Hemorrhoids

My doctor says I have hemorrhoids. Can you please tell me more about this subject? What is the treatment for hemorrhoids?

Answer: We all have hemorrhoids. Hemorrhoids are vascular cushions in the anal canal. External hemorrhoids are in the margins of the anal canal. Internal hemorrhoids are at the junction of the rectum and the anal canal. There are three internal hemorrhoidal cushions at three, seven and 11 o’clock.

It is important to remember that hemorrhoids are not always symptomatic and all problems in the rectal area are not due to hemorrhoids. It is difficult to estimate the true incidence of symptomatic hemorrhoids.

The earliest writings on the subject of symptomatic hemorrhoids occurred in 400 BC by Hippocrates. It was thought that the hemorrhoidal symptoms were due to infection of the veins in the rectum due to passage of stool. Red-hot iron was used to cauterize the hemorrhoids!

Napoleon was finally defeated by the British at the Battle of Waterloo in 1815. Several accounts by those who were close to him have indicated that the battle was lost because Napoleon was too busy treating his hemorrhoids. He routinely treated his hemorrhoids with three to four leeches!

There are two main reasons why people get symptomatic hemorrhoids: there is a history of straining while having a bowel movement and the aging process makes the supporting tissues in that area lax. Increased intra-abdominal pressure (for example in pregnancy) and increased congenital internal anal sphincter pressure can give rise to symptomatic hemorrhoids.

Internal hemorrhoids are classified by the degree of prolapse:
-First-degree hemorrhoids do not prolapse with straining, but can be associated with bleeding.
-Second degree hemorrhoids protrude during straining but will spontaneously retract.
-Third degree hemorrhoids protrude outside the anal canal with straining and require manual reduction.
-Fourth degree hemorrhoids remain prolapsed independent of straining and are irreducible.

Patients with hemorrhoids have no symptoms or present with variety of symptoms such as bleeding, prolapse, feeling of incomplete evacuation, soiling, irritation and itching. Severe pain in the rectal area is due to thrombosed hemorrhoid, fissure or cancer.

The diagnosis of symptomatic hemorrhoids is usually made with digital rectal examination and direct visualization with an instrument. If patient presents with rectal bleeding then other causes of bleeding should be ruled out by endoscopy.

Treatment of hemorrhoids includes dietary and lifestyle changes, rubber band ligation of hemorrhoids and surgery.

High fiber diet and fiber supplement reduces the bleeding and discomfort from hemorrhoids. Fiber causes bloating and flatulence so it should be increased gradually. Avoid straining at the time of defecation. Use hemorrhoidal ointment to lubricate the anal canal before and after bowel movement.

Hot baths help relax the internal sphincter and ease discomfort in the anal area. In 1963, Barron described rubber band ligation for second and third degree hemorrhoids. After the procedure the patient may experience a feeling of pressure or rectal fullness for a period of 24 to 48 hours. There are other complications but they are rare and occur in less than three to four per cent of people.

For fourth degree hemorrhoids, surgical excision is the best option for relief of symptoms. Likely post-operative complications are pain, bleeding and urinary retention. But these treatment options are better than using leeches or red-hot iron rod!

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