What are Hemorrhoids?
Hemorrhoids, also called piles, are enlarged, or varicose veins of the anus and rectum. They are among the most common of health ailments, affecting more than half of us at some point in our lives. There are two types of hemorrhoids – internal and external – that can occur separately or in combination.
Internal hemorrhoids are often present without causing any discomfort or even awareness of their presence, although you may feel fullness in the rectum, as if you need to have a bowel movement. Until they thrombose (clot) or bleed you may not know you have them. If your hemorrhoid bleeds, you may see bright red blood after a bowel movement. Because rectal lining, rather than skin, covers internal hemorrhoids, they are usually not as tender as external hemorrhoids. However, if they strangulate (lose their blood supply) then they can be very painful.
Internal hemorrhoids can be pushed down or stretch until they bulge outside your anus; this is called a prolapsed hemorrhoid. Prolapsed hemorrhoids can feel as if something is being pinched in you anus, or you may notice a painless lump when you wipe after a bowel movement.
External hemorrhoids develop under the skin just outside the opening of the anus. They usually cause symptoms if they thrombose, in which case they appear as a very tender circular purplish bulge adjacent to the anal opening.
People often assume that itching in the anal region is due to hemorrhoids. In fact, there are a number of other conditions that are more likely to cause anal itching than hemorrhoids, it is, therefore, important to receive a proper medical diagnosis to determine the true source of anal itching.
What causes hemorrhoids?
Hemorrhoids may have a number of predisposing causes, but in most cases, increased pressure in the abdomen plays a key role. Some of the most common underlying factors for developing hemorrhoids include straining during bowel movements, pregnancy, repeated lifting of heavy objects, prolonged sitting or standing, and being overweight. The excessive pressure can cause the small veins around the anus and rectum to stretch. As the veins lose their elasticity, they become distended with blood and more likely to thrombose and become more fragile. This may result in bleeding, which is often the first indication of hemorrhoids.
Some people can have a single episode of symptoms from hemorrhoids, and others are plagued by ongoing symptoms all of their lives. It is common for a woman to experience hemorrhoids during pregnancy and/or delivery, and then have a resolution shortly after birth, never to have a problem again.
Not all bleeding from the anus is due to hemorrhoids
Rectal bleeding is a potentially serious symptom, so don't dismiss this as ‘hemorrhoids' without a proper diagnosis, since other problems could be the cause. One such bleeding source could be anal fissures, which are tears in the lining of the anus. A hallmark of fissures is pain when passing a bowel movement. Some types of inflammatory bowel disease can also cause rectal bleeding, as can tumours of the rectum and colon. Therefore, if you pass blood from the anus, then you should consult with your doctor to determine if further testing is required.
Conservative (non-surgical) measures for dealing with hemorrhoids Avoid straining during bowel movements
Constipation and straining can make hemorrhoids worse. A high-fibre diet and adequate fluid intake are recommended. For more dietary suggestions for dealing with constipation, contact the CSIR office.
Resist the urge to scratch
Hemorrhoids can itch. While scratching may seem to make them feel better, don't give in to the urge to scratch. You may damage the delicate vein walls, and make matters much worse for yourself.
Clean carefully
It is extremely important to clean yourself properly and gently. Toilet paper can be scratchy, and some types contain chemical irritants. Use only non-perfumed, non-coloured (white) toilet paper, and try dampening it under the faucet before each wipe. Some varieties of toilet paper are softer than other varieties, and some facial tissues have a moisturizing cream coating, which may be more soothing than non-coated toilet paper.
Ointments and creams
There are many preparations marketed as hemorrhoid treatments, which usually contain one or more active ingredients, including a local anesthetic, anti-inflammatory compounds, or astringents. Witch hazel applied to the rectum with a cotton ball is a popular treatment that has stood the test of time. Hemorrhoidal symptoms often subside within 2-3 days even with no specific treatment, so the usefulness of some of these remedies is not always clear. Several also have ingredients designed to reduce inflammation, and may require a prescription.
Have a sitz bath
This bath, where you are sitting in very warm water with your knees raised, is a remedy that still tops most experts' list of the best way to deal with hemorrhoids. The warm water helps lessen the pain while increasing blood flow to the area, and this helps shrink the swollen veins. You may even try adding Epsom salts to the bath water.
Push it back inside
Sometimes the word "hemorrhoid" refers not to a swollen vein but to a downward displacement of the anal canal lining. If you have such a protruding hemorrhoid, try pushing it back into the anal canal. When hemorrhoids are left hanging out of the anus, they are prime candidates to develop clots.
Pregnant?
Pregnant women are particularly prone to hemorrhoids, in part, because the uterus sits directly on the blood vessels that drain the hemorrhoidal veins. A special hemorrhoid treatment, if you are pregnant, is to lie on your left side for about 20 minutes every 4 to 6 hours. By doing so, you decrease pressure on the main vein draining the lower half of the body.
Surgical treatment
If significant hemorrhoidal symptoms persist despite conservative measures, a number of surgical options are available. Treatment for internal hemorrhoids includes application of rubber bands, stapling, injection of sclerosant, (a material that blocks the vein) cryosurgery, laser, or electro-coagulation techniques. Surgical excision may be required for large, permanently prolapsed hemorrhoids or strangulated hemorrhoids. Thrombosed external hemorrhoids generally respond promptly to surgical incision and clot removal.
WARNING: Hemorrhoids that need help...see your doctor
Even if you are uncomfortable discussing such personal problems, you should see your doctor if you think you have hemorrhoids. Your doctor can establish the correct diagnosis, and then recommend the most appropriate treatment.
Are you taking prescription medication for any of the following stomach problems/symptoms:
Stomach pain or discomfort
Heartburn
Sour taste in mouth/acid regurgitation
Excessive burping/belching
Increased abdominal bloating
Nausea
Early satiety
If you answer yes to any one of the symptoms listed above then take this test to see if your current medication is adequately controlling your stomach symptoms.
The PASS Test
PPI* Acid Symptom Suppression Test
*PPI is short for proton pump inhibitor, a class of medication used to suppress the acid in your stomach. These include Losec®, Nexium®, Pantoloc®, Pariet™, and Prevacid®.
