What are Hemorrhoids?
Often
described as "varicose veins of the anus and rectum",
hemorrhoids are enlarged, bulging blood vessels in and about
the anus and lower rectum. There are two types of hemorrhoids:
external and internal, which refer to their location.
External (outside) hemorrhoids develop near the anus and
are covered by very sensitive skin. If a blood clot develops
in one of them, a painful swelling may occur. The external
hemorrhoid feels like a hard, sensitive lump. It bleeds
only if it ruptures.
Internal (inside) hemorrhoids develop within the anus beneath
the lining. Painless bleeding and protrusion during bowel
movements are the most common symptom. However, an internal
hemorrhoid can cause severe pain if it is completely "prolapsed"
- protrudes from the anal opening and cannot be pushed back
inside.
What causes Hemorrhoids?
An exact cause is unknown; however, the upright posture
of humans alone forces a great deal of pressure on the rectal
veins, which sometimes causes them to bulge.
Other contributing factors include:
Do Hemorrhoids lead to cancer?
No. There is no relationship between hemorrhoids and cancer.
However, the symptoms of hemorrhoids, particularly bleeding,
are similar to those of colorectal cancer and other diseases
of the digestive system. Therefore, it is important that
all symptom are investigated by a physician specially trained
in treating diseases of the colon and rectum. Do not rely
on over-the-counter medications or other self-treatments.
See a colorectal surgeon first so your symptoms can be properly
evaluated and effective treatment prescribed.
How are Hemorrhoids treated?
Mild symptoms can be relieved frequently by increasing the
amount of fiber (e.g., fruits, vegetables, breads and cereals)
and fluids in the diet. Eliminating excessive straining
reduces the pressure on hemorrhoids and helps prevent them
from protruding. A sitz bath - sitting in plain warm water
for about 10 minutes - can also provide some relief.
With these measures, the pain and swelling of most symptomatic
hemorrhoids will decrease in two to seven days, and the
firm lump should recede within four to six weeks. In cases
of severe, persistent pain, your physician may elect to
remove the hemorrhoid containing the clot with a small incision.
Performed under local anesthesia as an outpatient, this
procedure generally provides relief.
Severe hemorrhoids may require special treatment, much
of which can be performed on an outpatient basis.
Ligation - the rubber band treatment - works effectively
on internal hemorrhoids that protrude with bowel movements.
A small rubber band is placed over the hemorrhoid, cutting
off its blood supply. The hemorrhoid and the band fall off
in a few days and the wound usually heals in a week or two.
This procedure sometimes produces mild discomfort and bleeding.
Injection and Coagulation can also be used on bleeding
hemorrhoids that do not protrude. Both methods are relatively
painless and cause the hemorrhoid to shrivel up.
Hemorrhoidectomy - surgery to remove the hemorrhoids
- is the best method for the permanent removal of hemorrhoids.
It is necessary when (1) clots repeatedly form in external
hemorrhoids; (2) ligation fails to treat internal hemorrhoids;
(3) the protruding hemorrhoid cannot be reduced; or (4)
there is persistent bleeding. A hemorrhoidectomy removes
excessive tissue that causes the bleeding and protrusion.
It is done under anesthesia any may, depending upon circumstances,
require hospitalization and a period of inactivity. Laser
hemorrhoidectomies do not offer any advantage over standard
operative techniques. They are also quite expensive, and
contrary to popular belief, are no less painful.
Other treatments include cryotherapy, BICAP coagulation
and direct current. Cryotherapy, popular 20 years ago, consists
of freezing hemorrhoidal tissue. It is not recommended for
hemorrhoids because it is very painful. BICAP and direct
current are methods that shrink the hemorrhoid. None of
these treatments have 
gained
widespread acceptance.
Rubber Band Ligation of Internal Hemorrhoids
A. Bulging, bleeding, internal hemorrhoid
B. Rubber band applied at the base of the hemorrhoid
C. About 7 days later, the banded hemorrhoid has
fallen off leaving a small scar at its base (arrow)
