Hemorrhoids
Hemorrhoids are abnormally swollen veins in the rectum and anus. They are much like varicose veins you might see on a person's legs. When bulging hemorrhoidal veins are irritated, they cause surrounding membranes to swell, burn, itch, become very painful, and bleed. Hemorrhoids are caused by too much pressure in the rectum, forcing blood to stretch and bulge the walls of the veins, sometimes rupturing them. Listed below are the most frequent causes of hemorrhoids:
- Constant sitting
- Straining with bowel movements (from constipation or hard stools)
- Diarrhea
- Sitting on the toilet for a long time
- Severe coughing
- Childbirth
- Heavy Lifting
here are two kinds of hemorrhoids: internal and external (see diagram).
- Internal hemorrhoids usually don't hurt or itch; you can't feel them because they are deep inside the rectum. Internal hemorrhoids are pretty harmless. But since their bleeding could mask blood from a dangerous source like colorectal cancer, they should be treated.
- External hemorrhoids cause most of the symptoms we commonly hear about --- pain, burning, and itching. If an external hemorrhoid becomes strangulated (cut off from blood supply), a clot can form in it and become an excruciatingly painful thrombosed hemoroid. Because of these unpleasant symptoms, external hemorrhoids get the most treatment attention.
Once the rectal veins have been stretched out and hemorrhoids created, they are difficult to get rid of completely and tend to recur with less straining than it took to cause them in the first place. Fortunately, good habits and simple medical treatment usually control hemorrhoids well, and surgery is only recommended in unusually severe cases.
Avoiding the causes listed in Basics will prevent most cases of hemorrhoids, but this advice is sometimes hard to follow. For example, how can you avoid sitting all day if you have a seated job? And most of us would like to avoid coughing, diarrhea, and childbirth, but that's pretty much impossible, isn't it? Here are some practical hints to help:
- If your main job activity is seated, always stand or walk during your breaks. Make it a point to stand and walk at least 5 minutes every hour and try to shift frequently in your chair to avoid direct rectal pressure.
- Always exhale as you strain or lift. Don't hold your breath.
- Control coughing, diarrhea and constipation with early treatment since hemorrhoids may soon follow.
- Make a rule: No reading or other relaxing activity while on the toilet. If bowel movements take longer than 3-5 minutes, something is wrong. If you want to keep hemorrhoids away, maintaining good bowel habits and softer stools should be your highest priority (see Treatment section).
If these preventive measures fail, you must take action right away! Hemorrhoids are one condition that can be mild in the morning and become intolerable by nightfall.
You must first find the cause of your hemorrhoids and stop it. Treating the hemorrhoids themselves is pointless if you keep re-creating them. Click here to review the causes listed in Basics. You should also read the Self Care Advisory section on constipation, since it's probably the major cause of hemorrhoids.
Once you have eliminated factors causing your hemorrhoids, it's time to treat them. There are two treatment goals: first, take away the symptoms (burning, pain, itching) and second, shrink the hemorrhoids.
- Sitz baths (soaking the rectal area in hot water, in a shallow bath) for 15-20 minutes, 3-4 times/day are a simple and effective treatment for both goals.
- Pain medicine should be used for aching, but burning and itching respond best to surface-acting creams and suppositories found in the Recommended Products section.
- To shrink your hemorrhoids back down to normal size, topical medications are again useful.
- Cleanse the entire rectal area with warm water after each bowel movement, and use a bulk fiber laxative to soften stools. This helps eliminate straining with bowel movements.
- Many people use bulk fiber supplements daily to prevent recurrences of hemorrhoids. But remember, bulk fiber may take several days to work. If you have existing hemorrhoids and hard stools are already present, you may want to use an immediate-acting stool softener and laxative to encourage elimination without straining and further aggravating your hemorrhoids.
- Hemorrhoid Dx is an interesting new product that we have discovered. It is a natural hemorrhoids treatment that can help reduce flareups and alleviate painful symptoms. Other treatments include:
- Aleve (naproxen sodium 220 mg). Use this quick acting anti-inflammatory for the aching discomfort of severe hemorrhoidal flare ups.
- Anusol HC cream (hydrocortisone 1%). For swollen external hemorrhoids, brands containing hydrocortisone such as this one are effective at reducing the swelling, burning, and itching sensations.
- Anusol HC suppositories (hydrocortisone 1%). These hydrocortisone suppositories should be used for internal swelling and discomfort.
- Citrucel (methycellulose 2 grams/tbs.). Softening stools and treating constipation are crucial aspects of treating your hemorrhoids. Many find this brand of bulk fiber laxative to be less gritty than others, and it comes in both sugared and sugar-free versions.
- Senokot, Senokot S (senna concentrate, various concentrations; docusate sodium 50 mg per tablet is the softener in Senokot S). The active ingredient senna is a bowel contraction stimulant. If you desire stool softening or lubrication along with the stimulant effect, Senakot S is the recommended combination.
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