Definition Hemorrhoids (also known as "piles" are dilated or
bulging veins of the rectum and anus, caused by
increased pressure in the rectal veins. Fifty to
seventy-five percent of all Americans develop
hemorrhoids. Description Hemorrhoids involve the blood vessels that line the
anus. Pressure on the walls of the rectum weakens
the muscles that support the hemorrhoidal vessels.
They then become enlarged and lose their support
and result in a sac-like protrusion inside the rectal
canal (called internal hemorrhoids) or under the skin around the anus (called external hemorrhoids). If the internal hemorrhoid pushes out of the anal
opening, this hemorrhoid is called a prolapsed
hemorrhoid. Sometimes, blood can pool in an
external hemorrhoid, forming a clot (thrombus). This
hemorrhoid is called a thrombosed external
hemorrhoid. Hemorrhoids can occur at any time, but become more
common with advancing age. Younger people,
pregnant women and women who have had
children are most apt to develop hemorrhoidal
problems. The condition occurs more frequently in
some families. Causes The causes of hemorrhoids include: habitually straining (due to constipation)
diarrhea
coughing
sneezing
vomiting
prolonged sitting pregnancy (pressure on the lower abdomen caused
by the uterus)
sedentary lifestyle
eating a low-fiber diet
overweight
standing or lifting too much cirrhosis of the liver
anal intercourse
anal or rectal infection
Symptoms The most common symptoms of hemorrhoids are: small amount of blood in the stool or on the toilet
paper after wiping
incomplete bowel movements
rectal itching
soft lump felt at the anal opening
Note: Bleeding from the rectum should be reported to the doctor. Bleeding could be a symptom of other
medical conditions, such as inflammation of the
intestines, anal fissures (crack in the lining of the anal
canal), rectal polyps and/or colorectal cancer. Diagnosis To diagnose hemorrhoids, the doctor will do a rectal
examination. The doctor places a gloved and
lubricated finger into the rectum to feel for
abnormalities. External hemorrhoids can be
diagnosed by a visual and/or rectal examination. To diagnose internal hemorrhoids, the doctor will
insert a thin tube-like instrument (called an
anoscope) into the lower few inches of the rectum.
The anoscope has a light at the end and an eyepiece
at the front for viewing into the anal canal. To look for other sources of bleeding, the doctor may
perform a colonoscopy (an examination of the inside
of the colon) or a sigmoidoscopy (an examination of
the rectum and the last part of the colon - the sigmoid
colon). Treatment Medical treatment of hemorrhoids is initially aimed at
relieving symptoms. Measures to reduce symptoms
include: warm tub or sitz baths several times a day in plain,
warm water for about 10 minutes
ice packs to help reduce swelling
application of petroleum jelly, cortisone creams,
hemorrhoidal cream (such as Preparation-H) or
suppositories to the affected area wearing cotton underwear and loose clothing
cleaning the anus after each bowel movement by
patting gently with moist toilet paper or moistened
pads
taking acetaminophen or aspirin
For hemorrhoids that don't respond to self-care measures, there are some other techniques to
alleviate the hemorrhoids: For treatment of internal hemorrhoids, one of five
methods is usually used: 1. Rubber Band Ligation - This procedure involves
placing a small rubber band at the base of the
internal hemorrhoid. The band cuts off blood supply
to the hemorrhoid, causing it to shrivel up and fall off
in about four to seven days. 2. Injection Sclerotherapy - This procedure involves
injecting a chemical solution into the mucous
membrane near the hemorrhoid. This chemical
causes inflammation and closure of the veins,
thereby shrinking the hemorrhoid. 3. Infrared Photocoagulation - This procedure
involves directing an infrared light to coagulate (clot)
the dilated veins of the hemorrhoid. This causes the
hemorrhoids to shrink, since the blood does not flow
through the coagulated blood vessels. 4. Laser Coagulation - This new procedure involves
the application of an electric current to the
hemorrhoids. The electric current, emitted by an
electrode probe, triggers a chemical reaction that
shuts down the blood supply in the hemorrhoid and
causes the inflamed tissue to shrink. 5. Hemorrhoidectomy - This procedure involves
surgically removing the hemorrhoid groups in the
anal canal, and is performed with a scalpel, cautery
device or laser. For the treatment of external hemorrhoids, one of
three methods is used: 1. Infrared Photocoagulation 2. Laser Coagulation 3. Hemorrhoidectomy For the treatment of a prolapsed hemorrhoid, a
hemorrhoidectomy is recommended. For the treatment of a thrombosed external
hemorrhoid, drainage of the hemorrhoid or a
hemorrhoidectomy is recommended.