I know that this is a bit off the topic of colorectal cancer, but it seems important to address this because it so often comes up when someone has blood in the stool (or tissue paper or toilet bowl)…. see also yesterday’s blog topic…   To cover this topic, we again turn the blog over to my colleague, Dr. Schoenecker.…

What is a hemorrhoid?

Hemorrhoids are enlarged cushions above the anus. These cushions are made up of a complex of small arteries and veins which are important in preventing leakage from the anus.  Anatomically there are three.

[Click for Graphic]

What causes a hemorrhoid?

The cause of hemorrhoids is anything that increases intra-abdominal pressure over time such as constipation or diarrhea or obesity or heavy lifting.

Lack of soluble fiber, insufficient water, and straining for a long time on the toilet are major factors in causing hemorrhoids and their complications. Airplane travel can flair hemorrhoids as well. The best advice is to take a fiber supplement for several days prior to the trip, drink lots of water, and avoid alcohol on the plane. Also try to walk about as much as you can on the airplane. This is also important to prevent blood clots in your legs from sitting too long in an uncomfortable seat.

Pregnancy is a good example of a short period of increased pressure, relieved when the baby is delivered and this type of hemorrhoid may resolve on its own.

What’s the big deal?

Hemorrhoids get larger with time and may bleed or itch at the beginning but later may come out transiently or even stay out all the time. Tags can form on the outside and sometimes the hemorrhoids can develop a clot inside (thrombose)  and become very painful. When there are large tags it may be difficult to keep the area clean and there may be a discharge and itching or irritation.

Can my hemorrhoids be treated?

After age 50 half of people will have haemorrhoids but only 1% will need treatment each year.

The best treatment is prevention. Increasing dietary fiber with 2 tablespoons of bran or Psyllium (Metamucil) or flax or Benefiber in addition to 7 to 8 glasses of water per day is very helpful. Avoid obesity and exercise regularly.

Early hemorrhoids usually respond to the above suggestions, plus an over-the-counter hemorrhoid cream helps. Another important suggestion is not spending longer than 2 minutes on the toilet to have a bowel movement. Stop and wait, then go back a few hours later and try again for two minutes.

What if that do-it-at-home stuff doesn’t work?

If hemorrhoids persist specialty care may be needed. The most important issue is to be sure that hemorrhoids are the only problem…other causes such as inflammatory bowel disease, fissure (a tear) or even colon cancer may need to be excluded. 

Laser, injection of sclerosant, infrared, or surgery are available techniques to treat hemorrhoids, but the vast majority can be treated easily by “rubber band ligation.”

Rubber band ligation?

Hemorrhoids can be shrunk by applying an elastic band about an inch above the anus where there is no pain sensation. This restores the cushions to normal size but doesn’t remove them completely. This technique has been around since the 1960’s and recently modified with the O’Regan Ligator. 

A few patients with very advanced hemorrhoids (grade 4) may require surgery because of the large amount of hemorrhoid protruding through the anus.

This entry was posted on Wednesday, March 25th, 2009 at 12:01 am and is filed under Colon Cancer Awareness. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.