Surgical Facts

Hemorrhoids

Hemorrhoids are natural.........

That's right. Everyone has them - you just don't notice them as long as they're doing their job. Hemorrhoids are cushions of tissue that swell gently to aid in the process of elimination. You'll begin to notice hemorrhoids only when they swell too much. Then they may cause pain, itching, irritation, burning, and bleeding. If you have swollen hemorrhoids, you're not alone. All kinds of people get them - pregnant women, active and sedentary people, people who do a lot of heavy lifting, and many others.

Swollen Hemorrhoids.........

Swollen hemorrhoids have many causes. The primary cause is a low-fiber diet, leading to constipation and straining on the toilet. Other causes include a sedentary lifestyle, strenuous exercise, pressure on the rectum from pregnancy or simply from standing a lot, regulating bowel movements by the clock, and medications that cause diarrhea or constipation. Swollen hemorrhoids may even run in families.

Managing the Pain.........

When swollen hemorrhoids are painful, you want relief quickly - and you want to be sure that nothing else is wrong. That's where a trip to the doctor's office can be reassuring. Your doctor can accurately evaluate your condition and recommend a treatment and prevention approach that's right for you.

• Your Evaluation: Hemorrhoids aren't life threatening, but some of their symptoms are similar to symptoms of such serious diseases as colorectal cancer. If you experience rectal bleeding or a change in bowel pattern, or if the irritation persists despite your efforts to relieve the symptoms, see your doctor for an evaluation.
• Your Treatment: Once your doctor confirms a diagnosis of bleeding or swollen hemorrhoids, you can explore together your treatment options. For many people, a change in diet and level of activity is the solution. For others, treatment at the doctor's office or surgery may also be needed.
• Prevention: Maintaining a healthy, high fiber diet, which relieves constipation and eases the digestive process, is the best way to prevent bleeding or swollen hemorrhoids. Developing good exercise and bowel habits may help, too. Your doctor can give you specific advice on how to prevent future discomfort.

How Hemorrhoids Swell.........

Hemorrhoids are cushions of tissue and veins located both outside and inside the anal canal. Hemorrhoids inside the anal canal sense the difference between gas and stool and swell slightly and temporarily to aid in the passage of stool. However, straining to eliminate - especially when constipated - causes hemorrhoids to enlarge. And frequent straining causes them to remain enlarged.

The Anal Canal.........

Hemorrhoid cushions are found in the anal canal - the last one-and-a-half inches of the colon. Digested food passes from the stomach through the small intestine, then into the colon. The remaining waste material (stool) passes into the rectum for storage, then through the anal canal for elimination.

Normal Elimination........

When food with enough fiber is digested, waste collects in the rectum as soft stool. The sphincter muscles relax, and internal hemorrhoids swell just a bit to cushion the stool as it passes from the body.

Difficult Elimination..........

When food with too little fiber is digested it collects in the rectum as hard stool and remains there long after you feel ready to pass it. Prolonged straining causes hemorrhoids to swell repeatedly. When finally passed, hard stool scrapes against and irritates swollen hemorrhoids and pushes them out.

Types of Hemorrhoids.........

• External Hemorrhoids: Just outside the anus, these small soft pads are the same color as your skin. External hemorrhoids rarely cause pain unless they form a blood clot, or thromboses. Then they turn blue and may cause sudden, severe pain.
• Internal Hemorrhoids: Internal hemorrhoids commonly occur in clusters around the anal canal wall and are usually painless. They may protrude, or prolapse, from the anus when you strain and may disappear when you relax. Bright red or dull maroon in color, they may bleed or discharge mucus.
• Other Anal Problems: Other problems may cause discomfort in the anal area. A fissure, a crack in the anal canal's skin, may be painful and bleed. A fistula, an infected pathway, may develop as an abscess works its way from inside the anal canal to the outside skin. It may be either painful or painless, and usually causes a lot of drainage.

Diagnosing Hemorrhoids.........

If symptoms of irritation and swelling persist despite your efforts to relieve them, see your doctor right away for a medical evaluation. It's especially important to get an evaluation if you see blood in your stool or on toilet tissue, or if you notice a change in your bowel pattern. The evaluation gives your doctor the information needed to determine if you have swollen hemorrhoids and, if so, to plan your treatment. It also helps rule out the possibility of a more serious problem, such as cancer of the colon or rectum.

Your History..........

To begin making your diagnosis, your doctor asks you about the symptoms you've noticed and how long you've had them. You'll be asked about the kind of food you eat, how often and what kind of bowel movements you have, how much exercise you get, medications you take, and whether you or members of your family have ever had cancer or polyps of the colon.

Your Exam.........

During your examination, your doctor looks for signs of swollen hemorrhoids or other problems. This brief exam causes little discomfort. A visual examination of your outer anal skin comes first. A digital rectal exam is usually done next. Using a well-lubricated, gloved finger, your doctor feels for hemorrhoids in your anal canal and, in men, checks for prostate problems. An baroscopic exam may follow. Your doctor inserts a tube to view your lower anorectic canal.

Additional Tests.........

Additional tests may be done to be sure that your symptoms aren't caused by another problem such as colon or rectal cancer. Your doctor will advise you of any special preparations needed before these tests.

• Testing for Blood in Stool: Your doctor takes a sample of your stool, or asks you to take a sample at home, and has a lab test it for blood.
• Sigmoidoscopy: Your doctor inserts a lighted tube to visually inspect your rectum and lower colon. This brief exam can be done in your doctor's office and usually causes little or no discomfort.
• Barium Enema: A radiologist fills your rectum and colon with a liquid barium solution, then takes x-rays that show the whole colon. Done on an outpatient basis at a hospital or radiology center, this test may cause some discomfort.
• Colonoscopy: Your doctor inserts a lighted tube to visually inspect every inch of your colon. Usually performed under sedation on an outpatient basis at a hospital, this procedure may cause some discomfort.

Your Treatment Plan

After all the necessary tests have been completed, your doctor discusses your diagnosis with you and recommends treatment. If you do have swollen hemorrhoids, your doctor suggests a treatment plan ranging from a change in your diet to surgery. The treatment that's right for you depends on the type or severity of your problem.

Treatment at Home

In many cases, the efforts you make at home under your doctor's guidance are enough to cure your problems with hemorrhoids for good. The goal of home treatment is to ease constipation and relieve your symptoms. To accomplish this, your doctor may recommend changes in your diet and exercise habits as the primary treatment for hemorrhoids. Your doctor may also advise to change your bowel habits and take warm baths or other soothing measures to relieve the irritation.

To Ease Constipation.........

• Add Fiber and Water: You can ease constipation usually within a few days by eating more high-fiber foods and drinking six to eight glasses of water a day, especially with meals. Your doctor may also recommend a bulk agent, a high-fiber supplement usually made of phylum seed and readily available at the grocery store. You may notice an increase in gas when you first add more fiber to your diet. This gradually subsides. Insoluble Fiber in bulk agents and in such foods as wheat bran, whole-grain breads, fresh fruits and vegetables absorbs water to produce softer stool. Oat bran contains mostly soluble fiber, which doesn't absorb water. Oat bran is good for you, but it may not ease constipation as much as foods high in insoluble fiber.
• Get More Exercise: Exercise such as swimming, walking, or biking aids digestion and, when combined with a proper diet, helps prevent constipation. Check with your doctor first to determine the activities most appropriate for you.

High Fiber Hints.........

Fiber-rich foods offer so many benefits: they keep you regular, are usually low in calories, and taste great. A high-fiber diet not only helps heal and prevent swollen hemorrhoids, but also is effective in reducing the risk of colon and rectal cancer. Sometimes it's hard to change habits. But with just a little effort, you can begin to add more insoluble fiber to your diet. Here are some hints to help you get started.

Four Rich Sources of Insoluble Fiber.........

• Whole Grains, especially wheat bran, corn bran and brown rice.

• Vegetables, especially carrots, broccoli, and peas.

• Fruits, especially apples, bananas, raisins, and pears.

• Nuts and Legumes, especially peanuts, lentils, and kidney beans.

Four Easy Ways to Add Fiber.........

• Start your morning with a high-fiber breakfast. Eat wheat bran cereal and a sliced banana, or peanut butter on whole wheat toast, instead of bacon and eggs.

• Pack carrot sticks instead of chips in your lunch. You'll get the same crunch, fewer calories, and much more fiber.

• For a sweet treat, try an apple or some raisins instead of a candy bar. Fruits are packed with fiber and are much lower in calories than candy.

• Be daring. Try a lentil burger with brown rice for dinner. Lentils are full of fiber. And brown rice gives you twice as much fiber as white rice.

To Relieve Symptoms.........

• Develop Good Bowel Habits: Everyone's system is different, so don't push yourself to have a bowel movement every day. Don't strain on the toilet and don't put off the urge to go. Sit on the toilet only as long as necessary and don't read while you are there. Wipe gently with soft, white unscented toilet paper.

• Use Ice Packs: An ice pack applied to a thrombosed external hemorrhoid soon after it appears can relieve the pain within a few minutes and reduce the clot within a few days. Use the ice for no more than a few minutes at a time, and stop using it altogether after a few hours.

• Take Sitz Baths: Sit for a few minutes in about three inches of warm water for immediate relief of symptoms.

• Take Other Measures: Laxatives and enemas can help ease constipation, but use them only on your doctor's advice. Overuse of laxatives can actually make constipation worse. Non-prescription hemorrhoid ointments, petroleum jelly, or cotton pads soaked in witch hazel may give temporary relief. Your doctor may also recommend prescription ointments.

Treatment at Your Doctor's Office.........

Sometimes home treatment just isn't enough. If your symptoms are severe and persist despite changes in your diet and other remedies, your doctor may recommend an outpatient treatment, which can usually be done at the doctor's office or at a hospital or surgical center. No special preparation is required. These treatments usually take just a few minutes to complete.

Thromboses External Hemorrhoids.........

After numbing the area with a local anesthetic, your doctor makes a small incision and removes the thromboses hemorrhoid. The incision is left open and heals naturally within a few days.

Internal hemorrhoids.........

Your doctor inserts an baroscopic tube into the anal canal to reach the affected hemorrhoids. These treatments usually cause little discomfort.

• Injection Therapy: This method can be effective for small hemorrhoids that bleed. Your doctor injects a chemical into the tissue around the hemorrhoid, causing it to shrink in a few days. Symptoms of bleeding usually disappear in 24 hours.

• Infrared Coagulation: Your doctor may use this method for prolapsed hemorrhoids that bleed. Using a hot infrared light, your doctor irritates the hemorrhoid, which will heal in five to ten days. Light bleeding may occur for a few days following treatment.

• Banding: Banding is effective for prolapsed hemorrhoids. Your doctor places one or two tight elastic bands around the base of the hemorrhoid, which falls off in about seven to ten days. Tissue heals a few days later.

Other Procedures.........

Cryosurgery involves using liquid nitrogen to freeze the swollen hemorrhoid, which falls off within a week or two. Laser therapy is similar to infrared coagulation, but it uses a laser beam rather than an infrared light to treat the swollen tissue.

Call your doctor if.... you experience pain, fever, chills, persistent bleeding, or an inability to urinate. These may be signs of complications that require medical attention.

Treatment at the Hospital.........

You may have hemorrhoids that haven't responded to previous treatment, or hemorrhoids that produce severe, long lasting symptoms of prolapsed, bleeding, or mucus discharge. If so, your doctor may recommend surgical removal, called hemorrhoidectomy. You'll be admitted to the hospital or surgical center usually on the day of surgery. You may go home soon after surgery or one to two days later, depending on how you are feeling. You usually can begin to get back to your normal routine about a week after surgery.

A Few Days Before Surgery.........

• Schedule Lab Tests: Your doctor may request blood tests, an EKG (electrocardiogram), and a chest x-ray to be sure your heart and lungs are in good shape.

• Ask About Medications: You'll be told to stop taking aspirin, because it acts as a blood thinner. Ask your doctor if there are other medications you should also stop taking.

• Quit Smoking: Quit smoking to eliminate the strain "smokers cough" puts on your hemorrhoids.

• Don't Eat or Drink: No food or drink - not even water - may be taken after midnight the evening before surgery. This reduces the risk of vomiting under anesthesia.

• Arrange for Help: You'll want to take it easy after surgery, so arrange for help at home. Plan to have someone drive you to the hospital or surgical center and pick you up afterward.

Just Before Surgery.........

You'll be asked to sign a legal consent form authorizing your doctor to perform the surgery. Also, you may be given a mild laxative or an enema. Your doctor, anesthesiologist, or nurse anesthesiologist will explain the type of anesthetic to be used. Just before surgery, anesthetic is administered and an intravenous (IV) tube is started to give you medications and fluid.

During Surgery.........

Your doctor inserts a spoon-like instrument (retractor) into the anal canal, then removes the swollen hemorrhoid. To provide drainage for fluid or mucus, the incision may be left open or may be stitched partially closed. Several hemorrhoids may be removed during your surgery.

After Surgery.........

You'll be taken to the recovery area, where a nurse monitors your heart rate and blood pressure. If you don't have extensive pain or difficulty with urination, you may be able to go home the same day. Otherwise, your doctor may ask you to stay a day or two in the hospital. For a short time, you may have gas cramps, nausea, or light bleeding. These should soon disappear.

Over the next few days, you'll feel some discomfort and may have muscle spasms with bowel movements. You may fear the first bowel movement after surgery, but don't be afraid to push as hard as you usually do. Delaying your first bowel movement only makes it more difficult. Stool softeners, laxatives, bulk agents, and medications may be prescribed to relieve discomfort.

Risks and Complications.........

All surgery carries a slight risk of infection. Hemorrhoidectomy also carries a slight risk of urinary retention, the inability to urinate. Anal stenosis, a narrowing of the anal canal, is a rare complication that can occur several months after surgery. Both conditions, if they occur, can be treated.

Call your doctor if.... you experience pain, fever, chills, persistent bleeding, or an inability to urinate. These may be signs of complications that require medical attention.

Recovery and Prevention.........

Whether you've had surgery or some other treatment, you can aid in your recovery and prevent future discomfort by developing habits that promote the health of your colon and anal canal. If you've had outpatient treatment, you may experience no pain or discomfort at all after treatment, or you may feel mildly uncomfortable for a day or two afterward. Complete healing will take only a week or so. If you've had a hemorrhoidectomy, you'll need to take it easy for seven to ten days. Complete healing takes about six to eight weeks.

After Treatment.........

• Avoiding Constipation: Be sure to include wheat bran, fresh fruits, and plenty of vegetables in your diet. Don't over rely on laxatives. Drink lots of water and stay active without overexerting yourself.

• Avoiding Strain on the Toilet: Always avoid straining on the toilet, but especially a few days after treatment, when you may experience swelling that feels like an incompletely passed stool or hemorrhoid.

• Caring for the Wound: The day after treatment, you may remove your bandage. Wearing soft gauze pads or sanitary napkins in your underwear helps to control fluid drainage, discharge of mucus, and bleeding. Change pads and underwear frequently. Good hygiene promotes healing.

• Managing the Pain: Your doctor may prescribe pain medication and will instruct you on how to care for yourself until your first follow-up visit. If you feel a burning sensation when you have bowel movements, sitz baths may provide relief.

• Returning to Work: Your doctor can tell you when you're ready to work again. If you've had surgery, you may need to take a few days off if you're moderately active at work - and maybe longer if you are very active on the job.

Future Discomfort.........

With continuous self-care, you can prevent future symptoms of hemorrhoids. Remember:

• Eat High-Fiber foods.

• Drink plenty of Water.

• Get moderate Exercise.

• Develop good bowel Habits.

See Your Doctor.........

After treatment or surgery, it's possible you'll never experience problems with hemorrhoids again. But be sure to report any new or unusual symptoms to your doctor. Early consultation allows your doctor to evaluate both the progress of your recovery and the general health of your colon and anal canal.

Feeling Good Again.........

Anyone can have trouble with hemorrhoids. But, the good news is that no one has to suffer for long. From self-care to surgery, a wide range of treatment options are available. Your doctor can help you find the option that's right for you!

NOTE: The material presented here is provided for informational and reference of the condition stated, and is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem.