Hemorrhoids affect most of us at one time or another. Although common, it is not a problem that enjoys great discussion. Here are a few insights as to how to best deal with that painful, gnawing itch of a hemorrhoid flare.
What is a hemorrhoid?
Hemorrhoids are a series of "veins" found in the anal canal. These veins are present from birth and normally may act as cushions during regular elimination. These veins become troublesome when they bleed, clot (thrombose), enlarge, and become inflamed.
How do I know that I have hemorrhoids?
In the most simple but aggravating situation the first symptom may be rectal itching. Others may experience a "tearing" sensation with a constipated bowel movement. This is not a hemorrhoid but an associated condition. Either of these may readily resolve with a little time, cleanliness, and care. Bright red blood in the toilet is one symptom of great worry to an individual. Another demanding symptom is severe pain. Both of these symptoms are to be respected and should illicit a call to your physician. As anyone who has been pregnant can tell you, hemorrhoids are often synonymous with pregnancy, especially in the third trimester.
What causes hemorrhoids?
Though rarely symptomatic before the fourth decade of life (with the exception of pregnancy), it is believed that it is a combination of factors that lead to their becoming problematic. Straining upon defecation is the first to be mentioned. The other contributing factors may be more anatomic in nature, such as "sliding hemorrhoid", that is, loosening of the bands that typically hold veins in the anal canal. Increased anal canal pressure and weakness of the vessel wall itself may also contribute to the protrusion of hemorrhoids out the anal canal.
Is there anything to help prevent or relieve hemorrhoidal attack?
Diet is the number one highly contributing factor. Your diet should always contain a high degree of fiber from the unprocessed bran, fruits with skins, vegetables (both raw and cooked) and legumes. An increase in your daily water/liquids intake is also helpful, preferably six glasses a day. A psyllium product (such as Citrucel or Metamucil) may be used (be sure to follow the directions on the package). For those who love to read of the worlds events in the privacy of their bathroom, it is recommended that you do not do so sitting down. This is the habit that contributes to the downward pressure on these veins. If you have already developed hemorrhoids, alas, you read this article too late.
You may find relief with sitz baths, ice packs, or topical ointments. For soothing relief add a few tablespoons of Epsom salts to three to four inches of warm (not hot) bath water. Sit in this bath water for brief periods of temporary relief. To reduce discomfort of a thrombosed hemorrhoid (clotted vein), you may apply an ice pack for only a brief few minutes and rest. This is a common condition, however, until your appointment this may provide a little relief. Last but not least, topical agents, found in your local pharmacy, may provide some relief. If you continue to experience discomfort after this application you should check with your physician.
When should you see a surgeon?
Bleeding, painful, or swollen hemorrhoids not quickly relieved by over-the-counter treatments, or recurrence, are indications that you should see a surgeon. The diagnosis of hemorrhoids is fairly simple and begins with visual inspection. The examination may proceed with rectal examination to determine the extent of the hemorrhoids and to rule out other more serious problems. The exam will take place in the surgeon's office.
What types of treatment are available?
Thrombosed hemorrhoids, those where a clot has stretched the skin, are acutely painful and will need to be immediately relieved surgically. This will take place in the surgeon's office with local anesthetic and a small incision to remove the clot (enucleation). Internal and/or external hemorrhoids may be treated surgically, usually on an outpatient basis. A hemorrhoidectomy is the surgical removal of swollen veins. Your healing time following this may be from five weeks to two months, but you may return to work before this. Banding is another procedure but reserved for internal hemorrhoids only. Laser treatment is also available at the discernment of the surgeon. All of these surgical interventions are reserved for the treatment of hemorrhoids that are unresponsive to other means of relief. Your surgeon will be glad to discuss the options most appropriate for you.
