Hemorrhoids are swollen or enlarged veins in the lower rectum. Most commonly, patients with hemorrhoids can experience rectal bleeding, itching, and/or rectal pain. You may have some discomfort in the rectum, and feel a “bulge” outside of your anus if the hemorrhoids are prolapsed or external. Symptoms can also include stool “leaking” because it can interfere with the tightening of the sphincter.
If you see blood in your stool, it may be from hemorrhoids, but it may be from other causes as well. It is very important to have any blood in your stool evaluated promptly by your healthcare provider.
Causes of hemorrhoids can include diarrhea, constipation, pelvic tumors, pregnancy and post-pregnancy, and sitting for prolonged periods of time.
Hemorrhoid treatment always includes a high fiber diet. Plenty of fruits and vegetables throughout the day can usually give you enough fiber. The goal is to get 20 to 35 grams of fiber daily. If you are not able to obtain enough fiber through your diet, you can supplement with FiberCon capsules, Citrucel, Benefiber, Metamucil, or even fiber gummies. It is also important not to strain during bowel movements, as this can increase the pressure in the rectum and anal area and make hemorrhoids worse. If fiber isn’t enough to produce effortless, easy-to-pass bowel movements, and you are consuming an adequate amount of water defined as 48-64 ounces daily, then sometimes medications like Miralax or prescription strength laxatives can help to soften stool and make it easier to pass. This will help hemorrhoids subside over time.
You can also use sitz baths to help ease the discomfort of hemorrhoids. During a sitz bath, soak the rectum in warm water for 10-15 minutes about 2-3 times a day. You can do a warm sitz bath with 2-3 inches of warm water in your bathtub. You do not have to add soap, bubble bath, or salt to the water. Water alone can help to improve blood flow and to relax the muscle around the anus.
Sometimes topical medicines can help, like hydrocortisone cream or rectal suppositories. These help to reduce inflammation, pain, and itching in the anal area caused by hemorrhoids. These should not be used for longer than 1-2 weeks unless the healthcare provider approves longer usage. Preparation H is an over the counter medication you can buy that shrinks swollen hemorrhoids, which is safe to use. You can also use Pramoxine rectal foam, ointment, or wipes which are over-the-counter pain relievers. Numbing medicines like lidocaine, benzocaine, and dibucaine should only be used under your healthcare provider’s orders.
If your hemorrhoids are “internal” hemorrhoids or located inside the anal orifice (unable to be seen by the naked eye), you may qualify for hemorrhoid banding. Hemorrhoids cannot be removed during a colonoscopy. If you are an appropriate patient for hemorrhoidal banding, a doctor will use a tool to place a rubber band around your hemorrhoids. This is performed during a regular office visit but has to be pre-arranged in order to have the tool ready for use. Since there are three columns of hemorrhoids, if you choose to undergo banding, most patients require three separate treatments in order to adequately treat each site of hemorrhoids. You need to be awake during this procedure so you can alert the doctor if you experience any pain or discomfort, as this may mean the band is too tight. The doctor can loosen the band easily if needed. Sometimes an ulcer can form after banding the hemorrhoids, which is a raw, sore area. This usually heals by itself and does not cause any long-term serious complications.
External hemorrhoids or thrombosed hemorrhoids (clot development within hemorrhoids which can be extremely painful) may require a visit to the colorectal surgeon either to cut open the thrombosed hemorrhoid or to surgically remove bulky external hemorrhoids. External hemorrhoids cannot be banded. Usually, before surgery, an adequate trial of topical medicines and fiber supplements is recommended.
Article by Libby Greenwood, PA-C. Learn more about her here: https://digestivehealth.ws/provider/elizabeth-greenwood-pa-c/
Digestive Health Specialists, PA is here to help you if you, or someone you know, would like more information, or if you are experiencing any of the above symptoms and would like further evaluation. To make an appointment, feel free to give us a call at 336-768-6211.