Q: I am a 55-year old woman, and I discovered for the first time
recently that I have hemorrhoids. What can be done to treat
them?
Q: I am a 55-year old woman, and I discovered for the first time recently that I have hemorrhoids. What can be done to treat them?
A: Hemorrhoids are veins in the anus that become swollen. Normally, the veins lie underneath the skin, but when they become swollen, they bulge out. Pain, itching, and bleeding are the most common problems caused by hemorrhoids. A few simple strategies can help ease the pain and trouble associated with these bothersome bulging blood vessels.
Many women have a passing encounter with hemorrhoids during pregnancy. By midlife, hemorrhoids often become an ongoing complaint. By age 50, about half the population has experienced one or more of the classic symptoms, including rectal pain, itching, bleeding and possibly prolapse (hemorrhoids that protrude through the anal canal). They’re rarely dangerous, but they can be a recurrent and painful intrusion.
There are two kinds of hemorrhoids: internal, which occur in the lower rectum, and external, which develop under the skin around the anus. External hemorrhoids are the most uncomfortable. If a blood clot forms inside an external hemorrhoid, the pain can be sudden and severe. You might feel or see a lump around the anus. The clot usually dissolves, leaving excess skin, which may itch or become irritated.
Internal hemorrhoids are typically painless, even when they produce bleeding. They may also extend beyond the anus. This can cause several potential problems. When a hemorrhoid protrudes, it can collect small amounts of mucus and microscopic stool particles that may cause an irritation.
Experts are divided on exactly what causes hemorrhoids. Traditionally, hemorrhoids are associated with chronic constipation, straining during bowel movements and prolonged sitting on the toilet. All of these interfere with blood flow to and from the area, causing it to pool and enlarge the vessels.
Hemorrhoids can usually be diagnosed from a simple medical history and physical exam. If there’s evidence of rectal bleeding or microscopic blood in the stool, further tests may be performed to rule out other causes of bleeding, such as colorectal polyps or cancer. Most hemorrhoid symptoms improve dramatically with simple, at-home measures.
• Get more fiber: Add more fiber to your diet from food, a fiber supplement or both. Along with adequate fluid, fiber softens stools and makes them easier to pass. High-fiber foods include broccoli, beans, wheat and oat bran, whole-grain foods and fresh fruit. Another way to get fiber is to use a psyllium husk powder (such as Metamucil) that you can buy without a prescription at any drug store.
• Exercise: Moderate aerobic exercise, such as brisk walking 20 to 30 minutes a day, can help stimulate bowel function.
• Take time: When you feel the urge to defecate, go to the bathroom immediately.
• Sitz: A sitz bath is a warm water bath for the buttocks and hips. It can relieve itching, irritation and spasms of the sphincter muscle. Pharmacies sell small plastic tubs that fit over a toilet seat, or you can sit in a regular bathtub with a few inches of warm water. For hemorrhoid sufferers, most experts recommend a 20-minute sitz bath after each bowel movement and two or three times during the day.
• Seek topical relief: Over-the-counter hemorrhoid creams containing a local anesthetic or hydrocortisone can temporarily soothe pain. Be sure to follow the package directions carefully.
Witch hazel wipes (like Tucks) are soothing and have no harmful effects. A small ice pack placed against the anal area for a few minutes or sitting on a cushion can help reduce pain. Some hemorrhoids can’t be managed with home treatments alone. A number of minimally invasive treatments are available that are less painful than traditional surgical removal and allow a quicker recovery.
• Band it: The most commonly used hemorrhoid procedure in the United States is rubber band ligation, in which a small elastic band is placed around the base of a hemorrhoid. The band causes the hemorrhoid to shrink. It may take two to four procedures, done six to eight weeks apart.
• Surgery: In a traditional hemorrhoidectomy, a narrow incision is made around both external and internal hemorrhoid tissue and the offending blood vessels are removed. This procedure cures 95 percent of cases and has a low complication rate. It also has a well-deserved reputation for being painful. Patients can usually return to work after seven to 10 days.
• Staples: A newer alternative to surgery treats bleeding or prolapsed internal hemorrhoids. The surgeon uses a stapling device to anchor the hemorrhoids. This is performed under general anesthesia. It is less painful than traditional surgery and recovery is quicker.
While hemorrhoids can be quite painful and irritating, they can also be easily treated, both at home and by your doctor.
If you would like to e-mail questions to the Adviser, you can submit them to www.health.harvard.edu/adviser.
By the faculty of Harvard Medical School
