Hemorrhoids and fissures

What are hemorrhoids?

Hemorrhoids are swollen veins inside or around the rectum – the final portion of your colon. The anus is the actual opening at the end of your rectum. Hemorrhoids are not caused by any bacteria or infection. There are two kinds of hemorrhoids: internal and external hemorrhoids. Internal hemorrhoids occur when veins get swollen inside the rectum. External hemorrhoids occur when veins swell near the opening of the anus. You can have both at the same time, and they are extremely common.

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How dangerous are hemorrhoids?

Hemorrhoids are usually not dangerous. However, many people seek treatment because they can be very painful.

How do I get hemorrhoids?

Hemorrhoids are very common, and anyone can get hemorrhoids at any age. 50% of people older than 50 years old have hemorrhoids.

Hemorrhoids are swollen veins inside/around the rectum, so anything that increases the pressure in these veins can cause hemorrhoids. For example:

  • Straining when having a bowel movement causes increased pressure in the rectal veins, causing the veins to swell and stretch
  • Pregnant women near the end of the pregnancies can get hemorrhoids because of the increased pressure on blood vessels near the pelvic area from the fetus. When giving birth, the intense strain can make hemorrhoids worse
  • Obesity can cause hemorrhoids. The increased weight increases pressure on these vessels, leading to hemorrhoids
  • Diarrhea or constipation increases pressure on the rectal veins
  • Medical conditions like long-term heart or liver disease can cause blood to collect in the abdomen and pelvic area, causing the veins to swell

Signs of hemorrhoids:

The most common signs of both internal and external hemorrhoids are rectal pain, bleeding during bowel movements, or itching. The rectal pain is caused by the pressure from the swollen veins. You may notice bright red streaks of blood in the toilet bowl or on toilet paper after wiping. You may also feel a hard, painful lump near the anus, which occurs when the pooled blood clots in the veins.

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How are hemorrhoids diagnosed?

Hemorrhoids are diagnosed by doing a physical exam and examining your rectal area with a gloved finger.

  • To check for external hemorrhoids, your doctor will look at the area for any signs of visible bulging veins
  • To check for internal hemorrhoids, your doctor will insert a gloved, lubricated finger into your anus to feel for hemorrhoids. Your doctor may also use a scope with a light on it to look inside the rectum

Though these exams may be embarrassing or uncomfortable, it is important for the doctor to check to make sure that hemorrhoids are the cause of any bleeding or rectal pain you are experiencing. This is because rectal bleeding can also be a sign of something more serious, such as cancer.

How are hemorrhoids treated?

Most hemorrhoids are treated with home treatment, without any sort of special mediation, procedure, or surgery. Home treatment for hemorrhoids is focused on reducing the swelling in the veins by reducing the blood supply to the hemorrhoid. By doing so, the swollen vein/hemorrhoid shrinks and goes away on its own. Though there may be some scar tissue that forms, it is important for supporting the anal tissue and preventing future hemorrhoids. Home treatment includes:

  • Be very gentle with the anus when wiping after a bowel movement, and use moistened toilet paper to prevent rubbing and irritation
  • Do not use soaps that include strong scents or other irritating chemicals
  • For the pain and itching, take over-the-counter painkillers like acetaminophen or ibuprofen
  • Apply ice several times a day for about 10 minutes each time, followed by applying a warm compress
  • Take a sitz baths – fill your bathtub with just enough warm (not hot!) water to cover the anal area for about 15 minutes to soothe the area, especially after a bowel movement
  • Take pressure off the area by not sitting for long periods of time. Take breaks, or use a pillow as a chair cushion. Avoid lifting heavy objects, which increases pressure in the area
  • Wear 100% cotton underwear and loose clothing, which prevents moisture buildup that irritates hemorrhoids

If the hemorrhoids are very large, then procedures may be necessary to remove the hemorrhoid. These procedures may include rubber bind ligation, coagulation therapy, or hemorrhoidectomy. Your doctor will be able to tell you the most appropriate treatment for you.

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Rubber band ligation

This is the most common treatment for internal hemorrhoids. The hemorrhoid is tied off at its base with rubber bands. This cuts off blood flow to the hemorrhoid, causing it to shrink and, in about a week, fall off on its own. A doctor must perform this procedure; you cannot do this procedure on your own. The doctor will insert an anoscope (scope with a light) into the anus to view the hemorrhoid and use a device to place a rubber band around the base of the hemorrhoid. You will experience pain and slight bleeding during the next 1-2 weeks of recovery, but this is normal. Rubber band ligation works about 70-90% of the time.

Coagulation therapy

This is used for small to medium sized hemorrhoids. The doctor uses a device that creates a beam of infrared light, laser, or electrical current. The heat generated creates scar tissue, which cuts off blood supply to the hemorrhoid, causing it to shrink and die. The scar tissue also helps prevent future hemorrhoids.

Hemorrhoidectomy

This is surgery to remove very large internal or external hemorrhoids. The swollen vein is tied off to prevent bleeding, and the hemorrhoid is surgically removed. This is an outpatient procedure, which means you do not need to stay at the hospital after the surgery and can go home.

How can you prevent hemorrhoids?

Preventing hemorrhoids involved reducing the pressure on the pelvic vessels:

  • Avoid constipation – constipation causes you to strain during bowel movements, which greatly increases the pressure in the rectal veins. Eating foods high in fiber like fruit, vegetables, and whole grains, and drinking lots of water throughout the day helps prevent constipation. Exercising, even a little, can help, as well as taking a fiber supplement like Metamucil every day
  • Do not strain when having a bowel movement – relax and allow things to happen naturally. Do not hold your breath when passing stools, and do not stay on the toilet longer than necessary (do not read the paper)
  • Change your daily habits – do not sit for a long time, or use a pillow cushion if you must. Take frequent walking breaks. Do not lift heavy objects or hold your breath when lift. For pregnant women, sleeping on your side helps divert the pressure away from the pelvic area.

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