Important Facts About Hemorrhoids
by Beth G. Hodges, MD

Hemorrhoids are dilated veins in the rectum or anus. External hemorrhoids are located outside the rectum and internal hemorrhoids are inside the anal canal.

Hemorrhoids are caused by chronic constipation, straining excessively to produce bowel movements, doing a lot of heavy lifting, and the pressure of a baby sitting on the pelvic vessels during pregnancy.

Symptoms of hemorrhoids can include bleeding, itching and discomfort. If a blood clot forms inside a hemorrhoid (then called a thrombosed hemorrhoid), severe pain develops. Hemorrhoids, once they form, are always present, but may at times be asymptomatic (that is, not produce any symptoms.)

Bleeding from the rectum, even if thought to be due to hemorrhoids, should always be evaluated by a thorough exam of the colon, called a colonoscopy, to make sure there are no colon cancers or precancerous polyps present.

Treatment of symptomatic hemorrhoids should be dependent on the severity of the problem. A thrombosed hemorrhoid will usually have to be surgically drained to release the pressure from the clotted blood. Most of the time, though, hemorrhoids can be treated nonsurgically.

Steroid creams and suppositories can relieve itching and inflammation. Witch hazel gel will vasoconstrict dilated vessels, relieving pressure. Topical anesthetics can also help with the discomfort.

Increasing fiber and water in the diet to avoid constipation and straining is very important. If conservative methods do not work, hemorrhoids can be surgically removed, strangled and then removed with a technique called rubber band ligation, or photocoagulated with a laser. Sclerotherapy involves injecting a hypertonic solution into the hemorrhoid to cause scarring. All of these methods can be successful at hemorrhoid ablation, but carry some risk of constriction of the anal canal due to scarring, which can lead to voiding problems later.

Published - January, 2010