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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Hemorrhoids
What are hemorrhoids?
Hemorrhoids (or piles) are swollen veins in the lower rectum
and anus. The anus is the opening at the end of the rectum
through which a bowel movement passes. Hemorrhoids are one
of the most common problems of the lower digestive tract.
There are two types of hemorrhoids: One set of veins is
about an inch inside the rectum (internal). The other is
under the skin surrounding the anus (external).
Internal hemorrhoids are painless but they sometimes cause a
lot of bleeding. The internal veins can stretch and even
fall down (prolapse) through the anus to outside the body.
The veins may then become irritated and painful.
External hemorrhoids can be seen or felt easily around the
anal opening. When the swollen veins are scratched or
broken by straining or rubbing, they bleed.
How do they occur?
Veins in the rectum and around the anus tend to expand under
pressure. Hemorrhoids can result from too much pressure on
these veins. Factors that can put pressure on the veins
include:
- straining from constipation during bowel movements
- holding back or delaying emptying of the bowels
- diarrhea
- sitting for a long time on the toilet, which causes
strain on the anal area
- pregnancy and the strain of childbirth
- obesity
- coughing and sneezing often
- sitting for long periods
- liver disease.
Flare-ups of hemorrhoids may occur during periods of stress
or as a result of overuse of alcohol. Some people inherit a
tendency to have hemorrhoids.
Pregnant women should try to avoid becoming constipated
because they are more likely to have hemorrhoids during
pregnancy. In the last trimester of pregnancy, the enlarged
uterus pressing on blood vessels in the anal area can cause
hemorrhoids. Also, the strain of childbirth sometimes leads
to hemorrhoids after delivery.
What are the symptoms?
Symptoms of hemorrhoids include:
- itching, mild burning, and bleeding from the anus
- swelling and pain during bowel movements
- painful lumps around the anus ranging in size from a pea
to, in severe cases, a walnut.
How are they diagnosed?
Your health care provider will examine your rectum and anus.
He or she may use a lighted viewing tool called a
proctoscope or anoscope to look inside the rectum.
How is it treated?
The following treatments usually help to relieve most cases
of hemorrhoids:
- High-fiber diet
Eat more high-fiber foods, which will help prevent
constipation. Good sources of fiber include fresh fruit;
raw or cooked vegetables, especially asparagus, cabbage,
carrots, corn, and broccoli; and whole-grain cereals with
bran, such as shredded wheat or bran flakes.
- Fluids
Drink plenty of fluids, especially water. Drink six to
eight 8-ounce glasses of fluid (not alcohol) a day.
Fluid helps to soften bowel movements so they are easier
to pass.
- Sitz baths and cold packs
Sitting in lukewarm water 2 or 3 times a day for 15
minutes cleans the anal area and may relieve discomfort.
Also, you might try putting cold packs on the anus to
relieve pain.
- Medications
For mild discomfort, your health care provider may
prescribe a cream or ointment for the painful area. The
cream may contain witch hazel, zinc oxide, or petroleum
jelly. Your provider may also prescribe medicated
suppositories.
- Procedures and surgeries
A number of nonsurgical procedures can be used to remove
or shrink hemorrhoids. If you have protruding internal
hemorrhoids, your health care provider can do a procedure
called hemorrhoid banding. Your provider will put a
tight band around the enlarged vein, cut the hemorrhoid
open, and remove the blood clot. In a few days, the vein
will heal and the hemorrhoid will painlessly wither and
fall off. This method is effective in most cases. Other
methods include destroying the hemorrhoid with freezing,
electrical or laser heat, or infrared light. Or your
provider may shrink the hemorrhoid by injecting a
chemical around the vein.
For severe cases of hemorrhoids, a surgical procedure
called a hemorrhoidectomy may be done. For this
procedure you are first given an anesthetic to prevent
you from feeling pain. Then your provider cuts the
inflamed parts of the hemorrhoids and removes them.
How long will the effects last?
Usually hemorrhoids do not pose a danger to your health. In
most cases the symptoms go away in a few days. The painful
lumps of more severe cases should improve in 2 weeks.
How can I take care of myself?
Always tell your health care provider when you have rectal
bleeding. Although bleeding may result from hemorrhoids,
more serious illnesses such as colon cancer can also cause
bleeding.
Follow these guidelines to help prevent hemorrhoids and to
relieve their discomfort:
- Do not strain during bowel movements. The straining
makes hemorrhoids swell.
- Follow your high-fiber diet and drink plenty of water.
If necessary, take a stool softener, such as Haley's
M-O, Metamucil or Citrucel, or mineral oil. Softer stools
make it easier to empty the bowels and lessen pressure on
the veins.
- Don't overuse laxatives. Diarrhea can be as
irritating to the anus as constipation.
- Ask your health care provider what nonprescription
product you should buy to relieve pain and itching.
Also, ask about any side effects of any medications
prescribed for you.
- Exercise regularly to help prevent constipation.
- Avoid a lot of wiping after a bowel movement if you have
hemorrhoids. Wiping with soft, moist toilet paper (or a
commercial moist pad or baby wipe) may relieve
discomfort. If necessary, shower instead of wiping, then
dry the anus gently.
- Avoid lifting heavy objects when you have hemorrhoids.
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