What is a hemorrhoid?
A hemorrhoid is a term to refer to the veins inside or outside the rectum/anus that become swollen, inflamed or irritated. Another term for it is a varicose vein of the rectum/anus. They are often exacerbated by increased pressure within the rectal vault, leading to increased pressure of the rectal/anal veins. Although many people with these have no symptoms at all, many others suffer from severe symptoms, including rectal pain and bleeding. In general, aside from the discomfort one may encounter from hemorrhoids, they are benign and not going to harm you. That being said, it is very important to discuss your symptoms with a healthcare provider to be sure that you do not have something more serious, like colorectal cancer.
Who is at risk?
Anything that puts added pressure on your rectum could put you at risk:
- Pregnancy
- Obesity
- Chronic constipation or diarrhea
- Straining to move bowels
- Sitting or standing for long periods of time
- Anal intercourse
- Other factors include:
- Poor dietary habits: low fiber, high fat intake
- Cirrhosis of the liver
- Age
- Family history of hemorrhoids
- Other varicose veins in the body
What are the symptoms of external hemorrhoids?
- Bright red blood with bowel movements, either on the toilet paper, on the surface of the stool, or in the toilet
- Anal itching
- A lump outside the anus that may become larger with increased pressure
- A hard lump outside the anus that causes a lot of pain in the rectal area, or even in your legs, is often a clot that has developed within the hemorrhoid. It is called a thrombosed hemorrhoid.
How are external hemorrhoids diagnosed?
A visit to your healthcare provider is very important if you are suffering from the above symptoms. The provider will perform a targeted history and physical. During the history, be prepared to discuss what your symptoms are, when they began, what have you done to make them better (or worse), how long do the symptoms last. In addition, you may be asked to describe your eating and exercising habits, as this may greatly effect the development and treatment of hemorrhoids. Your sexual habits may also be discussed. For the physical exam, be prepared for the provider to examine your anal area, by first doing a visual exam of the external area, and then an internal exam to be sure there is nothing more serious going on.
What is the treatment for external hemorrhoids?
The treatment for external hemorrhoids depends on the severity of the symptoms and the size of the hemorrhoids:
- Local over the counter creams and lotions to sooth itching and irritation
- Sitting in a warm bathtub or sitz bath several times a day to sooth the area
- Ice packs
- Dietary changes such as increased fiber, decreased fat, increased fluid intake such as water
- Stool softeners
- Surgical procedures may be a last resort for some patients. The surgery may be as minor as an office visit to lance and remove the clot (thrombosed hemorrhoid) or more involved such as banding or even surgically removing the hemorrhoid if very severe.
How do you prevent external hemorrhoids?
Eat a well balanced diet with high fiber and low fat intake
Drink 8-10 glasses of water daily
Exercise
Avoid sitting or standing for long periods of time
Avoid straining with bowel movements
Use stool softeners for chronic constipation
What else should I know?
It is always important to be evaluated by a healthcare provider with rectal pain, bleeding and irritation. Although external hemorrhoids can be quite bothersome and problematic for many patients, there are also many who are able to control the symptoms and live a happy and fulfilling life. A few lifestyle changes may make the world of difference for hemorrhoid sufferers.
If you are suffering with pain and are embarrassed to see your healthcare provider, just remember, this is what they do for a living. They understand that it may be embarrassing for you, the patient, but as trained professionals, they can help you relieve the suffering.
