or laser coagulation or infrared photo coagulation - techniques that use special devices to burn hemorrhoidal tissue.

Key Points:
– Hemorrhoidal creams/suppositories, warm soaks, and ice packs can relieve symptoms
– Increased dietary fiber and fluids, stool softeners, and fiber supplements can help prevent them from coming back
– Surgery or procedures to remove or shrink hemorrhoids are sometimes necessary

Fast Facts:
– Hemorrhoids are swollen blood vessels in the area of the anus or lower rectum
– Chronic constipation or diarrhea, straining during bowel movements, pregnancy and childbirth can all cause hemorrhoids
– Symptoms include anal pain and irritation, blood in stools or on toilet paper, and swollen areas around the anus

References:
1. Alonso-Coello, P, Guyatt, G, Heels-Ansdell, D, et al. Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev 2005; CD004649.
2. Perez-Miranda, M, Gomez-Cedenilla, A, Leon-Columbo, et al. Effect of fiber supplements on internal bleeding hemorrhoids. HepatoGastroenterology 1996; 43:1504.
3. Shafik, A. Role of warm-water bath in the anorectal conditions. The "thermosphincteric reflex". J Clin Gastroenterol 1993; 16:304.
4. Altomare, DF, Rinaldi, M, La Torre, F, et al. Red hot chili pepper and hemorrhoids: the explosion of a myth: results of a prospective, randomized, placebo-controlled, crossover trial. Dis Colon Rectum 2006; 49:1018.
5. Berkelhammer, C, Moosvi, SB. Retroflexed endoscopic band ligation of bleeding internal hemorrhoids. Gastrointest Endosc 2002; 55:532.
6. Su, MY, Chiu, CT, Wu, CS, et al. Endoscopic hemorrhoidal ligation of symptomatic internal hemorrhoids. Gastrointest Endosc 2003; 58:871.
7. Fukuda, A, Kajiyama, T, Arakawa, H, et al. Retroflexed endoscopic multiple band ligation of symptomatic internal hemorrhoids. Gastrointest Endosc 2004; 59:380.
8. Wehrmann, T, Riphaus, A, Feinstein, J, Stergiou, N. Hemorrhoidal elastic band ligation with flexible videoendoscopes: A prospective, randomized comparison with the conventional technique that uses rigid proctoscopes. Gastrointest Endosc 2004; 60:191.