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The term hemorrhoids refers to a condition in which the
veins around the anus or lower rectum are swollen and inflamed.
Hemorrhoids may result from straining to move stool. Other contributing
factors include pregnancy, aging, chronic constipation or diarrhea, and
anal intercourse.
Types of Hemorrhoids:
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Internal Hemorrhoid: inside the anus
External Hemorrhoid: under the skin around the anus
What are the symptoms of hemorrhoids?
Many anorectal problems, including fissures, fistulae, abscesses, or
irritation and itching (pruritus ani), have similar symptoms and are
incorrectly referred to as hemorrhoids.
Hemorrhoids usually are not dangerous or life threatening. In most cases,
hemorrhoidal symptoms will go away within a few days.
Although many people have hemorrhoids, not all experience symptoms.
The most common symptom of internal hemorrhoids is bright red blood
covering the stool, on toilet paper, or in the toilet bowl. However, an
internal hemorrhoid may protrude through the anus outside the body,
becoming irritated and painful. This is known as a protruding hemorrhoid.
Symptoms of external hemorrhoids may include painful swelling or a
hard lump around the anus that results when a blood clot forms. This
condition is known as a thrombosed external hemorrhoid.
In addition, excessive straining, rubbing, or cleaning around the anus may
cause irritation with bleeding and/or itching, which may produce a vicious
cycle of symptoms. Draining mucus may also cause itching.
How common are hemorrhoids?
Hemorrhoids are very common in both men and women. About half of the
population have hemorrhoids by age 50. Hemorrhoids are also common among
pregnant women. The pressure of the fetus in the abdomen, as well as
hormonal changes, cause the hemorrhoidal vessels to enlarge. These vessels
are also placed under severe pressure during childbirth. For most women,
however, hemorrhoids caused by pregnancy are a temporary problem.
How are hemorrhoids diagnosed?
A thorough evaluation and proper diagnosis by the doctor is important any
time bleeding from the rectum or blood in the stool occurs. Bleeding may
also be a symptom of other digestive diseases, including colorectal
cancer.
The doctor will examine the anus and rectum to look for swollen blood
vessels that indicate hemorrhoids and will also perform a digital rectal
exam with a gloved, lubricated finger to feel for abnormalities.
Closer evaluation of the rectum for hemorrhoids requires an exam with an
anoscope, a hollow, lighted tube useful for viewing internal hemorrhoids,
or a proctoscope, useful for more completely examining the entire rectum.
To rule out other causes of gastrointestinal bleeding, the doctor may
examine the rectum and lower colon (sigmoid) with sigmoidoscopy or the
entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are
diagnostic procedures that also involve the use of lighted, flexible tubes
inserted through the rectum.
What is the treatment?
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1- Medical treatment
Medical treatment is aimed initially at relieving symptoms. Measures to
reduce symptoms include:
o tub baths several times a day in
plain, warm water for about 10 minutes
o application of a hemorroidal cream
or suppository to the affected area for a limited time
Preventing the recurrence of hemorrhoids will require relieving the
pressure and straining of constipation. Doctors will often recommend
increasing fiber and fluids in the diet. Eating the right amount of fiber
and drinking six to eight glasses of fluid (not alcohol) result in softer,
bulkier stools. A softer stool makes emptying the bowels easier and
lessens the pressure on hemorrhoids caused by straining. Eliminating
straining also helps prevent the hemorrhoids from protruding.
Good sources of fiber are fruits, vegetables, and whole grains. In
addition, doctors may suggest a bulk stool softener or a fiber supplement
such as psyllium (Metamucil) or methylcellulose (Citrucel).
2- Surgical Tratment
In some cases, hemorrhoids must be treated endoscopically or surgically.
These methods are used to shrink and destroy the hemorrhoidal tissue. The
doctor will perform the procedure during an office or hospital visit.
A number of methods may be used to remove or reduce the size of internal
hemorrhoids. These techniques include:
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o Rubber band ligation. A
rubber band is placed around the base of the hemorrhoid inside the rectum.
The band cuts off circulation, and the hemorrhoid withers away within a
few days.
o Sclerotherapy. A
chemical solution is injected around the blood vessel to shrink the
hemorrhoid.
o Infrared coagulation. A special
device is used to burn hemorrhoidal tissue.
o Hemorrhoidectomy.
Occasionally, extensive or severe internal or external hemorrhoids may
require removal by surgery known as hemorrhoidectomy.
How are hemorrhoids prevented?
The best way to prevent hemorrhoids is to keep stools soft so they pass
easily, thus decreasing pressure and straining, and to empty bowels as
soon as possible after the urge occurs. Exercise, including walking, and
increased fiber in the diet help reduce constipation and straining by
producing stools that are softer and easier to pass.
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