Hemorrhoids

Hemorrhoids

Definition

Hemorrhoids are swollen blood vessels that are found in and around the anus and lower rectum. They can be internal, which means inside the anus. Or, they may be external, which means they are found outside the anus.

What is going on in the body?

The blood vessels around the anus swell and may bleed or cause other symptoms. The exact cause of hemorrhoids is not always clear.

Risks

What are the causes and risks of the condition?

Hemorrhoids are dilated blood vessels, but the reasons why they occur are not always clear. Some types of hemorrhoids run in families.
Other factors that increase a person's risk for hemorrhoids include:
  • alcoholism
  • anal intercourse
  • chronic diarrhea
  • cancer of the rectum or colon
  • a diet that lacks fiber
  • frequent coughing and sneezing
  • liver disease, such as cirrhosis
  • loss of muscle tone in the rectum due to aging and rectal surgery
  • obesity
  • jobs that require standing or sitting for long periods of time
  • pregnancy
  • straining due to constipation

Prevention

What can be done to prevent the condition?

One of the best ways to avoid hemorrhoids is to prevent the pressure and straining that come from constipation.
The following actions can reduce the impact of hemorrhoids:
  • avoiding sitting in one place for long periods of time
  • drinking six to eight glasses of fluid each day
  • eating a diet high in fiber
  • exercising regularly
  • limiting the time one spends on the toilet
  • maintaining a healthy body weight
Many times, hemorrhoids are related to liver disease caused by alcohol abuse. It is important to drink alcohol only in moderation if at all.

Diagnosed

How is the condition diagnosed?

To diagnose hemorrhoids, the healthcare professional will start with a medical history and physical exam. As part of the exam, he or she will feel for internal hemorrhoids by inserting a lubricated finger into the rectum. This is called a digital rectal exam.
Sometimes a hollow, lighted tube called an anoscope is used to view internal hemorrhoids.
To rule out other disorders, the healthcare professional may order a sigmoidoscopy or proctoscopy. These tests also use a lighted tube, but look further inside the bowel than the rectum. Blood tests may also be needed.

Long Term Effects

What are the long-term effects of the condition?

If hemorrhoids are not effectively treated, they tend to worsen and infections may develop as a result. An anorectal abscess or anal fissure could result. A person may also lose the ability to control his or her bowel movements. If bleeding continues, a low red blood cell count, called anemia, can develop.

Other Risks

What are the risks to others?

Hemorrhoids are not contagious and pose no risk to others.

Treatments

What are the treatments for the condition?

Many times hemorrhoids resolve without any type of treatment.
The following measures can help to ease pain, decrease swelling, and regulate bowel movements:
  • over-the-counter hemorrhoidal creams, lotions, or suppositories to relieve pain
  • ice packs to reduce the swelling
  • stool softeners or laxatives to prevent constipation
  • sitting in a warm tub or sitz bath three to four times a day
If hemorrhoids are severe or treatment is not effective, the healthcare professional may recommend hemorrhoid surgery. A variety of procedures can be used to remove hemorrhoids or reduce their size.

Side Effects

What are the side effects of the treatments?

Medicines used to treat hemorrhoids may cause allergic reactions. Surgery can be complicated by bleeding, infection, or allergic reaction to the anesthetic.

After Treatment

What happens after treatment for the condition?

Symptoms may subside for a time if you prevent straining during a bowel movement. However, flare-ups of hemorrhoids are common. Hemorrhoid surgery may provide a permanent cure for the problem.

Monitor

How is the condition monitored?

The healthcare professional will check for further problems by doing a digital exam during a regular check-up. Any new or worsening symptoms should be reported.

Sources

Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998.

Griffith, H. Winter. Instructions for Patients. Philadelphia:W.B. Saunders Company,1994.

NIH Publication No. 95-3021, National Digestive Disease Information Clearinghouse, 2 Information Way, Bethesda, MD 20892

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