HEMORRHOIDS
WHAT ARE HEMORRHOIDS ?
Hemorrhoids are enlarged blood vessels in and around the anus and lower rectum. The rectum is the lowermost section of your large intestine. As a result of one or more factors, the supporting tissue stretches leading to expansion of these vessels and protrusion. This invites issues such as pain, bleeding, itching, swelling, difficulty maintaining hygiene, or clotting, etc.
Hemorrhoids are classified as both external and internal. External hemorrhoids are covered with sensitive skin. They are usually painless unless a blood clot forms (Thrombosis) They usually present with swelling (sensation of a lump around the anus), discomfort, or pain. Bleeding can occur as a later complication. Skin irritation and itching (pruritus) can occur due to difficulty in keeping clean.
Internal hemorrhoids, on the other hand, are found higher in the anal canal. Complications related to internal hemorrhoids include painless bleeding, irritation, and discharge. Should they protrude, internal hemorrhoids can also cause severe pain.
HEMORRHOIDS- PREVENTION:
All people have hemorrhoidal tissue as part of their normal anatomy. You can avoid or minimize complications related to hemorrhoids by adopting the following tips:
- Maintain soft and regular bowel habits:
- Eat high fiber foods including vegetables, fruits and whole grains. Beans and prunes are generally high in fiber content. Lettuce is not.
- Consume plenty of fluids- at least 6-8 gasses of water or fluid per day. Avoid alcohol as it can dehydrate you.
- Add fiber supplement to your diet- It is recommended that men consume 38grams of fiber daily while women 25grams daily. Most fail short of those recommendations hence the need to add a fiber supplement.
- Avoid straining/constipation: This may result in increased pressure in your hemorrhoidal vessels resulting in protrusion.
- Avoid prolonged sitting on toilet: This may result in protrusion of hemorrhoids.
- Exercise regularly: Staying physically active promotes general and colonic health and regular bowel habits.
HEMORRHOIDS- DIAGNOSIS AND TREATMENT:
Since the symptoms of anal pain and rectal bleeding can be caused by more serious conditions such as cancer, it is very important that you are checked by a colon and rectal surgeon first before you try self-treatments.
Treatment of hemorrhoids without surgery:
Mild hemorrhoid conditions can often be treated without surgery. These include taking stool softeners/fiber supplement with plenty of fluids to maintain soft bowel movements. Taking warm tub baths or sitz baths 10-15 minutes at a time 2-3 times a day also help alleviate symptoms. With non-surgical treatment, pain and swelling usually decrease in two to seven days. In general, hemorrhoid creams and suppositories are not effective remedies.
Other treatment options:
Your colon and rectal surgeon may recommend removal of the hemorrhoidal tissue. This can be accomplished by several techniques including the following:
- Excision of thrombosed hemorrhoids: If pain from a thrombosed hemorrhoid is severe, I may decide to remove the hemorrhoid and clot with a small incision. You can choose to have this done during your office visit or at a hospital or surgical facility.
- Rubber Banding or Rubber band ligation of internal hemorrhoids: This technique is best for treatment of troublesome internal hemorrhoids. It is highly effective and can be completed during your office visit with minimal discomfort. A small rubber band is placed over the internal hemorrhoid, cutting off its blood supply. The hemorrhoid and the band will then fall off in a few days. Most patients resume normal activities thereafter and note minor or no bleeding or discomfort. You may need to repeat this to address other remaining hemorrhoids.
- IRC or infrared coagulation treatment of hemorrhoids: Infrared photocoagulation (also called coagulation therapy) is an office procedure that is used to treat small internal hemorrhoids. A heat source is applied to the internal hemorrhoidal tissue causing a burn. Repeat application is usually required in a week or two. Other methods are used to achieve the same result using Laser (often advertised as laser hemorrhoid surgery) or an electrical current. This technique causes scarring in the anal canal and is only effective for smaller internal hemorrhoids and not external hemorrhoids. Other methods I mentioned here are more effective than this technique.
- Hemorrhoid stapling: Also referred to as procedure for prolapsed hemorrhoids (PPH), it involves the use of a special stapling device that removes excess hemorrhoidal tissue. Though it is less painful than hemorrhoidectomy, the risk of recurrence is somewhat higher.
- Transanal hemorrhoidal dearterialization (or THD): Involves the use of a Doppler to guide ligation of the hemorrhoidal arterial branches. Though less painful, the risk of recurrence has been found to be higher than conventional hemorrhoidectomy.
- Hemorrhoidectomy: This surgical treatment removes both internal and external hemorrhoids and remains the gold standard. It is painful, however, requires anesthesia, and though small, carries a higher risk of complications. It is therefore reserved for the most severe cases of hemorrhoidal disease. I can help advise you if this method is right for you.
- Laser hemorrhoidectomy: First proposed in the 1990s, a laser beam is used to cut hemorrhoid tissue instead of using a knife. Contrary to general belief, numerous studies have shown that the use of Laser does not offer any benefit compared to standard hemorrhoidectomy. Other than being more expensive, Laser hemorrhoid surgery is as painful and may carry more risk or complications. Having failed to show advantages over conventional surgery, it is rarely used today in the treatment of hemorrhoids.
CAN HEMORRHOIDS CAUSE CANCER:
The short answer is no. However, more serious conditions such as colorectal cancer can present in a similar way. One should never blame hemorrhoids for painless rectal bleeding, for instance, before ruling out other causes. This requires a thorough examination by a colon and rectal specialist. You can read more about hemorrhoids here.
Dr. Tarazi is a colon and rectal surgeon with over 22 years of experience treating hemorrhoids and can best advise you as to the treatment that is best for you. If you suffer from rectal bleeding, anorectal pain or swelling, or change in your bowel habits, please contact us for a consultation.