Hemorrhoids

(Health Bulletin)

Hemorrhoids, often called piles, are clusters of veins in the anus, just under the membrane that lines the lowest part of the rectum and anus. They occur when veins in your rectum enlarge from straining or pressure.
A sometimes embarrassing topic of discussion, hemorrhoids are common. By age 50, about half of adults deal with the itching, burning, bleeding and pain that often signal the presence of this condition.
Fortunately, effective medications and procedures are readily available to treat hemorrhoids. In many cases the condition may require only self-care and lifestyle changes.

Causes
Hemorrhoids can develop from any increase in pressure in the veins in the lower rectum. Common sources of pressure include:
• Constipation and the accompanying extra straining
• Diarrhea and the abrupt expulsion of diarrhea stools
• Sitting or standing for a long time
• Obesity
• Heavy lifting
• Pregnancy and childbirth
It's also possible to inherit a tendency to develop hemorrhoids.

Signs and symptoms
Signs and symptoms usually depend on the location of the hemorrhoids:
1. Internal hemorrhoids. You can't see or feel these hemorrhoids. But straining or irritation from passing stool can injure a hemorrhoid's delicate surface and cause it to bleed. You may notice small amounts of
bright red blood on your toilet tissue or in the toilet bowl. Because internal membranes lack pain sensitive nerve fibers, these hemorrhoids usually don't cause discomfort. However, you may experience a feeling of fullness in your rectum following a bowel movement. Occasionally, straining can push an internal hemorrhoid through the anal opening. If a hemorrhoid remains displaced (prolapsed), it can cause a constant, dull ache. When irritated, it can itch or bleed.
2. External hemorrhoids. These hemorrhoids tend to be painful. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), causing severe pain and inflammation. When irritated, external hemorrhoids can itch or bleed.
Screening and diagnosis
As a general rule, see your doctor if your hemorrhoids are painful or bleed frequently or excessively.
The most common sign of hemorrhoids is rectal bleeding. But because rectal bleeding can occur for other reasons, see your doctor to rule out more serious conditions or diseases.
If the onset of your hemorrhoids occurs along with a marked change in bowel habits or if you're passing black, tarry or maroon stools, consult your doctor without delay. These types of stools can signal more extensive bleeding elsewhere in your digestive tract.
Seek emergency care if you notice large amounts of rectal bleeding, lightheadedness, weakness or a rapid heart rate of more than 100 beats a minute.
A doctor can determine if you have external hemorrhoids simply by looking. For internal hemorrhoids, your doctor may want to conduct an examination with a rubber-gloved finger. But even this technique may be inconclusive because hemorrhoids are often too soft to detect.
In this case your doctor may want to examine the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope, barium enema or colonoscopy, These tests can determine that the bleeding is not from higher in the colon, which typically indicates other conditions.

Treatment of haemorroids
In most cases treatment of hemorrhoids involves steps that you can take on your own. But sometimes medications or surgical procedures are necessary.

• Medications
If your hemorrhoids are producing only mild discomfort, your doctor may suggest over-the-counter creams, ointments or pads containing witch hazel or a topical anti-inflammatory agent containing hydrocortisone. This local treatment, in combination with daily warm baths, may relieve your symptoms.
• Surgical or other procedures
If a blood clot has formed within an external hemorrhoid, your doctor can easily remove the clot with a simple incision, which should provide prompt relief.
For painful or persistent hemorrhoids, your doctor may recommend:
1. Tying off a hemorrhoid called rubber band ligation. A doctor ties one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation. Within 7 to 10 days, the hemorrhoid painlessly falls off. This simple, practically painless procedure is done in a doctor's office and is effective for most people.
2. Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the hemorrhoid.
3. Infrared light. A 1- or 2-second burst of infrared light also can cut off circulation to an internal hemorrhoid.
4. Laser therapy
5. Freezing/cryosurgery. This technique freezes the affected tissue, cutting off circulation and destroying the hemorrhoidal tissue.
6. Electric current. Bursts of electric current shrink a hemorrhoid in a procedure similar to infrared.
7. Surgery. If other procedures haven't been successful or if you have a large hemorrhoid, your doctor can remove tissue in a procedure called hemorrhoidectomy.
Prevention
To prevent hemorrhoids or hemorrhoidal flare-ups:
• Eat high-fiber foods. Eat more fruits, vegetables and grains. Doing so softens the stool and increases its bulk, which will help lessen the straining that can cause hemorrhoids.
• Drink plenty of liquids. How much water and other fluids should you drink daily? Average man needs 2,900 mL (about 12 cups), while woman needs about 2,200 mL, (about 9 cups) of water each day.
• Try fiber supplements. If you use fiber supplements,
be sure to drink at least 8 to 10 glasses of water or other fluids every day. Otherwise, fiber supplements can cause constipation or make constipation worse.
• Exercise. Stay active to reduce pressure on veins, which can occur with long periods of standing or sitting, and to help prevent constipation.
• Avoid long periods of standing or sitting.
• Don't strain. Straining and holding your breath when trying to pass a stool creates greater pressure in the anal veins.
• Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.

Self-care
You can temporarily relieve the mild pain, swelling and inflammation of most hemorrhoidal flare-ups with the following self-care measures:
• Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a topical numbing agent.
• Keep the anal area clean and dry.
• Soak in a warm bath several times daily.
• Apply ice packs or cold compresses on the anus for 10 minutes up to four times a day.
• If a hemorrhoid has prolapsed, gently push the hemorrhoid back into the anal canal.
• Use a sitz bath with warm water.
• Use moist towelettes or wet toilet paper after a bowel movement instead of dry toilet paper.
These self-care measures may relieve the symptoms, but they won't make the hemorrhoid disappear. See your doctor if you don't get relief in a few days.