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Hemorrhoids is right up there with anal itching, STDs, and toenail fungus as being one of those potentially embarrassing medical conditions that you dread seeing your doctor to discuss. As I’ve previously stated when reviewing all of these mentioned conditions in prior episodes, you should never fear discussing anything with your doctor. We hear it all over and over. It’s not embarrassing to us. It’s our job, and we cannot help you unless you feel comfortable enough to discuss anything.
And you’d be quite surprised to learn how common these embarrassing conditions really are. Hemorrhoids are a perfect example.
What Are Hemorrhoids?
Hemorrhoids are merely enlarged veins, that appear as bluish-purple or sometimes red and inflamed small bulges in and around the anus/rectum . There are two types
- Internal hemorrhoids that lye on the inside lining of the rectum, where you may not be able to easily feel.
- External hemorrhoids that lye on the outside of the rectum and are easily felt
Symptoms of Hemorrhoids
According to a study in the International Journal of Colorectal Disease, almost 40% of people have hemorrhoids. But not everyone is bothered by it. Only 45% of people with hemorrhoids have symptoms.
Symptoms depend on the type of hemorrhoids you have. Many people have both.
Internal hemorrhoids often cause a painless bleeding. You may notice it when you wipe or sometimes in the toilet bowl. However, other things can cause rectal bleeding, so this is a symptom you should always discuss with your doctor. When it’s in the toilet bowl, it becomes a challenge to quantify. But the amount of bleeding is something your doctor may ask you about.
External hemorrhoids are the opposite; they are the ones that hurt, and they don’t tend to bleed. When it becomes “thrombosed,” which means a clot forms within the hemorrhoid, it is often very painful. And the bulge can be felt if you simply touch the outside of the rectum. The inflammation and clot do slowly resolve on its own. However, patients with either type sometimes also report:
- Leaky feces
Diagnosis of Hemorrhoids
Hemorrhoids are diagnosed on a simple exam by your doctor. External hemorrhoids are usually easily visible without the need for any devices. In order to view internal hemorrhoids, however, your doctor may need to insert a hollow tube into the rectum, called an “anoscopy,” to about 4-5 inches deep. Then the anoscopy is slowly withdrawn while the rectum is examined for the presence of internal hemorrhoids.
Hemorrhoids can also be seen and diagnosed on colonoscopy, or via the shorter-spanned flexible sigmoidoscopy that views the second half of the colon. I can tell you that I see a lot of colonoscopy reports with incidentally-found hemorrhoids – in fact, I see it reported much more commonly than not.
So, what can you do to treat hemorrhoids?
Treatment of Hemorrhoids
If they are not bothersome, you don’t need to do a thing. However, if they tend to cause problems, then here are some tips to handle them:
- Prevent Constipation: By far the most common cause of hemorrhoids is constipation. Shoot for stool as soft as toothpaste. The hardened stool, and the straining of constipation, causes hemorrhoids to form and/or become inflamed. Check out my prior article on how to treat constipation.
- Avoid Prolonged Sitting
- Fiber: The average adult requires a minimum of 5 servings of fruits and veggies a day.
- Fluids: Stool requires fluids to pass through more easily.
- Sitz Baths: Epsom salt over-the-counter can be used with warm water several times a day to help soothe and calm down the hemorrhoids.
- Topical Hemorrhoid Creams: These often involve a steroid cream called “hydrocortisone,” that is sold over-the-counter (a classic example is “Preparation-H”). It can be applied like a cream directly on external hemorrhoids, and applied via an inserted applicator for internal ones. If insufficient, there are higher dosed versions that your doctor can prescribe.
- Surgical Procedures: Rubber band ligation is by far the most common procedure I see on hemorrhoids. However, there are other less commonly used methods that involve laser or sclerotherapy (injection of a chemical into the hemorrhoid that destroys the tissue there, similar to varicose vein treatment). Surgery to remove the hemorrhoids are quite rare, and often unnecessary – but a last resort option.
The 8th point would be to avoid pregnancy—because almost all pregnant women eventually develop hemorrhoids, whether it’s during pregnancy or after. However, that would be very silly advice, since hemorrhoids are usually so benign. All in all, hemorrhoids are not serious. However, they can be quite a nuisance for a select few. If they are painful to you, never hesitate to discuss it with your doctor, however.
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.