What is hemorrhoid?

A hemorrhoid is a swollen vein in the area around the anus, the opening through which stool passes. Hemorrhoids are a very common health problem. Many people have both internal and external hemorrhoids.

• Internal hemorrhoids develop inside the anal passageway. They are usually not painful, but they can cause a small amount of bleeding, most often with bowel movements.

• External hemorrhoids develop around the rim of the anus, where they can cause itching and discomfort.

What are the signs of hemorrhoids?

You may see a bit of blood on the toilet paper after having a bowel movement. You might also see traces of blood on your stool or coloring the water inside the toilet bowl. You may feel a bulge or lump in the area around your anus.

What causes them?

Hemorrhoids can develop from chronic constipation, straining to pass stools, and recurrent diarrhea. Women sometimes get hemorrhoids from pregnancy and childbirth. As you get older, you are more likely to develop hemorrhoids.

What is the treatment for hemorrhoids?

Although hemorrhoids are annoying, they are not usually a serious medical problem. Most of the time, you can relieve the symptoms of hemorrhoids with home treatments. However, if you notice rectal bleeding, it is important to see your doctor for an examination. Your doctor will check to see whether the bleeding is coming from hemorrhoids or something more serious, such as rectal cancer.

Recommended home treatments include:

• Increasing the amount of fiber in your diet. A fiber-rich diet softens stools so that they pass more easily, reducing pressure on hemorrhoids

   ○ High-fiber foods include beans, broccoli, carrots, bran, whole grains, and fresh fruits. Ask your doctor for patient handouts on dietary fiber and fiber content of foods. To avoid bloating and gas, add these foods gradually over several days. Drinking enough fluids (six to eight cups a day) helps you digest fiber and also helps soften stools.

   ○ If you don't think you are getting enough fiber in your diet, you can also buy fiber supplements in the drug store (without a prescription). Flavored and artificially sweetened varieties are available. The usual dose is two teaspoons or two packets in liquid once or twice a day.

• Sitz baths. Sitting in a tub filled with warm water for 10 to 15 minutes several times a day can ease discomfort. (Large pharmacies and medical supply stores also sell convenient plastic sitz bath devices that fit into a toilet.) The warm water will keep the area clean, and the warmth will reduce inflammation. Be sure to dry the rectal area thoroughly after each sitz bath. If you work, try taking a sitz bath in the morning, upon your return from work and

before bedtime.

• Applying a cold compress or icepack to the anal area, or try a cool cotton pad soaked in witch hazel.

• Petroleum jelly or aloe vera gel, applied to the anal area, can soothe the skin. Over-the-counter hemorrhoid preparations containing hydrocortisone can reduce swelling, but use them sparingly because they can dry out your

skin.

If hemorrhoids do not respond to these measures, your doctor may recommend medical treatment.

Medical treatments for small to medium, mostly internal hemorrhoids can usually be done in a surgeon’s office. They include:

• Rubber-band ligation - A rubber band is slipped around the base of hemorrhoid to cut off its circulation. Once it has been deprived of its vital blood supply, the banded hemorrhoid withers and falls off. This treatment is the most effective and most common.

• Sclerotherapy - an irritating chemical solution is injected directly into hemorrhoid or the area around it. The solution interferes with blood flow inside the hemorrhoid, causing it to shrink.

• Laser therapy, infrared light therapy, electro-cauterization, or freezing therapy are all used to shrink hemorrhoids.

For patients who have large hemorrhoids, or prominent external hemorrhoids, hemorrhoidectomy (surgically removing the hemorrhoids) is sometimes recommended. This procedure is an outpatient procedure done under anesthesia. It usually has excellent results.

What can I do to prevent another flare-up of hemorrhoids?

• Eat plenty of fiber-rich foods.

• Drink plenty of liquids. To help keep your stool soft, it’s a good idea to drink between six and eight glasses of water daily.

• Exercise regularly. Twenty to thirty minutes of brisk walking daily helps to stimulate easier bowel movements.

• Respond immediately to the urge to have a bowel movement. Do not postpone until the time is more convenient.

Home Treatments for Hemorrhoids

To avoid making hemorrhoids worse:

• After a bowel movement, blot the area gently with white toilet paper moistened with water. You can also use Baby Wipes or other premoistened towels (such as Tucks) for this purpose.

• In the bath or shower, use only soaps without perfumes or dyes. Avoid rubbing the anal area. Gently pat dry with a soft, absorbent, or cloth.

To relieve pain and itching:

• Apply ice several times a day for 10 minutes at a time. Follow this by placing a warm compress on the anal area for another 10 to 20 minutes.

• Take a sitz bath once or twice a day. Sock in a tub or a pan of plain, warm water (at bathwater temperature) for 15 to 20 minutes. You can buy a plastic sitz bath basin that fits into the toilet at larger pharmacies and medical supply stores. The sitz bath water keeps the area clean, decreases redness and swelling, and relaxes the muscles.

To prevent hemorrhoids from coming back:

• Add more fiber to your diet to prevent constipation. Focus on fruits, vegetables, and whole grains. Fiber supplements such as Citrucel and Metamucil can also add bulk to the diet. You can buy fiber supplements at a drug store without a prescription. They are not laxatives. They do not stimulate the bowel to move. They help make your bowel movements soft and less irritating. Follow the label instructions for use. Be sure to drink plenty of water or other fluids when you increase the fiber in your diet.

• Get more exercise. Moderate exercise - 30 minutes or more three or four times a week - helps keep your bowels functioning properly. Brisk walking, swimming, gardening, dancing, housework, any activity that gets you moving will do. Vary the kinds of exercise you do to keep it interesting.

This document is intended to provide health-related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

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