A good bowel movement should be a relaxing affair, with little straining and a satisfying outcome. Seeing blood in your stool or experiencing itching and burning when you wipe is hardly going to contribute to a positive experience. For many older Americans, blood in the stool and discomfort, pain or itchiness around the anus are signs of a very common condition called hemorrhoids.
What Are Hemorrhoids?
Hemorrhoids are swollen blood vessels in or near your lower rectum or anus. These veins are similar to varicose veins that appear on the legs. Hemorrhoids can occur outside the anus, inside the rectum, or may straddle the line between internal and external.
Itching, burning, and pain are all common external hemorrhoid symptoms, particularly with external hemorrhoids as the blood vessels are close enough to the skin to have sensory nerves attached. Internal hemorrhoids are not typically painful, though they can rupture, leaving blood in your stool or visible on toilet paper after you wipe.
Typically, the irritation and discomfort associated with external hemorrhoids comes on slowly over time, and can be treated at home. In cases where a blood clot forms inside a hemorrhoid, pain may be more sudden and severe and medical treatment may be necessary.
Unless there are complications or other medical reasons not to do so (like being on blood thinner), your doctor will likely recommend one of a few simple, minimally invasive procedures, such as a rubber band ligation, during an office visit. In a rubber band ligation, a small rubber band is placed over the base of the hemorrhoid to cut off blood flow. The hemorrhoid will form a blood clot that will eventually be absorbed by the body. At GI Associates, we use the CRH O’Regan System®, which is more than 99% effective in treating hemorrhoids.
If your hemorrhoids are recurring, even after conservative treatment or a minimally invasive procedure, your doctor may recommend a more advanced course of action. In some cases, this means removing the hemorrhoid entirely with a hemorrhoidectomy. Other options include stapling the affected tissue during a hemorrhoidopexy, or performing a sclerotherapy, which seals the vein.
What Causes Hemorrhoids?
Hemorrhoids are relatively common, with the majority of American adults developing them at some point in their lives. Not everyone who has hemorrhoids will have symptoms, and for many who do, home remedies are usually sufficient to bring relief. There are some cases, however, when medical intervention is necessary. If you have internal hemorrhoids or hemorrhoids that have prolapsed through the anus, an in-office treatment or surgery may be necessary.
Several lifestyle and health factors can increase your risk of hemorrhoids. Sitting for long periods on the toilet or straining during a bowel movement are common contributing factors. The amount of fiber in your diet can also play a part, as the volume and consistency of your stool can affect the amount of stress on the rectum and anal sphincter. Chronic diarrhea or constipation are also potential risk factors in the formation of hemorrhoids.
Non-digestive causes of hemorrhoids include pregnancy, obesity, and anal intercourse. Heavy lifting, either for work or just working out, can also cause muscle strain that contributes to hemorrhoids. In addition to these causes, simply growing older will increase your chances of getting hemorrhoids. As you age, tissues in the body start to stretch and weaken, and the tissues supporting your anus are no exception.
Home Remedies for Hemorrhoids
Whether your hemorrhoids are an ongoing concern or you are experiencing them for the first time, it is good to know there are many home remedies available to provide relief. If the pain and inconvenience of hemorrhoids persist, you need to ask your doctor about hemorrhoid treatment; there are procedures available that are typically less involved than you might think.
Changing your bowel and digestive habits will be an important part of managing your symptoms. Avoid long periods of sitting on the toilet, which can interrupt blood supply and increase pressure on the blood vessels around the anus. Similarly, not straining during bowel movements will reduce pressure in the anal canal.
Going to the bathroom when you feel the urge is also helpful. Waiting until the urge passes will only make it harder to pass stool, which leads to greater stress on the anus as well as a tendency to strain more during a bowel movement.
If you are suffering from constipation, you may need to add fiber to your diet or use stool softeners to maintain a regular bowel habit. By working to keep your stool soft, you will reduce the pressure on the anus and lower rectum while passing stool. Eating certain vegetables, fruits, beans, and other high fiber foods can make passing stool easier. Switching from baked goods made with bleached flour to whole grain breads and pastas can also add fiber to your diet.
If simple changes to your diet are not having an effect, you may want to consider taking a fiber supplement to increase your level of dietary fiber. When adding fiber to your diet, do it slowly. Adding too much fiber to your diet too soon can cause an increase of bloating and gas that may add to your discomfort. Steadily working up to around 25-30 grams of fiber a day will help your digestive system adjust to your changing diet.
There are numerous over-the-counter options such as psyllium or methylcellulose that can improve the quality and volume of your stool. Make sure you drink plenty of fluids to help keep your bowel movements regular. Appropriate fluid intake is particularly important if you are taking a fiber supplement, as taking supplements without proper hydration can lead to constipation rather than preventing it.
Exercise is one of the most important things you can do to maintain your overall health, and it provides benefits in avoiding hemorrhoids as well. Keeping your abdominal muscle tone high, improving circulation, and keeping excess weight off all help to prevent hemorrhoids. Even brisk walking for as little as 20 minutes a day may help. Regular movement throughout the day to break up long periods of standing or sitting also helps to reduce the pressure on blood vessels in the rectum and near the anus.
Common over-the-counter pain medications such as ibuprofen or acetaminophen (Tylenol) can be taken to relieve the pain associated with hemorrhoids. Ibuprofen also has a benefit of being an anti-inflammatory drug, which can help reduce swelling. You should use caution with both of these drugs, as taking too much can have damaging effects on your health. If your pain is too severe to be managed by recommended doses of these pain killers, talk to your doctor.
Witch Hazel and Aloe Vera
For external hemorrhoids, products that reduce the itching and burning sensations can be a huge relief. Some remedies such as witch hazel and aloe vera are not scientifically validated, but have long been used to relieve hemorrhoid symptoms. Neither of these will be effective in reducing blood clots or fixing internal hemorrhoids, so it is important to match the treatment to your symptoms. Blood in the stool without any external discomfort is associated with internal hemorrhoids or possibly more serious digestive conditions like colorectal cancer. Never ignore blood in the stool, but instead, speak to your doctor.
Several over-the-counter creams and ointments are widely available, and can provide fast relief. Preparation H and other creams are applied directly to the affected area, and are used to soothe itching, burning, and other symptoms. Creams, suppositories, and pads containing lidocaine or hydrocortisone are also available. If you are using any topical medication that contains steroids, do not use it for more than one week, as prolonged use may cause skin irritation.
The swelling and irritation associated with hemorrhoids can be reduced by applying ice packs or a cold compress to the anal region. Icing the area will help reduce symptoms, but should not be used for too long. You should also be sure never to apply ice directly to the skin. Insulate your skin by wrapping the ice pack or compress with a paper towel or thin cloth before use.
The sitz bath is one of the most common remedies for hemorrhoids. From “sitzen,” the German word for “sit,” a sitz bath is a shallow bath of warm water intended to relieve pressure and relax the anal canal and sphincter. With water just deep enough for your buttocks, you can take a sitz bath in a small plastic tub placed over a toilet seat, or by sitting in a few inches of warm water in a bathtub.
Taking a sitz bath for 20 minutes or so following each bowel movement, or at regular intervals throughout the day, can relieve a wide variety of symptoms of external hemorrhoids. Be sure to gently and thoroughly dry yourself off afterwards. It will also help to pat, rather than rub or wipe, the anal area to prevent further irritation.
Toilet paper can often be rough and abrasive. This may not bother you normally, but during a hemorrhoid flare-up, wiping can be uncomfortable. Soothing wipes are a great alternative that can keep you clean while providing soothing relief. Some wipes also contain aloe or witch hazel to relieve itching and burning. Use care in selecting you wipes, though, as some contain perfumes and alcohol that can further irritate your skin instead of helping you heal.
Wearing loose, breathable clothing can also help relieve symptoms. Breathable cotton underwear instead of tight-fitting polyester is often recommended. As with wipes, removing dyes or perfumes from your detergent will also help reduce irritation.
Surgical Procedures For Hemorrhoids
Some hemorrhoids resolve without treatment at all, while others may require medical treatment. This is particularly true if your hemorrhoids are recurrent, meaning they return after conservative treatment.
Fortunately, even if your doctor determines treatment is necessary, many different procedures can be done in an office visit and do not require a separate surgery or anesthesia. Even if your case requires surgical treatment, most options are minimally invasive.
After a physical exam, your doctor will make a decision about what treatment may be necessary based on the location and severity of your hemorrhoids. If you have internal hemorrhoids, a colonoscopy may also be required. There might also be complications and risks to assess, such as whether you are taking a blood thinner or may be at risk for sepsis, which can be a risk with procedures like a hemorrhoidopexy.
In a hemorrhoidectomy, the bulging or prolapsed vein is removed to prevent further bleeding and discomfort. A hemorrhoidectomy can be performed to mitigate both internal and external hemorrhoids. Typically, anesthesia is required for the surgery, though you will typically be released that day.
In a hemorrhoidopexy or a sclerotherapy, the vein is left in place. Rather than removing it, the vein is fixed in place or sealed, depending on the procedure. Doctors typically only recommend these kinds of operations if your hemorrhoids have not responded to conservative treatment.
When to Talk to Your Doctor
Hemorrhoids are not typically dangerous, though they can be very uncomfortable. The real danger comes from your hemorrhoids masking other health conditions. Rectal bleeding can be caused by many different diseases, some of which are very serious or even deadly. Both colorectal and anal cancer can be life-threatening, and can produce rectal bleeding. Assuming that blood in your stool is simply due to your hemorrhoids could prevent a more serious disease from being diagnosed.
Take your symptoms into consideration. If you are also experiencing a noteworthy change in the color or consistency of your stool, as well as blood appearing in the stool, it may be time to talk to your doctor. If you are over the age of 45 and could be at risk for colorectal cancer, you should definitely consult with your physician rather than relying solely on home treatment of hemorrhoids. Whatever your age or risk factors, use common sense. If you are losing significant amounts of blood in your stool, and experiencing lightheadedness or dizziness, seek medical attention immediately.
If you have any questions about your current symptoms, or if your hemorrhoid symptoms are worsening or changing, contact GI Associates today to set up an appointment.