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Understanding Hemorrhoids

Treatment

How Do I Know If I Have It?

First, your doctor will look at the anal area, perhaps by inserting a lubricated gloved finger or an anoscope (a hollow, lighted tube for viewing the lower few inches of the rectum) or a proctoscope (which works like an anoscope, but provides a more thorough rectal examination).

More procedures may be needed to identify internal hemorrhoids or rule out other ailments that frequently cause anal bleeding, such as anal fissure, colitis, Crohn's disease, and colorectal cancer.

To see further into the anal canal (into the lower colon, or sigmoid), sigmoidoscopy may be used, or the entire colon may be viewed with colonoscopy. For both procedures, a lighted, flexible viewing tube is inserted into the rectum. A barium X-ray can show the entire colon's interior. First a barium enema is given, then X-rays are taken of the lower gastrointestinal tract.

What Are the Treatments?

Once you develop hemorrhoids, they don't usually go away completely unless you undergo one of the procedures below. They can get better, however, so that living with them is tolerable. Both conventional and alternative practitioners consider diet the best treatment for hemorrhoids. A diet rich in high-fiber foods and low in processed or snack foods is essential. Increasing fluid intake to six to eight eight-ounce glasses a day also is important. Probably half of all hemorrhoid sufferers find relief with dietary changes alone.

Most hemorrhoid treatments aim to minimize pain and itching. Warm (but not hot) sitz baths are the most time-honored and oft-suggested therapy: Sit in about three inches of warm water for 15 minutes, several times a day, especially after a bowel movement. If you are pregnant, discuss any treatment, including dietary changes, with your doctor before proceeding.

If you have been diagnosed with hemorrhoids, a high-fiber diet combined with sitz baths and acetaminophen should reduce discomfort within two weeks. If symptoms persist, your physician may suggest one of the following procedures. Many can be performed in your doctor's office.

Injection. An internal hemorrhoid can be injected with a solution which creates a scar and closes off the hemorrhoid. The injection hurts only a little, as any injection does.

Banding. Prolapsed hemorrhoids are often removed using rubber-band ligation. A special tool secures a tiny rubber band around the hemorrhoid, shutting off its blood supply almost instantly. Within a week, the hemorrhoid shrivels and falls off.

Coagulationor cauterization. Using either an electric probe, a laser beam, or an infrared light, a tiny burn painlessly seals the end of the hemorrhoid, causing it to close off and shrink. This is most useful for prolapsed hemorrhoids.

Surgery.For large internal hemorrhoids or extremely uncomfortable external hemorrhoids (such as thrombosed hemorrhoids that are too painful to live with), your physician may elect traditional surgery, called hemorrhoidectomy.

The success rate for hemorrhoid removal approaches 95%, but unless dietary and lifestyle changes are made, hemorrhoids are likely to recur.

Nutrition and Diet

Prevent constipation by following a high-fiber diet. Meals and snacks should consist primarily of vegetables, fruit, nuts, and whole grains, and as few processed foods and meats as possible. If this is a big change for you, introduce the new foods slowly, to avoid gas.

If you aren't able to eat enough high-fiber food, supplement your diet with stool softeners or bulk-forming agents. (Avoid laxatives, which may cause diarrhea that can further irritate the swollen veins.)

Drink at least eight glasses of water each day; if your life is especially active or you live in a hot climate, you will need more.

Monitor your sodium intake. Excess salt in the diet causes fluid retention, which means swelling in all veins, including hemorrhoids.

At-Home Remedies

• Try not to sit for hours at a time, but if you must, take breaks: Once every hour, get up and move around for at least five minutes. A doughnut-shaped cushion can make sitting more comfortable and ease hemorrhoid pressure and pain.
• Insert petroleum jelly just inside the anus to make bowel movements less painful.
• Dab witch hazel, a soothing anti-inflammatory agent, on irritated hemorrhoids to reduce pain and itching.
• Resist the temptation to scratch hemorrhoids, as it makes everything worse: The inflamed veins become more irritated; the skin around them becomes damaged; and the itching itself intensifies. Instead, to help stop the itching, apply an over-the-counter 0.5% hydrocortisone cream to the skin (not inside the anus -- on the outside only) and a cold pack. You might try over-the-counter hemorrhoidal creams for relief from itching.
• If you need a pain reliever, try acetaminophen. Avoid ibuprofen and aspirin, which foster bleeding.
• Bathe regularly to keep the anal area clean, but be gentle: Excessive scrubbing, especially with soap, can intensify burning and irritation.
• Don't sit on the toilet for more than five minutes at a time, and when wiping, be gentle. If toilet paper is irritating, try dampening it first, or use cotton balls or alcohol-free baby wipes. You may prefer washing yourself and then dabbing the area dry.
• When performing any task that requires exertion, be sure to breathe evenly. It's common to hold your breath during exertion, and if you do, you're straining and contributing to hemorrhoid pain and bleeding.

How Can I Prevent Them?

A healthful diet and lifestyle are good insurance for preventing hemorrhoids, whether you already suffer hemorrhoid symptoms or are intent on preventing them. Regular exercise also is important, especially if you work a sedentary job. Exercise helps in several ways: keeping weight in check, making constipation less likely, and enhancing muscle tone.

Healthy bowel habits also help prevent hemorrhoids. Use the toilet as soon as you feel the urge to do so. Also, avoid sitting on the toilet for prolonged periods (more than five minutes) and avoid straining during a bowel movement.

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