Medical Mondays „ News Notes
TOPIC: Understanding Hemorrhoids
Dr. Susan Briley, Colorectal Surgeon
Dr. Bill Harb, Colorectal Surgeon
Monday, March 12, 2012
News notes via www.webmd.com
Not all rectal bleeding is caused by Hemorrhoids or Diarrhea—THERE ARE OTHER CAUSES.
Rectal bleeding (blood in stool) is a symptom of a problem, usually something that can be controlled. Hemorrhoids or diarrhea sometimes can cause bloody stool. Other possible causes include GERD, stomach ulcers, colon polyps, infections, Crohn's disease, and many others. Rectal bleeding should be evaluated by your doctor to determine the cause and treatments.
Understanding Hemorrhoids -- Diagnosis and Treatment
How Do I Know if I Have Hemorrhoids?
First, your doctor will look at the anal area, perhaps by inserting a lubricated gloved finger or an anoscope (a hollow, lighted tube for viewing the lower few inches of the rectum) or a proctoscope (which works like an anoscope, but provides a more thorough rectal exam).
What Are the Treatments for Hemorrhoids?
Once you develop hemorrhoids, they don't usually go away completely unless you undergo one of the procedures below. They can get better, however, so that living with them is tolerable. Both conventional and alternative practitioners consider diet the best treatment for hemorrhoids. A diet rich in high-fiber foods and low in processed foods is essential. Increasing fluid intake to six to eight eight-ounce glasses a day also is important. Probably half of all hemorrhoid sufferers find relief with dietary changes alone.
Most hemorrhoid treatments aim to minimize pain and itching. Warm (but not hot) sitz baths are the most time-honored and oft-suggested therapy: Sit in about three inches of warm water for 15 minutes, several times a day, especially after a bowel movement. If you are pregnant, discuss any treatment, including dietary changes, with your doctor before proceeding.
If you have been diagnosed with hemorrhoids, a high-fiber diet combined with sitz baths and acetaminophen should reduce discomfort within two weeks. If symptoms persist, your physician may suggest one of the following procedures. Many can be performed in your doctor's office.
Injection. An internal hemorrhoid can be injected with a solution which creates a scar and closes off the hemorrhoid. The injection hurts only a little, as any injection does.
Banding. Prolapsed hemorrhoids are often removed using rubber-band ligation. A special tool secures a tiny rubber band around the hemorrhoid, shutting off its blood supply almost instantly. Within a week, the hemorrhoid shrivels and falls off.
Coagulation or cauterization. Using either an electric probe, a laser beam, or an infrared light, a tiny burn painlessly seals the end of the hemorrhoid, causing it to close off and shrink. This is most useful for prolapsed hemorrhoids.
Surgery. For large internal hemorrhoids or extremely uncomfortable external hemorrhoids (such as thrombosed hemorrhoids that are too painful to live with), your doctor may elect traditional surgery, called hemorrhoidectomy.
The success rate for hemorrhoid removal approaches 95%, but unless dietary and lifestyle changes are made, hemorrhoids may recur.
Nutrition and Diet
Prevent constipation by following a high-fiber diet. Meals and snacks should consist primarily of vegetables, fruit, nuts, and whole grains, and as few processed foods and meats as possible. If this is a big change for you, introduce the new foods slowly, to avoid gas.
If you aren't able to eat enough high-fiber food, supplement your diet with stool softeners or bulk-forming agents, such as fiber supplements. (Avoid laxatives, which may cause diarrhea that can further irritate the swollen veins.)
Drink at least eight glasses of water each day; if your life is especially active or you live in a hot climate, you will need more.
Monitor your sodium intake. Excess salt in the diet causes fluid retention, which means swelling in all veins, including hemorrhoids.
Hemorrhoid Home Remedies
How Can I Prevent Hemorrhoids?
A healthful diet and lifestyle are good insurance for preventing hemorrhoids, whether you already suffer hemorrhoid symptoms or are intent on preventing them. Regular exercise also is important, especially if you work a sedentary job. Exercise helps in several ways: keeping weight in check, making constipation less likely, and enhancing muscle tone.
Healthy bowel habits also help prevent hemorrhoids. Use the toilet as soon as you feel the urge to do so. Also, avoid sitting on the toilet for prolonged periods (more than five minutes) and avoid straining during a bowel movement.
In many cases, hemorrhoids can be treated effectively with diet, good hygiene, and topicalmedications. In some cases, though, diet and drugs are not enough. People who do not respond to non-surgical treatments might experience long-term relief through surgery.
Types of Hemorrhoid Surgery
Surgery should be considered for people with large hemorrhoids that are very painful or bleeding. Here are the options:
Surgery to remove hemorrhoids is called hemorrhoidectomy. During hemorrhoidectomy, the doctor makes incisions around the anus to cut away the hemorrhoids. People undergoing the procedure may be given local anesthesia (the patient is awake though relaxed during the procedure but the area being operated on is made numb) or general anesthesia (the patient is put to sleep during the procedure).
Hemorrhoidectomy is generally an outpatient procedure, and patients usually go home the same day.
While surgery usually relieves the pain, swelling, bleeding, and itching caused by hemorrhoids, a drawback to this procedure is that the incisions are made in a highly sensitive area and might require stitches, which can cause the area to be tender and painful.
The Procedure for Prolapse and Hemorrhoids (PPH)
PPH is a minimally invasive procedure to treat hemorrhoids and/or prolapse, a condition in which the hemorrhoids or anal tissue slips down out of the anal canal. During PPH, a stapler-like device is used to reposition the hemorrhoids and cut off their blood supply. Without blood, the hemorrhoids eventually shrivel and die. This procedure moves the hemorrhoid higher in the anus, where there are fewer nerve endings, thus reducing pain.
Benefits of PPH include:
Other Options for Hemorrhoids
Other minimally invasive options for reducing the size of or removing hemorrhoids include:
Although these minimally invasive procedures might result in less pain and fewer complications, hemorrhoidectomy might provide better long-term results. Talk to your doctor to see which procedure is right for you.
What Are the Risks of Hemorrhoid Surgery?
Hemorrhoid surgery is very common and is considered safe. However, every surgery has some risks including:
In addition, patients might have some trouble urinating because the pain following surgery makes it difficult to relax and allow urine to flow. Further, the anal sphincter might be damaged during surgery, which can lead to pain and/or fecal incontinence. Fecal incontinence is the inability to control your bowels, which can lead to the involuntary release of feces or gas.
Treating Pain After Hemorrhoid Surgery
Pain is the most common complaint after surgery, especially during bowel movements. Pain medication -- including over-the-counter acetaminophen (such as Tylenol) and/or ibuprofen (such as Advil or Motrin) -- can help provide pain relief. Do not take any new medication without your doctor's approval. Soaking in a warm bath might also help reduce pain. Taking stool softeners can make it easier to move your bowels, which helps prevent straining and constipation. Straining to have a bowel movement can lead to a recurrence of hemorrhoids.
In most cases, recovery takes about two weeks following hemorrhoidectomy. In some cases, it can take as long as three to six weeks to make a full recovery.
How Effective Is Hemorrhoid Surgery?
Hemorrhoid surgery is effective in most cases. However, it's important to eat a high-fiber diet, maintain good hygiene, and avoid becoming constipated, which can cause new hemorrhoids to form.
When to Call the Doctor About Hemorrhoids: If you have hemorrhoids, call the doctor immediately if you experience any of the following: Considerable bleeding, inability to urinate, fever, inability to have a bowel movement
How Can I Prevent Hemorrhoids From Reoccurring?
The best way to prevent hemorrhoids is to keep your stools soft so they are easy to pass and don't require straining. Eating a high-fiber diet and drinking plenty of fluids (six to eight glasses each day) can help you stay regular and your stools soft, and may reduce constipation and the need to strain on the toilet, lowering your risk of developing new hemorrhoids.
An over-the-counter fiber supplement (such as Citrucel or Metamucil) will add bulk to the stool and can also help prevent hemorrhoids from coming back. Ask your doctor about including this in your regimen.