Hemorrhoids

What is it?

Hemorrhoids are swollen blood vessels (veins) found in and around the anus and lower rectum. These vessels are normally present but stretch, enlarge and become swollen under pressure. They are very similar to varicose veins.

Who gets it?

This is a common problem in both men and women. It is more common between ages 45-65 but can affect anyone. It is rare before 20 years old. Hemorrhoids are often seen in people who strain to have a bowel movement, have constipation, diarrhea, are pregnant, or sit for long periods of time.

Why does it happen?

The exact cause is unknown but there are several theories including:

The connective tissue holding up the hemorrhoid can breakdown with age or with other conditions allowing the tissue to slide or bulge.
The muscle band around the inner anus (the internal anal sphincter) is big or very tight and when stool is being passed it forces the hemorrhoid to bump into this muscle band causing the hemorrhoid tissue to enlarge and develop symptoms.
Swelling develops simply because of increased blood flow.

What are the symptoms?

Painless rectal bleeding. Blood may be present on the stool, in the toilet, or on the tissue paper.
Itching and irritation of the skin around anus
Pain
Tissue bulging around the anus
Leakage of stool
Difficulty cleaning after a bowel movement

How is it diagnosed

Hemorrhoids can be diagnosed on physical exam. Further testing may be necessary especially if you have rectal bleeding as this may be a symptom of something more serious. A procedure may be performed to look further throughout the colon, such as a flexible sigmoidoscopy or colonoscopy.

How is it treated?

The first step in treating and preventing hemorrhoids is avoiding constipation. Hard stools can lead to rectal bleeding or tearing of tissue. Straining to pass a bowel movement can cause new hemorrhoids to develop or worsen hemorrhoids that are already there.

This can be accomplished by:

Increasing fiber through diet or taking a supplement. Your goal should be to eat 20-35 grams of fiber daily. If taking a fiber supplement, start with a small amount and increase this slowly to avoid side effects such as cramping and gas.
Increasing water consumption
Increase exercise.
Stool softeners. If your stool is not soft and regular with the above measures, taking stool softeners is an appropriate next step.
Sitz baths. This is soaking your anal area for 10-15 minutes, 2-3 times daily. The warm water can improve blood flow and relax the muscular tissue around the anus. You can buy a special bowl or sit in a bathtub with warm water but no soap, salts, or bubble bath.
Creams and suppositories. There are multiple varieties of these products available with and without prescriptions that help relieve pain, inflammation, and itching.

If none of these treatments work, it may be time to consider further intervention.

Internal hemorrhoids can be addressed with:

Rubber band ligation. This is beneficial in 70-80% of people. A rubber band is placed around the base of the hemorrhoid which cuts off the blood supply causing the tissue to shrink and die.
Surgery. This treatment can be used for internal or external hemorrhoids. The extra hemorrhoid tissue will be removed. It is successful in 95% of people.

What are the complications?

A clot can form within the hemorrhoidal tissue; this is called a thrombosed hemorrhoid. This can be very painful. Immediate relief comes from cutting the skin over the clot. Over time the clot will go away on its own so symptomatic treatment is also an option with pain medicine, stool softeners, and sitz baths.