Hemorrhoids

Medically reviewed by The Dermatologists and written by Dr. Alexander Börve

Hemorrhoids are a normal part of the rectal area: they are the veins that encompass the mucus membranes in this region. The condition that we call “hemorrhoids” is very common but harmless. 

It occurs when these veins become inflamed and/or distended beyond the anus. Many factors can contribute to vein pressure in the rectum such as straining during bowel movements, pregnancy, obesity, anal intercourse and constipation. Although it is not a serious health hazard, hemorrhoids can cause significant discomfort, itching, inconvenience and pain.

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Symptoms

Depending on the location of the hemorrhoids – internal or external – the symptoms may include bleeding during bowel movements, itching, pain, swelling and uncontrollable gas or stool and mucus leaks. A small bump near the anus may form. Because the tissues surrounding veins in the rectum weaken and stretch over time, hemorrhoids are more likely to appear in older individuals.

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What can I do?

Change your diet
Constipation increases the symptoms of hemorrhoids. You can change your diet to soften the stool. To avoid constipation, you should eat more high fiber foods such as muesli and rough, dark bread. Wheat bran is rich in fiber and can be used as a supplement in porridge or other food. You should also replace white bread, lettuce, tomatoes and cucumbers, which do not contain as much fiber, with beans, peas, potatoes, broccoli and cauliflower. If you find it difficult to get fiber in your diet, there are the fibers in powder form that your doctor can prescribe or available at pharmacies. Fiber in powder forms should be taken with plenty of fluids, because they bind to the fluid in the colon.

Drink an extra glass of water with each meal – liquids soften and smoothen the stool consistency and facilitate the passage through the intestine. Try to go to the toilet every day ideally at the same time of the day.

Relieve symptoms
Creams and suppositories can relieve mild pain and itching, while ice packs can relieve swelling. If you have had hemorrhoids before and recognize the symptoms, you can buy prescription drugs at pharmacies. You should also wash the skin around the anus with warm water after defecation in both mornings and evenings. Avoid the soap because it can irritate the hemorrhoids further. Wipe gently by patting dry with a towel instead of rubbing. If it does not hurt, you can also try to push back the hemorrhoids.

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Should I seek medical care?

If it is the first time there is bleeding from the rectum, even if it is just a little bleeding, you should contact your health care provider. It is important to find out where the bleeding is and what caused it. Seek help also if you have previously had little bleeding but the bleeding now become larger or more frequent. Bleeding should always be taken seriously as they could be due to serious illnesses, such as cancer.

Other reasons to contact a healthcare provider include severe pain, chronic itching, feces or mucus leaks, if you treat the symptoms on your own and they do not disappear within two or three weeks, if the symptoms become severe or if the hemorrhoids are increasing.

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Treatment

Eating foods high in fiber such as fruits and vegetables can soften stool to reduce the need for straining during bowel movements. Drinking plenty of water and exercising regularly can reduce pressure on veins.

Hemorrhoids usually last for a week or less, but for more severe cases, hemorrhoids may need to be removed by sclerotherapy, rubber band ligation, laser coagulation, or surgery. If an investigation shows that hemorrhoids are large or that they cause heavy bleeding may sometimes need to be examined by a surgeon. There are several different treatments to remove hemorrhoids:

Injection Treatment
Drugs injected with a syringe at haemorrhoids. The agent causes the blood vessels leading to hemorrhoids shrivel, as the flow of blood causes the hemorrhoids to wither and fall off.

Rubber band litigation
With the help of a special apparatus, a rubber band is pulled around the hemorrhoid. When the hemorrhoid no longer receive any blood supply, it shrinks and detaches itself after one to two weeks.

Surgery
Hemorrhoids can be removed with surgery. You might be epidurally or fully anesthetized during the surgery. The wound is then sewn back together either or left open and allowed to heal by itself. Other methods include cutting the hemorrhoids with a special device that also splices lining with small staples or putting a stitch around hemorrhoids’ blood vessels. Surgery to remove the hemorrhoids are considered more effective than injection treatment and rubber band litigation. It is often painful during the healing process but the pain usually disappear after one to two weeks. The time right after surgery can be a bit tricky and it is important that the stool is kept soft to reduce the pain – be sure to drink plenty of water and eat the grain after the surgery.

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Source:

U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2005.

The burden of digestive diseases in the United States. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.  James E. Everhart, M.D., M.P.H. Hemorrhoids. In: Everhart JE, editor.. Washington, DC: US Government Printing Office, 2008; NIH Publication No. 09-6443