Hemorrhoids, some you can live with, some you can’t

Hemorrhoids (also called piles) develop in about 3 out of 4 Americans
sometime in their life. They’re most common in middle age and later. All of us
have “hemorrhoids-in-waiting” because we all have clusters of veins that lie
just beneath the membranes of the lower rectum and the anus. Like varicose veins
in our legs, veins in the anorectal area may become enlarged and inflamed.
Excess pressure can cause blood to pool in the area. Such pressure can come from

• chronic constipation and straining to defecate
• frequent diarrhea
• prolonged periods of sitting
• pregnancy and labor (which place pressure on the lower abdomen)
• overweight and/or a sedentary lifestyle.

The ins and outs of hemorrhoids

Hemorrhoids may be either internal (in the lower rectum) or external (under
the skin around the anus). With external hemorrhoids, the skin can become
irritated, making sitting uncomfortable. If a blood clot develops within an
external hemorrhoid, you may experience sudden severe pain. Internal
hemorrhoids, on the other hand, tend not to produce symptoms. However, you may
see bright red blood on toilet paper or in the toilet bowl after a bowel
movement. Internal hemorrhoids can also prolapse, or protrude down through the
anus. When mucus and stool particles attach to these hemorrhoids, they may
become irritated and itchy.

Taking care

Most of the time hemorrhoids don’t require medical treatment. The following
are steps you can take to relieve discomfort as well as prevent existing
hemorrhoids from becoming more troublesome.

• Avoid becoming constipated. Add more fiber to your diet to soften stool and
  make it easier to pass. Good sources of fiber are fruits, vegetables, and
  whole-grain foods. Fiber supplements may also be helpful. In addition, drink
  plenty of fluids.
• Don’t strain to move your bowels; go to the toilet only when you feel the
  urge. But, try to set aside a certain time each day for bowel movements (called
  “good” bowel habits).
• Engage in physical activity such as brisk walking for half an hour or so
  daily to stimulate intestinal muscle.
• Use wet tissue or premoistened wipes to keep the anal area clean.
• Sit on a cushion rather than a chair with a hard seat.
• To help relieve irritation and itching, take sitz baths—sit in a few inches
  of warm water. Cold compresses or ice packs also may help.
• Try topical preparations such as those containing zinc oxide, petroleum
  jelly, or hydrocortisone cream (0.5% strength) to make bowel movements easier
  and relieve itching. Witch-hazel compresses or products made specifically for
  hemorrhoids may also help.

When to seek medical attention

If hemorrhoids cause substantial pain or throbbing, or produce bleeding
that’s not associated with a bowel movement, see a doctor. The bleeding may be
caused by an abscess (accumulation of pus), anal fissure (ulcer), polyps, or a
tumor. Throbbing generally indicates that a blood clot has formed.

Among the measures a doctor may use is sclerotherapy. It
involves injecting hemorrhoids with a substance that turns them into scar
tissue. Other procedures that work on the same principle use a laser, or tissue
may be frozen.

Probably the most commonly used technique, however, is rubber band
ligation. The doctor places a small elastic band around the hemorrhoid’s
base. It cuts off the blood supply, causing the hemorrhoid to shrink and
eventually wither away. It may take as many as 4 sessions to eliminate the
hemorrhoids.

For hemorrhoids that persist and are large and protruding or that cause
severe symptoms, hemorrhoidectomy is usually a permanent solution.
The inflamed veins are removed. This surgery requires general anesthesia, and it
can be quite painful for some time following the procedure. A newer approach,
called stapled hemorrhoidopexy, uses a stapling device on tissue to
reduce the hemorrhoids’ blood supply. This method also requires general
anesthesia, but it is less painful and recovery is more rapid.