Hemorrhoids

Hemorrhoids are blood vessels and their surrounding tissue in and around the anus and lower rectum that have become swollen, due to stretching under pressure. Nearly everyone has this condition at some point or at least in some minor form. Enlarged or protruding hemorrhoids can cause uncomfortable symptoms. They are a problem equally in men and women, and are especially prevalent in the 45-to-65-year-old age group.

Hemorrhoids are either internal (inside the anus) or external (under the skin around the opening and outside of the anus). While they may be uncomfortable and inconvenient, they are usually not dangerous or life threatening.

In rare cases, hemorrhoids may create an infection that requires immediate treatment.

Causes/risk factors

Hemorrhoids may develop as a result of repeated straining during bowel movements. Thus, chronic constipation or diarrhea can be a contributing factor. Heredity and aging are also risks for hemorrhoids.

In addition, hemorrhoids are common in pregnant women, due to the pressure of the fetus on the pelvic floor and due to hormonal changes that cause hemorrhoidal vessels to enlarge. The process of childbirth also puts stress on these vessels.

Signs and Symptoms

Common symptoms of hemorrhoids include:

• bright red blood present on the stool, toilet paper, or in the toilet bowl;
• irritation and pain around the anus;
• a swelling, lump, protrusion or bulge at the anus;
• and itching around the anus.

The degree of severity of a hemorrhoid is based partly on the extent to which protrudes, or prolapses, from its normal position.

Diagnosis

Diagnosing hemorrhoids involves a physical examination of the anus and rectum to look for swollen blood vessels. Diagnosis may also include:

• digital rectum examination, in which the physician inserts a gloved, lubricated finger into the rectum to check for abnormalities;
• anoscopy, in which a hollow, lighted tube (endoscope) that is useful for viewing internal hemorrhoids is inserted into the anus;
• proctoscopy, which uses an endoscope to completely examine the rectum;
• colonoscopy or sigmoidoscopy.

Treatment

Often hemorrhoids will go away on their own within a few days, as the protruding blood vessel or vessels and surrounding tissue contract and return to (or closer to) normal shape and position. Initial treatment, though, may include:

• sitting in plain, warm water in the tub several times a day;
• ice packs to reduce swelling;
• and application of hemorrhoidal creams or suppositories.

To avoid further irritation, it is helpful to keep the hemorrhoid and anus as clean as possible. Your physician may also recommend increasing both fiber and fluids to soften stools. A softer stool lessens pressure on hemorrhoids, as a result of decreased straining during bowel movements and softer feces.

In some cases, it is necessary to treat hemorrhoids surgically. Several surgical techniques are used to remove or reduce internal and external hemorrhoids. These include:

• rubber band ligation, in which a rubber band is placed around the base of the hemorrhoid inside the rectum to cut off circulation to the hemorrhoid, so that the hemorrhoid will shrink and wither away over several days;
  
  
• sclerotherapy, in which a chemical solution is injected around the blood vessel to shrink the hemorrhoid;
  
  
• electrical or laser coagulation or infrared photocoagulation – techniques that use special devices to burn hemorrhoidal tissue;
  
  
• or hemorrhoidectomy, a surgical procedure that permanently removes hemorrhoids by cutting them away.