Hemorrhoid Treatment, Prevention, Home Remedies, Symptoms, Diagnosis And Causes

Hemorrhoid Treatment, Prevention, Home Remedies, Symptoms, Diagnosis And Causes 


What is Hemorrhoid


Hemorrhoids (Piles) are blood vessels located in the smooth muscles of the walls of the rectum and anus. They are a normal part of the anatomy and are located at the junction where small arteries merge into veins. They are cushioned by smooth muscles and connective tissue and are classified by where they are located in relationship to the pectinate line, the dividing point between the upper 2/3 and lower 1/3 of the anus. This is an important anatomic distinction because of the type of cells that line the hemorrhoid, and the nerves that provide sensation.

Hemorrhoid Treatment, Prevention, Home Remedies, Symptoms, Diagnosis And Causes
Hemorrhoid

Internal hemorrhoids are located above the pectinate line and are covered with cells that are the same as those that line the rest of the intestines. External hemorrhoids arise below the line and are covered with cells that resemble skin.

Hemorrhoids become an issue only when they begin to swell, causing itching, pain and/or bleeding.

What causes hemorrhoids?


While the presence of hemorrhoids is a reflection of the normal anatomy, most people and care professionals refer to hemorrhoids as an abnormal finding because they only present when they swell and cause problems.

Hemorrhoid swelling occurs when there is an increase in the pressure in the small vessels that make up the hemorrhoid causing them to swell and engorge with blood. This causes them to increase in size leading to symptoms. Increased pressure may be caused by a variety of factors:

  • Low fiber diet and smaller caliber stool causes a person to strain when having a bowel movement, increasing the pressure within the blood vessels.
  • Pregnancy is associated with hemorrhoid swelling and is likely due to increased pressure of the enlarged uterus on the rectum and anus. In addition, hormonal changes with pregnancy may weaken the muscles that support the rectum and anus.
  • Prolonged sitting on the toilet may increase pressure within the hemorrhoid blood vessels
  • Previous rectal surgery
  • Spinal cord injury and lack of erect posture

Hemorrhoid Symptoms


Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching (pruritus ani), have similar symptoms and are incorrectly referred to as hemorrhoids.

Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.

Although many people have hemorrhoids, not all experience symptoms. The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding hemorrhoid.

Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.

How Common Are Hemorrhoids?


Hemorrhoids are very common in both men and women. About half of the population have hemorrhoids by age 50. Hemorrhoids are also common among pregnant women. The pressure of the fetus in the abdomen, as well as hormonal changes, cause the hemorrhoidal vessels to enlarge. These vessels are also placed under severe pressure during childbirth. For most women, however, hemorrhoids caused by pregnancy are a temporary problem.

What does a hemorrhoid look like?


Normal hemorrhoidal tissue cannot be seen since they must first swell and become inflamed or develop a clot to cause symptoms. One can see swollen external hemorrhoids or prolapsed internal hemorrhoids exposed outside the anus but internal hemorrhoids cannot be seen because they remain inside the anus. A thrombosed hemorrhoid will appear as a lump at the anal verge, protruding from the anus and will be dark bluish in color because of the blood clot contained inside the swollen blood vessel. A non-thrombosed hemorrhoid will appear as a rubbery lump. Often more than one swollen hemorrhoid appears at the same time.

How Are Hemorrhoids Diagnosed?


A thorough evaluation and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.

The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an exam with an anoscope, a hollow, lighted tube useful for viewing internal hemorrhoids, or a proctoscope, useful for more completely examining the entire rectum.

To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and lower colon (sigmoid) with sigmoidoscopy or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures that also involve the use of lighted, flexible tubes inserted through the rectum.

Hemorrhoid Treatment


Medical treatment of hemorrhoids is aimed initially at relieving symptoms. Measures to reduce symptoms include
  • Warm tub baths several times a day in plain, warm water for about 10 minutes. 
  • Application of a hemorroidal cream or suppository to the affected area for a limited time. 

Preventing of the recurrence of hemorrhoids will require relieving the pressure and straining of constipation. Doctors will often recommend increasing fiber and fluids in the diet. Eating the right amount of fiber and drinking six to eight glasses of fluid (not alcohol) result in softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on hemorrhoids caused by straining. Eliminating straining also helps prevent the hemorrhoids from protruding.

Good sources of fiber are fruits, vegetables, and whole grains. In addition, doctors may suggest a bulk stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).

In some cases, hemorrhoids must be treated endoscopically or surgically. These methods are used to shrink and destroy the hemorrhoidal tissue. The doctor will perform the procedure during an office or hospital visit.

A number of methods may be used to remove or reduce the size of internal hemorrhoids. These techniques include

  • Rubber band ligation. A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within a few days.
  • Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the hemorrhoid. 
  • Infrared coagulation. A special device is used to burn hemorrhoidal tissue.
  • Hemorrhoidectomy. Occasionally, extensive or severe internal or external hemorrhoids may require removal by surgery known as hemorrhoidectomy. 

How Are Hemorrhoids Prevented?


The best way to prevent hemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure and straining, and to empty bowels as soon as possible after the urge occurs. Exercise, including walking, and increased fiber in the diet help reduce constipation and straining by producing stools that are softer and easier to pass.

Stay regular by eating enough fiber and drinking enough fluid. Most Americans only take in 13 grams of fiber in their daily diet, half of what is recommended. Adding fiber to your diet helps to produce stools that are softer and easier to pass.

OTC medications and home remedies for hemorrhoids


Grade 1 hemorrhoids are treated symptomatically. There can be some spasm of the anal muscles. Warm sitz baths, sitting in a warm tub for 20 minutes, two or three times a day may be helpful. Avoiding spicy food may also prevent anal itching. Over-the-counter medications may be helpful.

  • Medications are used to control symptoms by softening the stool, decreasing the inflammation of the hemorrhoids and treating the pain.
  • Stool softeners work by increasing the water and fat content within the stool allowing it to be passed more easily. Docusate sodium is most often recommended drug in this class (Colace, Surfak, Correctal).
  • Inflammation can be controlled with over-the-counter creams or suppositories. Some brand ingredients (Preparation H) include low dose topical anesthetics to help with symptoms. Others (Anusol, witch hazel) contain astringents that help shrink the swollen tissues. Both may contain low dose steroids (hydrocortisone) to decrease inflammation. People with diabetes should check with their pharmacist or health care professional before using OTC hemorrhoid treatments. If the medication contains a vasoconstrictor (for example, phenylephrine HCI, ephedrine, or epinephrine) it may elevate blood sugar levels if absorbed in large amounts.
  • Prescription strength lidocaine or hydrocortisone may be offered by the health care professional.

How can I avoid getting hemorrhoids?


You're more susceptible to hemorrhoids when pregnant, but they're not inevitable. Here are some ways to ward them off – or get rid of them if you do get them:

  • First and foremost, avoid constipation: Eat a high-fiber diet (plenty of whole grains, beans, fruits, and vegetables), drink plenty of water (eight to ten glasses a day), and get regular exercise, even if you only have time for a short, brisk walk. If you're constipated, ask your practitioner about using a fiber supplement or stool softener.
  • Don't wait when you have the urge to have a bowel movement, try not to strain when you're moving your bowels, and don't linger on the toilet, because it puts pressure on the area.
  • Do Kegel exercises daily. Kegels increase circulation in the rectal area and strengthen the muscles around the anus, decreasing the chance of hemorrhoids. They also strengthen and tone the muscles around the vagina and urethra, which can help your body recover after you give birth.
  • Avoid sitting or standing for long stretches of time. If your job involves sitting, get up and move around for a few minutes every hour or so. At home, lie on your left side when sleeping, reading, or watching TV to take the pressure off your rectal veins and help increase blood return from the lower half of your body.


What else can I do to get relief?


  • Apply an ice pack (with a soft covering) to the affected area several times a day. Ice may help decrease swelling and discomfort. Some women find cold compresses saturated with witch hazel to be soothing.
  • Soak your bottom in warm water in a tub for 10 to 15 minutes a few times each day. (If you don't have a tub, you can buy a sitz bath at the drugstore. It's a small plastic basin that you fill with water and position over your toilet, allowing you to submerge your rectal area simply by sitting down.)
  • Try alternating cold and warm treatments.
  • Gently but thoroughly clean the affected area after each bowel movement using soft, unscented, white toilet tissue, which causes less irritation than colored, scented varieties.
  • Moistening the tissue can help, too. Many women find using premoistened wipes more comfortable than using toilet tissue. You can buy wipes medicated with witch hazel that are made specifically for people with hemorrhoids.
  • Ask your healthcare practitioner to recommend a safe topical anesthetic or medicated suppository. There are many hemorrhoid-relief products on the market, but consult your practitioner before trying one on your own. Most of these products should be used for no more than a week. Continued use can cause even more inflammation.