There are some medical conditions we go through in life that we don’t mind sharing about with our family and friends, like having a cavity, a migraine, or even being a little gassy (okay - that’s pushing it a little!). There are others, though, where the mere thought of this condition and where it brings the suffering incites enormous amounts of embarrassment and ultimately silence from the afflicted. In reality, though, these painful little guys are much more common than we think. Why would we know that when no one talks about them? Well, that’s a great point, and we wouldn’t. But, and no pun intended, chances are you’ve had one (we’re looking at you!), and if you haven’t, statistics show that you’ll perform a google search - standing up - at some point in your life in search of how to deal with and treat hemorrhoids.
What is a Hemorrhoid?
Hemorrhoids are clumps of tissue with tiny veins that have become swollen and inflamed near your lower rectum or anus. They are largely similar to varicose veins that appear on the legs. There are two different types of these painful little piles, external hemorrhoids and internal hemorrhoids.
What are External Hemorrhoids
External hemorrhoids get their name from where they are found near the anus or lower rectum. They are the more obvious affliction and appear under the skin on the outside of the anus. This type of hemorrhoid typically becomes itchy, feels hard and lumpy, and often becomes painful or extremely uncomfortable, especially when sitting. If a blood clot forms inside the hemorrhoid, a person can experience sharp and severe pain. Ultimately, the clot will dissolve over time, but can leave a reminder it was there in the form of excess skin or a skin tag. External hemorrhoids usually form due to excess straining (like when one is constipated or even happens to women who are pregnant) or when one sits on the toilet for too long.
What are Internal Hemorrhoids
Internal hemorrhoids, on the other hand, occur inside the rectum, so far in fact that you usually can’t feel or see them. These are mostly painless even when they cause bleeding. This bleeding can be minimal and seen on toilet paper when wiping after a bowel movement or as significant as a slow dripping from your anus into the toilet. Sometimes, a prolapse can occur. This happens when the hemorrhoid inside the anus begins to protrude outside of the anus. If they don’t go back in on their own, they can often be softly pushed back inside.
How to Treat Hemorrhoids
Hemorrhoids, while being an extremely painful and uncomfortable condition, is normally a treatable condition that subsides within a week or two after they are first noticed. There are some treatments that help deal with the conditions and even help get rid of them more quickly.
Topical Relief
There are many over the counter creams and ointments available, and these often 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.
Cold Compress
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.
Sitz Bath
The sitz bath comes from 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.
Wet Wipes
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.
Clothing
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.
Managing the Pain from Hemorrhoids
As many of you know, hemorrhoids can be very painful. In most cases, 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. As always, one 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.
Advanced Treatment for Hemorrhoids
Even with the treatments listed above, there are some situations that may require medical treatment - especially if your hemorrhoids are recurrent!
Fortunately, even if your doctor determines treatment is necessary, you have many options, as there are several procedures that can be done in an office visit that 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 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.
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.
Hemorrhoids are ‘small’ conditions that can create large problems for many different Americans. While the pain and uncomfortability can be substantial, there are treatment options available if you are dealing with them or if you have continually suffered from them for many years as they come and go as they seemingly please. If you are suffering from hemorrhoids, or believe you may have an internal hemorrhoid, please contact our office as soon as you can. We are committed to your gastrointestinal health, and we want to help you make sure things are ‘smooth’ from start to finish in regards to your digestive tract.
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