Hemorrhoids are engorged, often painful veins located in your anus.
Hemorrhoids can build up in 2 different places. There are 2 distinct branches of veins that drain the blood from the lower rectum and anus.
The internal veins can become swollen to form internal hemorrhoids. Internal hemorrhoids, unless they are severe, cannot be seen or felt, unlike external hemorrhoids.
Similarly, the external veins can enlarge to form external hemorrhoids. External hemorrhoids can be seen around the outside of the anus and, often, can be felt.
Hemorrhoids are associated with constipation, straining at bowel movements, and pregnancy. Many physicians believe that these conditions lead to increased pressure in the hemorrhoid veins, thus causing them to swell. Hemorrhoids are very common and have been estimated to occur in up to half the general population by age 50.
The symptoms are fairly straightforward. The most common is painless rectal bleeding. You will see bright red blood on the outside of your bowel movement, on toilet tissue, or dripping into the toilet. The bleeding usually is self limited and does not last long.
Hemorrhoids may become prolapsed.
External hemorrhoids may become quite painful when they get thrombosed.
If you notice recurrent bleeding between bowel movements or have a moderate amount of bleeding, you should consult with your doctor.
If you have a family history of colon cancer or are over age 40 you should see your doctor for evaluation of the recurrent rectal bleeding.
If you have prolapsed hemorrhoids that will not go back into the anus, or you have significant anal or rectal pain, you should consult your doctor.
There are numerous other medical causes of rectal bleeding that are much more serious than hemorrhoids. These will require a doctor to further evaluate he cause so that serious conditions such as colon cancer and colitis are not overlooked
Most of the time hemorrhoids can be managed by your primary care physician. A few situations exist that may require that instead you to go to the hospital emergency department.
If you have considerable pain, bleeding, or a prolapsed hemorrhoid and are unable to get in touch with your doctor, then you should be evaluated in the emergency department.
If you have a large amount of bleeding from your rectum, become weak, or experience lightheadedness you should be evaluated in the emergency department.
The number one tool that the doctor will need is a medical history and physical exam to evaluate your hemorrhoids. Occasionally your doctor may need to evaluate your hemorrhoids by looking directly at them by performing an anoscopy.
During an anoscopy, a small, lighted scope is placed into the anus and rectum to fully view the anal canal and lower rectum. This procedure is a bit uncomfortable but is easily performed in a doctor’s office and does not require sedation, usually a local anesthetic gel is applied.
If there has been significant bleeding or symptoms of severe blood loss, then your doctor may order a simple blood test to ensure that you have notdeveloped anemia.
Self-Care at Home
The treatment varies depending on the severity of the problem. Most of the time, conservative treatment can be performed at home.
Hot sitz baths
Prolapsed internal hemorrhoids
The surgeon can elect to inject the hemorrhoids with a medicine to shrink them or place small rubber bands around the hemorrhoids to cut off the blood supply so they will die. These procedures are usually done in the office and don’t require you to be put to sleep or admitted to a hospital.
Sometimes, it is necessary for the surgeon to actually remove the hemorrhoids. In this case you will need to be put to sleep or have a spinal anesthetic.
Warm sitz baths 3 times a day and after each bowel movement along with increasing the amount of dietary fiber is beneficial.
Any pain associated to the surgery can be easily managed with over-the-counter pain relievers.
There is no scientifically proven method for avoiding the development of hemorrhoids. Eating a high-fiber diet and avoiding straining is believed to aid in preventing hemorrhoids, but there is no way to completely eliminate the risk.
Most people with hemorrhoids have an excellent outcome. There cab be flare-ups of bleeding or slight discomfort from time to time, but they don’t last long and can be relieved with care at home, typically with sitz baths.