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Health Tip: Self-Care and Prevention of Hemorrhoids
References have been made to hemorrhoids throughout history, starting with the writings
of the father of modern medicine, Hippocrates.
Some historians even cite painful hemorrhoids as one of the reasons for Napoleon's
defeat at Waterloo.
Even with our advanced knowledge of their causes
and treatment, however, hemorrhoids have continued to plague humans into modern times.
What are hemorrhoids? Hemorrhoids are often referred to as veins in the anal region
that become swollen and inflamed. More accurately, they should be considered to
be "cushions" of tissue within the anal canal that contain muscle, connective tissue,
as well as blood vessels. They are thought to develop as a result of increased pressure
in the lower rectum or anus. This increased pressure causes blood to pool in the
veins, eventually stretching the surrounding tissue forming the hemorrhoid. Hemorrhoids
are of two types--either inside the anus (internal) or under the skin of the anus
(external).
Who gets hemorrhoids? Hemorrhoids are very common, affecting about half
of the population in the U.S. by age 50. A number of factors are related to the
development of hemorrhoids including chronic constipation, prolonged standing or
sitting, pregnancy, aging, diarrhea, and obesity.
How do you know if you have hemorrhoids?
Hemorrhoid symptoms vary somewhat depending on whether the hemorrhoid is internal
or external. Pain is a common feature of external hemorrhoids since they have a
similar type of pain receptors as skin. Internal hemorrhoids, which are further
up in the anal canal lack pain receptors and are usually painless. In either case,
bleeding is often the first sign of a hemorrhoid. Bright red blood may be noticed
on toilet tissue, in the toilet bowl, or on stool. Other signs that a hemorrhoid
may be present include anal itching, pain during bowel movements, or a lump near
the anus. On occasion an internal hemorrhoid may protrude through the anus outside
the body. This is known as a prolapsed hemorrhoid. A blood clot (thrombus) developing
in an external hemorrhoid can result in severe pain, swelling, and inflammation.
How are hemorrhoids diagnosed? By taking a history of symptoms, the doctor may suspect
that a hemorrhoid is present. This impression will need to be confirmed through
an examination. This could include an external inspection of the anal region, a
digital rectal exam to see if the hemorrhoid is internal, and evaluation of the
lower rectum with an instrument known as an anoscope. When bleeding is present,
particularly in those over the age of 50, a more in-depth evaluation of the colon
via sigmoidoscopy or colonoscopy is performed, since the risk of rectal cancer becomes
higher.
Can hemorrhoids be managed at home? Most hemorrhoidal flare-ups can be managed
at home without having to see the doctor. The goals of treatment are to restore
normal bowel habits, relieve pain and itching, and to decrease inflammation. Here
are the most important self-care measures for hemorrhoids:
- Keep stool soft and
bulky. If constipated, taking an OTC stool softener or bulk laxative can help to
soften stool and decrease straining during bowel movements.
- Take OTC pain medicines.
Acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) will temporarily
help with discomfort from hemorrhoids.
- Maintain cleanliness. Use of a proprietary
cleanser like Balneol or premoistened towels (e.g. Tucks) will help with itching
and irritation in the anal region. After cleansing, the area should be patted dry
with a soft, absorbent towel or cloth.
- Try topical treatments. Witch hazel applied
with cotton swabs, OTC steroid creams, anesthetic creams (e.g. Lanacaine), and OTC
hemorrhoid creams, such as Preparation-H can help with pain and itching.
- Apply
ice and/or heat. Some people receive benefit from hemorrhoid discomfort with the
application of ice packs. Others find that application of warm compresses or sitting
in a warm tub of water provides relief.
Can hemorrhoids be prevented? The keys to
preventing hemorrhoids are to avoid constipation, so that stools pass easily, and
to avoid activities that increase pressure on the veins in the lower rectum. Here
are some specific suggestions for preventing hemorrhoids:
- Eat high-fiber foods.
Good sources of fiber are beans, fruits, vegetables, and whole grains.
- Consider
taking a fiber supplement. If a high-fiber diet alone is not enough to produce soft,
bulky stools, a fiber supplement such as psyllium (Metamucil) or methylcellulose
(Citrucel), may be needed.
- Avoid prolonged sitting or standing. If you work a
desk job, get up and walk regularly.
- Drink plenty of fluids, at least eight glasses
per day.
- Practice healthy bowel habits. Go to the bathroom as soon as you have
the urge. Avoid straining during bowel movements. Get off the toilet as soon as
you have finished.
- Exercise regularly. This helps to improve bowel regularity.
- Lift properly. If you must lift heavy objects, avoid holding your breath and straining.
Instead exhale as you lift the object.
When should you call the doctor?
If you are
younger than age 50 and have had previously diagnosed hemorrhoids, self-care measures
are appropriate for a week or so. If you have an undiagnosed anorectal problem it is best to check with the doctor, particularly if the first sign of
a problem is rectal bleeding. This is because colon or rectal cancer can sometimes
present in the same manner as hemorrhoids. If you have known hemorrhoids but your
home treatment has not been effective after a week, you should see your doctor.
Medical attention is usually necessary also for brisk or persistent rectal bleeding,
painful thrombosed hemorrhoids, or for prolapsed hemorrhoids that do not retract
back into the anal canal.
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