Hemorrhoids

Defining Hemorrhoids

Constipation can lead to hemorrhoids.
Constipation can lead to hemorrhoids. coloroftime/Getty Images

Medical Specialties: Family practice, Internal medicine, Surgery

Clinical Definition: Hemorrhoids are dilated vascular structures located beneath the rectal mucosa. Hemorrhoids may develop outside of the external anal sphincter or inside the anal canal. Hemorrhoids are often due to increased pressure on the anorectal area; increased pressure may be due to constipation and straining during bowel movements.

In Our Own Words: Very common among people in the 45 – 65 age group, hemorrhoids are enlarged veins in or around the anus. They are often harmless except for the itching and perhaps some bright red blood on the toilet paper, but they can be the source of a variety of problems.

Similar to varicose veins, hemorrhoids often occur because of an increase in pressure on the blood vessels. Straining during a bowel movement, which is often due to constipation, can cause increased pressure. The increased pressure causes the veins to swell and stretch, which leads to hemorrhoids. Hemorrhoids can develop externally, occurring under the skin around the anus. Hemorrhoids can also develop internally, inside the anus.

Treatment for Hemorrhoids

More than one million people in Western countries have hemorrhoids. Hemorrhoids are more common in the Western world than they are in many developing countries because Westerners typically consume high-fat and low-fiber diets, which result in constipation and straining.

Any mass affecting your rectum or anus should be checked out by a physician. Please understand that bleeding from a mass thought to be hemorrhoid could also, more rarely, be due to colorectal cancer. If you have hemorrhoids, in addition to getting treatment for this condition, it's also a good idea to get a colonoscopy, too--especially if you're older.

Mild cases of hemorrhoids can be treated with conservative (nonsurgical measures), including the following:

  • increased dietary fiber
  • increased fluid intake
  • stool softeners
  • warm (Sitz) baths
  • analgesia or pain relief

Hemorrhoids can be cured with surgery. There are different surgeries that can be done to remove hemorrhoids.

First, if you present with a (very painful) thrombosed hemorrhoid, which means that there's a clot in your hemorrhoid that causes it to appear purplish and engorged, you need to have this hemorrhoid taken out. Typically, a surgeon will quickly do this surgery, within 72 hours.

Second, your physician may choose to band your hemorrhoid in the office. Banding, or sclerotherapy, involves placing a band around the hemorrhoid and choking off the blood supply so that the hemorrhoid necrotizes or dies.

Severe hemorrhoids can be removed in the operating room by means of various surgical procedures, including transhemorrhoidal dearterialization (THD), stapled hemorrhoidectomy or excisional hemorrhoidectomy.

All these surgeries have high cure rates.

It should be noted that many people who undergo hemorrhoid surgery experience much pain, discomfort and other complications after the surgery. In fact, satisfaction rates with hemorrhoid surgery tend to be lower than other types of surgery.

Sources:

The Merck Manual. “Hemorrhoids.” Last review/revision July 2012. Accessed November 2013.

The Ohio State University Wexner Medical Center. “Hemorrhoids.” Accessed November 2013.

Harvard Medical Center. “Hemorrhoids and What to do About Them.” Accessed November 2013.

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