Hemorrhoids

Definition

Hemorrhoids are enlarged veins in the anus or lower rectum. They often go unnoticed and usually clear up after a few days, but can cause long-lasting discomfort, bleeding and be excruciatingly painful. Effective medical treatments are available, however.

Description

Hemorrhoids (also called piles) can be divided into two kinds, internal and external. Internal hemorrhoids lie inside the anus or lower rectum, beneath the anal or rectal lining. External hemorrhoids lie outside the anal opening. Both kinds can be present at the same time.

Hemorrhoids are a very common medical complaint. More than 75% of Americans have hemorrhoids at some point in their lives, typically after age 30. Pregnant women often develop hemorrhoids, but the condition usually clears up after childbirth. Men are more likely than women to suffer from hemorrhoids that require professional medical treatment.

Causes and symptoms

Precisely why hemorrhoids develop is unknown. Researchers have identified a number of reasons to explain hemorrhoidal swelling, including the simple fact that people's upright posture places a lot of pressure on the anal and rectal veins. Aging, obesity, pregnancy, chronic constipation or diarrhea, excessive use of enemas or laxatives, straining during bowel movements, and spending too much time on the toilet are considered contributing factors. Heredity may also play a part in some cases. There is no reason to believe that hemorrhoids are caused by jobs requiring, for instance, heavy lifting or long hours of sitting, although activities of that kind may make existing hemorrhoids worse.

The commonest symptom of internal hemorrhoids is bright red blood in the toilet bowl or on one's feces or toilet paper. When hemorrhoids remain inside the anus they are almost never painful, but they can prolapse (protrude outside the anus) and become irritated and sore. Sometimes, prolapsed hemorrhoids move back into the anal canal on their own or can be pushed back in, but at other times they remain permanently outside the anus until treated by a doctor.

Small external hemorrhoids usually do not produce symptoms. Larger ones, however, can be painful and interfere with cleaning the anal area after a bowel movement. When, as sometimes happens, a blood clot forms in an external hemorrhoid (creating what is called a thrombosed hemorrhoid), the skin around the anus becomes inflamed and a very painful lump develops. On rare occasions the clot will begin to bleed after a few days and leave blood on the underwear. A thrombosed hemorrhoid will not cause an embolism.

Diagnosis

Diagnosis begins with a visual examination of the anus, followed by an internal examination during which the doctor carefully inserts a gloved and lubricated finger into the anus. The doctor may also use an anoscope, a small tube that allows him or her to see into the anal canal. Under some circumstances the doctor may wish to check for other problems by using a sigmoidoscope or colonoscope, a flexible instrument that allows inspection of the lower colon (in the case of the sigmoidoscope) or the entire colon (in the case of the colonoscope).

Treatment

Hemorrhoids can often be effectively dealt with by dietary and lifestyle changes. Softening the feces and avoiding constipation by adding fiber to one's diet is important, because hard feces lead to straining during defecation. Fruit, leafy vegetables, and wholegrain breads and cereals are good sources of fiber, as are bulk laxatives and fiber supplements such as Metamucil or Citrucel. Exercising, losing excess weight, and drinking six to eight glasses a day of water or another liquid (not alcohol) also helps. Soap or toilet paper that is perfumed may irritate the anal area and should be avoided, as should excessive cleaning, rubbing, or wiping of that area. Reading in the bathroom is also considered a bad idea, because it adds to the time one spends on the toilet and may increase the strain placed on the anal and rectal veins. After each bowel movement, wiping with a moistened tissue or pad sold for that purpose helps lessen irritation. Hemorrhoid pain is often eased by sitting in a tub of warm water for about 10 or 15 minutes two to four times a day (sitz bath ). A cool compress or ice pack to reduce swelling is also recommended (the ice pack should be wrapped in a cloth or towel to prevent direct contact with the skin). Many people find that over-the-counter hemorrhoid creams and foams bring relief, but these medications do not make hemorrhoids disappear.

When painful hemorrhoids do not respond to home-based remedies, professional medical treatment is necessary. The choice of treatment depends on the type of hemorrhoid, what medical equipment is available, and other considerations.

Rubber band ligation is probably the most widely used of the many treatments for internal hemorrhoids (and the least costly for the patient). This procedure is performed in the office of a family doctor or specialist, or in a hospital on an outpatient basis. An applicator is used to place one or two small rubber bands around the base of the hemorrhoid, cutting off its blood supply. After three to 10 days in the bands, the hemorrhoid falls off, leaving a sore that heals in a week or two. Because internal hemorrhoids are located in a part of the anus that does not sense pain, anesthetic is unnecessary and the procedure is painless in most cases. Although there can be minor discomfort and bleeding for a few days after the bands are applied, complications are rare and most people are soon able to return to work and other activities. If more than one hemorrhoid exists or if banding is not entirely effective the first time (as occasionally happens), the procedure may need to be repeated a few weeks later. After five years, 15-20% of patients experience a recurrence of internal hemorrhoids, but in most cases all that is needed is another banding.

External hemorrhoids, and some prolapsed internal hemorrhoids, are removed by conventional surgery in a hospital. Depending on the circumstances, this requires a local, regional, or general anesthetic. Surgery does cause a fair amount of discomfort, but an overnight hospital stay is usually not necessary. Full healing takes two to four weeks, but most people are able to resume normal activities at the end of a week. Hemorrhoids rarely return after surgery.

Alternative treatment

Like mainstream practitioners, alternative practitioners stress the importance of a high-fiber diet. To prevent hemorrhoids by strengthening the veins of the anus, rectum, and colon, they recommend blackberries, blueberries, cherries, vitamin C, butcher's broom (Ruscus aculeatus ), and flavonoids (plant pigments found in fruit and fruit products, tea, and soy). Herbal teas, ointments, and suppositories, and other kinds of herbal preparations, are suggested for reducing discomfort and eliminating hemorrhoids. In particular, pilewort (Ranunculusficaria ), applied in an ointment or taken as a tea, can reduce the pain of external hemorrhoids. Acupuncture, acupressure, aromatherapy, and homeopathy are also used to treat hemorrhoids.

Prognosis

Hemorrhoids do not cause cancer and are rarely dangerous or life threatening. Most clear up after a few days without professional medical treatment. However, because colorectal cancer and other digestive system diseases can cause anal bleeding and other hemorrhoid-like symptoms, people should always consult a doctor when those symptoms occur.

KEY TERMS

Anus— The opening at the lower end of the rectum. The anus and rectum are both part of the large intestine, a digestive system organ.

Colon— The major part of the large intestine, a digestive system organ.

Defecation— Passage of feces through the anus.

Embolism— Obstruction of blood flow in an artery by a blood clot or other substance arising from another site. An untreated embolism can endanger health and even cause death.

Enema— The introduction of water or another liquid into the bowels through a tube inserted into the anus. Enemas are used to treat constipation and for other purposes.

Feces— Undigested food and other waste that is eliminated through the anus. Also called stools.

Rectum— The lower section of the large intestine, a digestive system organ. After food has passed through the stomach and intestines and been digested, the leftover material, in the form of feces, enters the rectum, where it stays until defecation.

Suppository— A medicinal substance that slowly dissolves after being inserted into the rectum (or other body cavity).

Prevention

A high-fiber diet and the other lifestyle changes recommended for coping with existing hemorrhoids also help to prevent hemorrhoids. Not straining during bowel movements is essential.

Resources

ORGANIZATIONS

National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389. 〈http://www.niddk.nih.gov/health/digest/nddic.htm〉.

Hemorrhoids

Definition

Hemorrhoids, which are also called piles, is a condition of weakened and swollen veins in the anus or lower rectum. They often go unnoticed and usually clear up after a few days, but can also cause long-lasting discomfort of the rectum such as pain, itching , and bleeding. Hemorrhoids can be divided into two types: Internal hemorrhoids lie inside the anus or lower rectum; external hemorrhoids lie outside the anal opening. Both can be present at the same time. Sometimes a blood clot forms in an external hemorrhoid and inflammation and a painful lump develops. This condition is called a thrombosed hemorrhoid.

Description

Hemorrhoids are a very common medical complaint. More than 75% of Americans have hemorrhoids at some point in their lives, typically after age 30. Men are more likely than women to suffer from hemorrhoids that are serious enough to require professional treatment.

During a bowel movement, veins in the anus are protected from damage by expanding to drain blood away from the area. The veins are normally somewhat elastic, and they snap back to their regular size after defecation is finished. However, repeated straining due to constipation or hardened stools causes the veins to be swollen and stretched out of shape. The swelling also triggers nerves in the area, causing itchiness and a sensation of fulless in the bowel. In addition, straining may cause the rupture of blood vessels and bleeding at the anus.

Causes & symptoms

Aging, obesity , pregnancy, chronic constipation or chronic diarrhea , excessive use of enemas or laxatives, straining during bowel movements, and spending too much time on the toilet are all factors that can contribute to the development of hemorrhoids. In some people there is also a genetic tendency to have fragile veins that are prone to developing hemorrhoids and varicose veins .

The most common symptom of internal hemorrhoids is bright red blood in the toilet bowl or on one's feces or toilet paper. When hemorrhoids remain inside the anus they are almost never painful, but they can protrude outside the anus and become irritated and sore. Such hemorrhoids are called prolapsed hemorrhoids. These sometimes move back into the anal canal on their own or can be pushed back inside; however, they may remain permanently outside the anus until treated by a doctor. Small external hemorrhoids usually do not produce symptoms. Larger ones, however, can be painful and interfere with sitting, walking, defecating, and cleaning the anal area after a bowel movement.

Diagnosis

Diagnosis of hemorrhoids begins with a visual examination of the anus, followed by an internal manual examination. The doctor may also insert an anoscope, a small tube with a light that can be used to view the anal canal. More serious problems may be ruled out using a sigmoidoscope or colonoscope to inspect the colon.

Treatment

An herbal sitz bath using witch hazel , Hamamelis virginiana, may shrink hemorrhoids and ease discomfort. A strong infusion should be prepared by adding a

gallon of boiling water to eight ounces of the dry herb, and then letting this mixture steep overnight. The infusion can be used several times as a 15-minute soak. Witch hazel can also be wiped directly over external hemorrhoids. In addition, an ointment formulated of plantain , Plantago spp. and yarrow , Achillea millefolium, will reportedly reduce pain and swelling.

Chinese herbal medicine may be formulated to treat Spleen Qi deficiency or heat in the lower burner. Hemp seeds are recommended for constipation. Daily helpings of foods that soften the stools and make them easier to pass are recommended by traditional Chinese medicine (TCM); examples of these include carrots, broccoli, dried persimmons and unripe figs. Acupuncture and acupressure are also recommended.

Homeopathy offers a gentle treatment solution for hemorrhoids. It is, therefore, especially appropriate for use during pregnancy. Suggested remedies include Aeschulus hippocastanum 30c, Hamamelis virginiana 6c, and Calcarea fluorica 6c. Homeopathic and herbal rectal suppositories are available.

Allopathic treatment

Hemorrhoids can often be dealt with effectively by dietary and lifestyle changes. Avoiding constipation is important; therefore adding fiber to the diet is recommended. Bulk laxatives and fiber supplements such as Metamucil or Citrucel may be suggested. After each bowel movement, wiping with a moistened tissue or pad sold for that purpose helps lessen irritation. A warm sitz bath for about 10 or 15 minutes two to four times a day can ease hemorrhoid pain. A cool compress or ice pack to reduce swelling is also recommended. Many people find temporary relief using over-the-counter hemorrhoid creams and foams. These products, however, are not receommended during pregnancy.

When painful hemorrhoids do not respond to home-based remedies, professional medical treatment is necessary. Rubber band ligation is probably the most widely used of the many treatments for internal hemorrhoids. It is also the least costly for the patient. This procedure is performed on an outpatient basis. An applicator is used to place one or two small rubber bands around the base of the hemorrhoid, cutting off the blood supply. After 3 to 10 days in the bands, the hemorrhoid falls off, leaving a sore that heals in a week or two. Because internal hemorrhoids are located in a part of the anus that is not sensitive to pain, anesthesia is unnecessary and the procedure is painless in most cases. The procedure may need to be repeated a few weeks later. After five years, 15–20% of patients experience a recurrence of internal hemorrhoids, but in most cases all that is needed is another banding.

External hemorrhoids, and some prolapsed internal hemorrhoids, are removed by conventional surgery in a hospital. Depending on the circumstances, this procedure may require anesthesia. Full healing takes two to four weeks, but most people are able to resume normal activities at the end of a week. Hemorrhoids seldom return after surgery.

Expected results

Hemorrhoids are rarely life-threatening. Most clear up after a few days without medical treatment. However, because colorectal cancer and other digestive system diseases can cause anal bleeding and other hemorrhoid symptoms, people should always consult a healthcare practitioner when hemorrhoid symptoms occur.

Prevention

A high-fiber diet , daily exercise , and losing excess weight are recommended to maintain healthy digestion and elimination. To prevent hemorrhoids by strengthening the veins of the anus, rectum, and colon and increasing circulation, blackberries, blueberries, cherries and vitamin C are recommended. Tinctures of butcher's broom (Ruscus aculeatus, and horse chestnut (Aesculus hippocastanum ), plant pigments (called flavonoids) found in fruit and fruit products, tea, and soy also are recommended. It should be noted that horse chestnut, along with commercial hemorrhoid preparations, is contraindicated during pregnancy.

Drinking water with a high-fiber meal or supplement will cause the stools to be softer and easier to pass, reducing straining. Constipation should be avoided, and good toilet habits should be cultivated. Promptly responding to the urge to defecate will help encourage regular bowel movements. Defecation should be done without rushing or straining. A squatting position over the toilet or having the feet raised on a small bench or footstool will also improve elimination. Reading, working or watching television are discouraged, because they entail prolonged sitting on the toilet, which increases the strain placed on the anal and rectal veins. Perfumed soaps or toilet waters may irritate the anal area and should be avoided, as should excessive cleansing, rubbing, or wiping.

Resources

BOOKS

The Burton Goldberg Group, eds. Alternative Medicine: The Definitive Guide. Fife, WA: Future Medicine Publishing, 1999.

Lininger, D.C., Skye, editor-in-chief, et al. The Natural Pharmacy. Rocklin, CA: Prima Health, 1998.

Simons, Anne M.D., Bobbie Hasselbring, and Michael Castleman. Before You Call the Doctor: Safe, Effective Self-Care for Over 300 Common Medical Problems. New York: Fawcett Columbine, 1992.

PERIODICALS

Pfenninger, John L. "Modern Treatments for Internal Haemorrhoids." British Medical Journal, 1997.

Surrell, James. "Nonsurgical Treatment Options for Internal Hemorrhoids." American Family Physician (September 1995).

ORGANIZATIONS

National Digestive Diseases Information Clearinghouse. 2 Information Way, Bethesda, MD 20892-3570. http://www.niddk.nih.gov/health/digest/nddic.htm

Patience Paradox

haemorrhoids (piles) are swellings arising from the anus that may bleed or cause the area to be itchy or painful. They are a common condition and many of us will experience them to a certain degree at some time during our lives. They are especially common in women during pregnancy. The majority of haemorrhoids resolve spontaneously, but persistent symptoms, especially of bleeding in people over 50 years old, may need investigation as, rarely, they can mimic other more serious bowel disease such as cancer. Haemorrhoids are the most common cause of bleeding from the anus; the bleeding usually occurs after passing a bowel motion and will appear on the toilet paper.

Haemorrhoids have been recognized and treated for at least 4000 years. The term itself, as described by Hippocrates, comes from the Greek, haema — blood — and rhoos — flowing. Despite their common occurrence and extended history the exact cause of haemorrhoids is still unclear. In medieval times it was thought that haemorrhoids were enlarged veins that expelled superfluous melancholy humours. The concept of haemorrhoids as enlarged veins persisted until recently, when detailed anatomical studies demonstrated their soft tissue nature and the close association they have with the normal anus. Many long-held beliefs regarding the exact cause of haemorrhoids have been difficult to prove scientifically. Generally accepted associations are that haemorrhoids occur more frequently in those who are constipated, strain excessively when passing a bowel motion, or spend a long time sitting (especially on the toilet seat). In some cases a genetic component for the formation of haemorrhoids may well be responsible.

Haemorrhoids arise from the three cushions of tissue just inside the anus that normally function to give a watertight seal. These cushions may be damaged, bleed, or be pushed down by the passing bowel motion, thus forming a haemorrhoid. If trapped outside the anus the haemorrhoid's blood supply may be disrupted, causing the severe pain of a ‘thrombosed pile’.

The cornerstone of treatment and prevention of haemorrhoids is a high-fibre diet, producing a soft bowel motion that is easy to pass without straining. Combined with this it is important to avoid sitting for prolonged periods or excessive wiping of the anus after passing a bowel motion. Use of a moist cloth, wet wipe, or lying in a bath filled with lukewarm water are also helpful when the haemorrhoids cause symptoms. Historically, anaesthetic creams have been used to reduce the pain felt locally; however these may be irritating to the skin and should be considered secondary to other measures. If basic treatment fails, outpatient ‘banding’, injection, or freezing treatments can shrink the haemorrhoid, thus speeding resolution. Surgical treatment, where the haemorrhoids are removed at operation (haemorrhoidectomy) is used less frequently now, as outpatient treatment is very effective.

G. A. Smith, and P. J. O'Dwyer

hemorrhoids or piles, dilatations of the veins about the anus (external hemorrhoids) or those higher up inside it (internal hemorrhoids). They appear as small, rounded, purplish tumors, often complicated by inflammation, clotting, and bleeding. Hemorrhoids are very common phenomena and are brought about by factors that produce venous congestion, such as constipation, diarrhea, or pregnancy. In some instances, the pain from inflamed hemorrhoids can be intense, and the bleeding so profuse as to pose the threat of anemia. Hemorrhoids that are uncomplicated or bleed only slightly at infrequent intervals do not require specific treatment except to improve the condition that may be causing them, such as constipation. Hemorrhoids that are very painful or bleed excessively are treated by warm baths and suppositories and, if necessary, by injection, laser surgery, or traditional surgery.

haemorrhoids (piles) (hem-er-oidz) pl. n. enlargement of the normal spongy blood-filled cushions in the wall of the anus (internal h.), usually a consequence of prolonged constipation or, occasionally, diarrhoea. The main symptom is bleeding. external h. prolapsed internal haemorrhoids or perianal haematomas. first-degree h. haemorrhoids that never appear at the anus but cause bleeding at the end of defecation. second-degree h. haemorrhoids that protrude beyond the anus as an uncomfortable swelling but return spontaneously. third-degree h. haemorrhoids that remain outside the anus and need to be returned by pressure. They often require surgery (see haemorrhoidectomy), especially if they become strangulated (producing severe pain and further enlargement).

Hemorrhoids

Where Do People Get Hemorrhoids?

What Causes Hemorrhoids?

What Are the Symptoms of Hemorrhoids?

How Are Hemorrhoids Diagnosed and Treated?

Resource

Hemorrhoids (HEM-o-roids), sometimes called “piles,” are enlarged veins in the rectum, which is the lower portion of the digestive tract. They are similar to varicose veins of the legs. Hemorrhoids may bleed and cause pain.

KEYWORDS

for searching the Internet and other reference sources

Anorectal disorders

Digestive tract

Vascular system

Where Do People Get Hemorrhoids?

Hemorrhoids occur in two places. When they are located in the upper part of the rectum, the hemorrhoids are called internal hemorrhoids. In the lower part of the rectum, they are called external hemorrhoids. Hemorrhoids are said to be prolapsed if they have slipped down from their usual position and extend outside of the anal opening.

What Causes Hemorrhoids?

Hemorrhoids have a number of different causes. They occur often in women who are pregnant or who have just given birth to babies. People with chronic constipation are at risk for hemorrhoids because of added pressure to the anorectal area when they pass stools (solid waste matter) that are hard and dry.

What Are the Symptoms of Hemorrhoids?

Pain during bowel movements and blood in the stool are the usual symptoms that accompany hemorrhoids. Sometimes there is a discharge of mucus, and there may also be itching, burning, or pain in the area. The enlarged vein in the rectum sometimes develops a clot, which can be very painful. People with hemorrhoids sometimes develop iron deficiency anemia* from the bleeding that occurs.

* anemia

results when people have too few red blood cells and hemoglobin to carry oxygen in the blood.

How Are Hemorrhoids Diagnosed and Treated?

The doctor first examines the anal area through a viewing tube called an anoscope to rule out other conditions that cause similar symptoms. For mild cases of hemorrhoids, doctors may recommend:

a diet with adequate amounts of fiber (whole grains, vegetables, and fruit) to prevent constipation

• drinking lots of liquids to prevent constipation
• sitz baths, which are shallow baths of warm water
• medicines that soften stools and make them easy to pass
• creams that can be applied to the hemorrhoids to reduce pain, swelling, and itching.

When the hemorrhoids are internal, they can be removed in the doctor’s office by a simple procedure. Tiny rubber bands are wrapped tightly around the hemorrhoids. Following this procedure, the hemorrhoids wither away and drop off without causing pain.

Internal hemorrhoids that stay prolapsed outside the body, or external hemorrhoids that have clotted, are often removed surgically. This method of removal is usually done on an outpatient* basis with local anesthesia*.

* outpatients

are people who go to a doctor’s office or hospital for treatment but do not stay overnight in a hospital bed.

* local anesthesia

(an-es-THEE-zha) means using medicine to block or numb pain in one part of the body while patients remain awake. General anesthesia blocks pain over the entire body while patients sleep.

See also

Constipation

Varicose Veins

Resource

U.S. National Digestive Diseases Information Clearinghouse, 2 Information Way, Bethesda, MD 20892-3570. This division of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) posts information about hemorrhoids at its website. http://www.niddk.nih.gov/health/digest/pubs/hems/hemords.htm

hem·or·rhoid / ˈhem(ə)ˌroid/ (Brit. haem·or·rhoid) • n. (usu. hemorrhoids) a swollen vein or group of veins in the region of the anus. Also (collectively) called piles. DERIVATIVES: hem·or·rhoi·dal / ˌhem(ə)ˈroidl/ adj.

haemorrhoids (hemorrhoids) Or piles, varicosity in the lower rectum or anus due to congestion of the veins; caused or exacerbated by a low‐fibre diet and consequent straining to defecate. See also dietary fibre.

hemorrhoid see H(A)EMORRHOID.

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