HEMORRHOIDS

Hemorrhoids are essentially varicose veins. The just happen to occur at a site most people would consider a sensitive area. Nothing could be more embarrassing than visiting the proctologist, but actually this problemit occurs very frequently, especially in older people and in pregnant women. It does not make for very good dinner conversation, but needs to be discussed.

WHAT IS A HEMORRHOID?

A hemorrhoid is a collection of varicose veins either inside (internal) or just outside (external) the anus. These veins naturally occur at this site, but once they are enlarged, they are defined as hemorrhoidal tissue.

WHAT SYMPTOMS DO HEMORRHOIDS CAUSE?

Most hemorrhoids do not cause symptoms. The most common symptom of internal hemorrhoids is bright red blood in the stool, on toilet paper, or in the toilet bowl. Sometimes, internal hemorrhoid may stick out through the anus, and can be difficult to push back in. They can become irritated, inflammed and painful. External hemorrhoids can also be painful, or even thrombose to form a har, painful knot.

HOW ARE HEMORRHOIDS DIAGNOSED?

The diagnosis is made by history and physical examination. Included in the work-up might be a digital examination to feel for masses, as well as an anascopic examination, looking up the anus for pathology using a short scope. Further evaluation with colonoscopy or flexible sigmoidoscopy can reveal other potential sources of bleeding or pain. In individuals who have blood coming out of their rectum, one cannot ascribe the bleeding to being just from the hemorrhoid, without being sure that there is not another source of blood higher up the colon.

HOW DO YOU PREVENT HEMORRHOIDS?

Maintaining good bowel habits is important in trying to prevent hemorrhoids. That means keeping the stool soft and bulky with a high fiber diet, and avoiding straining in the bathroom.

HOW ARE HEMORRHOIDS TREATED?

Once the diagnosis has been established, then medical management of hemorrhoids is initiated. The first goal is to reduce the inflammation and pain. Various techniques to accomplish this goal include sitting in a bath tub several times a day in warm water for about 10 minutes. There are various hemorroidal creams or suppository that can be applied to soothe the area. Concomittantly, the second goal of medical management is to prevent recurrence of the inflammation and prolapsing of the internal hemorrhoids through the anus. Therefore, it is imperative to avoid constipation and straining by increasing fiber and fluids in the diet. A softer and bulkier stool makes emptying the bowels easier and lessens the strain on hemorrhoidal tissue. Sources of fiber include dietary intake, as wellas psyllium (Metamucil) or methylcellulose (Citrucel).

Hemorrhoids that are large and cause recurrent symptoms might need to be treated more aggressively. There are numerous different ways of achieving this destruction of the hemorrhoidal tissue. These options can range from a simple office to a more aggressive approach.