Hemorrhoids are swelling of veins in the anus. They may present as a single swelling or multiple, and sometimes protrude out of the anus. Although they appear in various sizes, shapes and colors (pink, red, blue and purple), a small, round, flesh colored lump at the anus is most common. Hemorrhoids may bleed with the passage of stool and may be painful.
While hemorrhoids may be very manageable to some, they may be a nuisance and a terrible inconvenience to others. Usually they are caused by anything that increases pressure in the abdomen such as a chronic cough, prolonged straining/ heavy lifting, constipation and pregnancy.
Hemorrhoids may be classified into four types according to their degree of prolapse.
Grade 1: these may bleed, but do not protrude from the anus.
Grade 2: these protrude with defecation, but go back into the anus afterward.
Grade 3: these protrude, but can be pushed back inside the anus by hand.
Grade 4: these protrude from the anus permanently.
It is important to know what grade of hemorrhoids you have as this affects what kind of treatment options may be best for you. Below are a few tips on the best treatments available for hemorrhoids.
Other serious disorders may present similar to hemorrhoids. Diseases such as anal cancer, colon cancer, anal fissures, perianal abscesses and inflammatory bowel disease may present with bleeding in the stool and/or a lump at the anus. If you have been experiencing a sudden change in bowel habit, weight loss, fever, severe pain around the anus, tearing pain when passing stool, or if you have a family history of colon cancer, you may have a more serious condition. Your doctor may want you to do other tests such as a colonoscopy in order to rule out other illnesses.
Maintain soft bulky stools that can be passed without straining. Keep a diet that has adequate amount of fluid and fiber. Studies show that fiber supplementation with psyllium or sterculia (e.g. Metamucil), or unprocessed bran/whole grain foods decreases bleeding, pain, prolapse, and itching from hemorrhoids.
Over the counter topical preparations that contain steroids, anesthetics, astringents, and/or antiseptics can be used for hemorrhoids. Although studies done are unsure of their value in the treatment of hemorrhoids, many persons claim that they do relieve symptoms.
Avoid using topical preparations that contain steroids for prolonged periods because they may cause thinning of the skin around the anus.
Many persons also claim to find relief from sitz baths. You can prepare a sitz bath by placing warm water in a container, and then sitting in it for a few minutes several times per day. It is important not to make the make the water too hot that it burns the skin. You may consider this method as a form of treatment as it is simple and cost nothing, however studies are unsure if there are any real benefits to this.
Several minor surgical procedures can be done at the doctor’s office to remove/ treat grades 1 to 3 type of hemorrhoids. These procedures are simple and are usually well tolerated by patients; however, there is a high possibility that hemorrhoids can return with these treatments. The three main office procedures include Banding, Sclerotherapy and Infrared coagulation. Persons who are on blood thinners should inform their doctors before considering one of these procedures, because there is a risk for significant bleeding.
Rubber Band Ligation
Rubber band ligation, also called Banding is a very popular and effective method to treat hemorrhoids. The doctor inserts an anoscope (or and instrument with a short tube and a light at the end) into the anus so that the hemorrhoid(s) can be visualized easily. Afterward another instrument is used to put a very small rubber band at the base of the hemorrhoid. The band is left on for about 5 to 7 days, and the blood supply to the hemorrhoid is gradually interrupted. The hemorrhoid eventually falls off when passing stool without you noticing it. The method is generally painless and there is usually no need for anesthesia. Banding has a lower need for repeated treatment when compared with sclerotherapy and infrared coagulation but the chances of complications (such as bleeding and abscesses) are higher, and there may be pain after the procedure.
Sclerotherapy involves the injection of a sclerosant into the hemorrhoid. The procedure is also very simple; an anoscope is passed into the anus and a liquid containing drugs is injected into the area around the hemorrhoid. The aim of this procedure is to shrink the hemorrhoids by damaging their blood vessels. It usually needs to be carried out several times in order to treat all of the enlarged hemorrhoids. The injections are typically given every few weeks. Recurrence is frequent and complications are similar to banding. Sclerotherapy is not commonly done.
Infrared coagulation involves the application of light/radiation from a specific type of lamp to the base of the hemorrhoid, using a probe tip. The heat/radiation reduces blood flow to the hemorrhoid and creates an ulcer that eventually heals. The procedure is well tolerated, but success rates are lower than those with banding. Infrared coagulation may be considered for persons who are on blood thinners.
Surgery is very effective for grades 3 and 4 hemorrhoids. It is a very efficient technique for removal and it is the most successful method that reduces recurrence of hemorrhoids. Unlike office procedures, surgery may result in greater postoperative pain and could require a longer time for recovery and return to work and regular activities. Complications are not very common but include: bleeding after the operation, wound infections, abscesses, narrowing of the anus and anal leakage. Nevertheless, surgery is a great option for persons who have not had success using other treatment methods.
There may be significant pain after surgery, and medication will be helpful. Additionally, your doctor may prescribe some topical preparations to apply around the anus to prevent pain. It is important not to strain when passing stool after surgery; using stool softeners and bulking agents can prevent this. Sitz baths and warm water sprays can also be used to keep the site clean.
I hope these tips on HEMORRHOIDS were useful; REMEMBER, YOUR HEALTH IS INVALUABLE.
By Dr. Lawarna Matthew