Hemorrhoids are a common problem in both men and women who come to see their primary care or urgent care doctor. Hemorrhoids are enlarged or swollen veins in the lower rectum. They can cause pain, itching and rectal bleeding. Sometimes you can feel or see hemorrhoids around the outside of the anus. Other times they may be hidden from view inside the rectum (internal hemorrhoids).
They are more common in older individuals and patients during and after pregnancy, those with diarrhea or constipation or in people who sit for prolonger periods of time.
1) Anal pain or itching
2) Tissue bulging around anus
3) Painless rectal bleeding
4) Difficulty cleaning or leakage of feces after bowl movement
Diagnosis: Your healthcare provider will examine the rectum and anus to inspect for hemorrhoids. This exam may include inserting a gloved finger into the rectum. The reason for the digital exam is to inspect for possible rectal cancers and also to collect any stool that’s present and test for blood. If there is blood present, your healthcare provider may use a special tube called an anoscope, that is clear and allows visualization of the rectum/anus.
Treatment: If hemorrhoids are diagnosed, one of the most important steps is avoiding constipation because they can lead to rectal bleeding or tearing the anus (called a fissue). Also, it is important to avoid pushing or straining during bowl movements because that can worsen existing hemorrhoids and risk causing development of additional hemorrhoids. Reducing constipation can be done by:
1) Increasing fiber – increasing fruits and vegetables contain fiber. In addition fiber supplements such as Metamucil may be helpful.
2) Laxatives – These are not “addictive” or increase your risk of constipation in the future.
3) Warm sitz baths – soaking the rectal area in warm water for 10 minutes 3x/day improve blood flow by relaxing the internal anal sphincter.
4) Topical treatments – Suppositories are creams with hydrocortisone may be helpful to relieve pain, itching and irritation.
More invasive procedures:
1) Rubber band ligation – a rubber band or ring is place around the base of the internal hemorrhoid which restricts the blood supply to that area. This shrinks the hemorrhoid and reduces it.
2) Laser surgery – uses a laser or infrared light to destroy internal hemorrhoids
3) Sclerotherpay – a chemical solution is injected into the hemorrhoidal tissue causing it to break down and form a scar
4) Surgery – hemorrhoidectomy is the treatment of choice for patients with large internal hemorrhoids.
A gastroenterologist is a doctor who specializes in the gastrointestinal tract. If you are looking for a gastroenterologist in your area, the American Gastroenterological Association has a locator: https://secure.gastro.org/GILocator/locator.asp
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO