The earliest writings on the subject of symptomatic hemorrhoids occurred in 400 BC by Hippocrates. Red-hot iron was used to cauterize the hemorrhoids. In 1815, at the Battle of Waterloo, Napoleon was defeated by the British because he was too busy treating his hemorrhoids with leeches. The treatment of hemorrhoids has come a long way since.
Hemorrhoids, also known as piles, are swollen veins around the anus or lower rectum. They are either inside the anus (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). We all have hemorrhoids. We are born with them. They are in the form of small veins. Hemorrhoidal veins get bigger from straining to have a bowel movement, during pregnancy and aging, as aging process makes the supporting tissues in that area lax. Usually, people with chronic constipation or diarrhoea are affected.
Internal hemorrhoidal veins are at three locations: at three, seven and 11 o’clock. When these veins get large and stretch out (like varicose veins in the legs) we call them hemorrhoids. External hemorrhoids are in the form of redundant skin usually at the same three locations. Some internal hemorrhoids can be quite big and prolapse through the anus that they need to be pushed back. Some people have extensive circumferential hemorrhoids and redundant skin in the anal area.
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.
Troublesome hemorrhoids present with symptoms like bleeding, prolapse, feeling of incomplete evacuation, soiling, irritation and/or itching. Severe pain in the rectal area is usually due to thrombosed hemorrhoid, fissure, infection (abscess) or cancer.
The diagnosis of symptomatic hemorrhoids is usually made with digital rectal examination and direct visualization with an instrument. If a patient presents with rectal bleeding then other causes of bleeding should be ruled out by a scope test. All patients with symptomatic hemorrhoids do not require leeches, iron rod, Captain Hook (just kidding) or surgery. I find that about 80 per cent of my patients with symptomatic hemorrhoids can be managed by medical treatment only.
Medical treatment includes careful examination and diagnosis, detailed explanation of the problem, careful review of treatment options and monitoring progress to see if the medical treatment has worked. Detailed advice consists of high fiber diet, fiber supplement, use of hemorrhoidal ointment, hot baths and explanation on how to take meticulous care of the anal are – just like flossing and brushing your teeth!
Failure of medical treatment and patients with no external hemorrhoidal components will benefit from rubber band ligation of internal hemorrhoids in the office – a less than five-minute procedure. Patients do not require any anaesthetic for this.
Symptomatic patients with big hemorrhoids with external components require surgical excision. Duration of this procedure and post-operative recovery time depends on the extent of surgery required to fix the problem.
If you think you have hemorrhoidal problems then do not be afraid to have your butt checked out. Believe it or not, there are gentler and kinder ways to take care of the area. And you might even get a candy or a sucker after the procedure! You may even say “thank you” before you leave the office.
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