Hemorrhoids are swollen veins. Each of us has veins around the anus that tend to stretch under pressure, somewhat like varicose veins in the legs. When these veins swell, we call them "hemorrhoids." One set of veins is inside the rectum (internal), and another is under the skin around the anus (external).
Hemorrhoids also are known as "piles." As a rule, they do not cause pain or bleeding. Problems can occur, however, when these veins become swollen because pressure is raised in them. Increased pressure may result from straining to move your bowels, from sitting too long on the toilet, or from other factors such as pregnancy, obesity, or liver disease.
What are the Symptoms of Hemorrhoids?
The only sign you may notice from internal hemorrhoids is bright red blood on the toilet paper or in the toilet bowl. Sometimes, however, these veins stretch, and may even fall down (prolapse) through the anus to outside the body (protruding hemorrhoids). When this happens, the vein may become irritated and painful.
The set of veins around the anus causes problems when blood clots form in them, and they become large and painful. (These are called thrombosed external hemorrhoids.) You may notice a tender lump on the edge of the anus. Bleeding starts when the swollen veins are scratched or broken by straining or rubbing. People who have external hemorrhoids may feel itching at the anus too. This might result from draining mucus and irritation caused by too much rubbing or cleaning of the anus, or alternatively by inadequate anus hygiene leading to particles of stool around the anus caught in between the hemorrhoidal protrusions. Any stool particles on the perianal skin will cause itching and irritation in this area.
How Common are Problems with Hemorrhoids?
Hemorrhoidal problems are very common in both men and women. About half of all people have hemorrhoids to some extent by the age of 50. Many people have bleeding from hemorrhoids sometimes, but most often the bleeding is not serious. Women may begin to have problems during pregnancy. The pressure of the fetus in the abdomen, as well as hormonal changes, causes hemorrhoidal veins to enlarge. These veins are also placed under severe pressure during the birth of the baby. For most women, however, such hemorrhoids are a temporary problem.
What is the Treatment?
Often all that is needed to reduce symptoms is to include more fiber in your diet to soften the stool. Eat more fresh fruits, leafy vegetables, whole grain breads and cereals (especially bran). Drinking six to eight glasses of fluid (not alcohol) each day will also help. Softer stools make it easier to empty the bowels and lessen pressure on the veins.
Good hygiene is also important. Bathe the anus gently after each bowel movement using soft, moist toilet paper (or a commercial moist pad). Avoid a lot of wiping. If necessary, you can even use a bath or shower as an alternative to wiping. After bathing, dry the anus gently with a soft cloth or towel.
When Do I Need to See My Doctor?
It is a good idea to see your doctor any time you see bleeding from the anus. This is important to make sure you dont have cancer or some other disease of the digestive system. You will need an examination of your anus and rectum and possibly further examination of the bowel. If the doctor finds hemorrhoids, you may be advised to change your diet or to use a fiber supplement that softens the stool, or a stool softener. Your doctor might only recommend ice, tub bath, warm soaks (sitz bath), or rest in bed.
If you know you are having pain from hemorrhoids, you might try putting cold packs on the anus, followed by a tub bath or sitz bath, three or four times a day. To protect against irritation, cleanse the anus carefully and apply zinc oxide paste (or powder) to the area. Medicated suppositories or creams are available at the drug store. Any of these home treatments may relieve the symptoms, and no other treatment may be needed. If symptoms persist, see your doctor.
In some cases, internal hemorrhoids that have fallen outside of the anus (prolapsed) or that bleed too much must be removed. Your doctor may be able to remove them during an outpatient visit to his office or to the hospital.
A number of methods besides surgery with a scalpel can be used to remove or reduce the number of hemorrhoids. The surgeon may decide to use a technique in which a rubber band is put around the base of the hemorrhoid. The band cuts off circulation, and the hemorrhoid withers away within a few days. This technique is used only for internal hemorrhoids. Sometimes a chemical is injected around the vein to shrink the hemorrhoid.
Other methods include the use of freezing electrical or laser heat, or infrared light to destroy the hemorrhoidal tissue.
PREVENTION OF HEMORRHOIDS
The best way to prevent the problem is to pass your bowel movements as soon as possible after the urge occurs. Also, dont sit on the toilet too long, since this is the only time that the anus truly relaxes, allowing the veins there to fill with blood. The longer you sit, the longer pressure is put on the hemorrhoids. To avoid constipation, be active. Move around, walk, and exercise to help move the stools through your body. Also, add fiber to your diet to reduce bowel straining and to help produce stools that are softer and easier to pass.
Remember, hemorrhoids usually do not pose a danger to your health. In most cases, hemorrhoidal symptoms will go away naturally within a few days. Although it is rare, chronic bleeding from hemorrhoids may lead to anemia.
- Chasnoff IJ, Ellis JW, Fainman ZS. Family Health and Medical Guide. Lincolnwood, Ill. Publications International: 1998. General medical guide with sections on hemorrhoids and other digestive diseases.
- Napoli M. Ultimate Medical Answer Book. New York, New York. Hearst Books; 1997. A question and answer book that contains a chapter on hemorrhoids.
- Feinstein A. Symptoms: Their Causes and Cures. New York, New York. Bantam Books; 1994. General reference book that has a section on hemorrhoids.
- Griffith H.W. Complete Guide to Symptoms, Illness, and Surgery. New York, New York. The Body Press/Perigee Books: 1995. A general handbook of symptoms and their therapies, including surgical interventions.
- Mazier PW. Hemorrhoids, Fissures, and Pruritus Ani. Surgical Clinics of North America 1994; 74: 1277-1292. This excellent review article for physicians is written in technical language and is available in medical libraries.