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Hemorrhoids – Symptoms & Treatment 16November

Hemorrhoids – Symptoms & Treatment

Are you suffering from Hemorrhoids?

Hemorrhoids:

Hemorrhoids are tissue consisting of blood vessels, connective tissue, and a small amount of muscle. We all have hemorrhoids. It is normal anatomy. However, when hemorrhoids become enlarged, it may cause symptoms.

There are two main types of hemorrhoids: internal and external.

Internal hemorrhoids are covered with a lining called mucosa inside anal canal.

External hemorrhoids are covered by skin.

Symptoms and treatments are different for internal and external hemorrhoids.

Symptoms:

Internal hemorrhoids can cause painless bright rectal bleeding or prolapse of anal tissue. It may be found on the wipe, dripping into the toilet bowl, or streaked on the bowel movement (BM) itself. When hemorrhoids tissue prolapses, it can often be felt on the outside of the anus. Prolapsing tissue can cause significant irritation and itching around the anus. Patients may also complain of mucus discharge, difficulty with cleaning themselves after a BM, or a sense that their stool is “stuck” at the anus with BMs.

Symptomatic external hemorrhoids often present as a bluish-colored painful lump just outside the anus.

Causes:

Common causes include: straining when having a bowel movement, constipation, diarrhea, pregnancy, and irregular bowel patterns.

Diagnosis:

Careful history and examination by an experienced physician is necessary to make a correct diagnosis of hemorrhoids. A consultation with a physician knowledgeable in evaluating the anal and rectal area should be made in order to rule out other serious diseases such as anal and colorectal cancer.

Treatments:

Dietary/life style changes Increasing dietary fiber, taking a fiber supplement, getting plenty of fluids, and exercising may be helpful in alleviating symptoms.

It is usually recommended to achieve 20-35 grams of fiber per day in the diet.  Most people can benefit from taking a fiber supplement.

Use topical treatments. Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone.

If nonsurgical treatment does not help, further treatment may be necessary.

Office-based treatment for Internal hemorrhoids

Most common is rubber band ligation.

This involves the placement of rubber bands at the base of internal hemorrhoids. It cuts off the hemorrhoid’s blood supply, and hemorrhoids fall off around 1- 4 days.  Usually, 2-3 visits are necessary to relieve symptoms. There is no need for pain medication during procedure. Rubber bands can be associated with a dull ache or feelings of pressure, which is usually well-treated with Tylenol.  Complications from the procedure are unusual but can include pain, bleeding, and, rarely, infection.

Other options: infrared coagulation, and sclerotherapy.

Office-based treatment for External hemorrhoids

Painful thrombosed external hemorrhoids are removed surgically. It involves the injection of a local anesthetic and excising/lancing of the hemorrhoidal tissue.

Operative treatment of hemorrhoids

It is needed when other treatment fails.

Hemorrhoidectomy is surgical removal of the hemorrhoidal tissue. It is performed in an operating room. After hemorrhoidectomy, patients may feel severe pain for a few days after the procedure. Patients need to discuss surgery, complications and aftercare in detail with treating surgeons.

Authors: Sushil Pandey, MD, Rhea Kundan

Dr. Pandey can be seen here at Wickenburg Community Hospital Specialty Clinic.

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