Thomas P. Sokol, MD received his medical degree from the University of Health Sciences/The Chicago Medical School in 1980. He went on to his general surgical residency at Harbor/UCLA Medical Center and then to the Carle Clinic/ University of Illinois for Fellowship Training in Colon and Rectal Surgery.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Most individuals who have hemorrhoids discover them in one of several ways. They
either feel the lump of an external hemorrhoid when they wipe themselves after a
bowel movement, note drops of blood in the toilet bowl or on the toilet paper,
or feel a prolapsing hemorrhoid (protruding from the anus) after bowel
movements. Severe anal pain may occur when an external hemorrhoid thromboses, or
a prolapsing internal hemorrhoid becomes gangrenous. Symptoms of anal discomfort
and itching may occur, but anal conditions other than hemorrhoids are more
likely to cause these symptoms than hemorrhoids. (Hemorrhoids often get a "bum
rap" for such symptoms since both hemorrhoids and other anal conditions are
common and may occur together. For example, up to 20% of individuals with
hemorrhoids also have anal fissures.)
By the history of symptoms, the physician can suspect that hemorrhoids are
present. Although the physician should try his or her best to identify the
hemorrhoids, it is perhaps more important to exclude other causes of
hemorrhoid-like symptoms that require different treatment. These other
causes - anal fissures, fistulae, perianal (around the anus) skin diseases,
infections, and tumors - can be diagnosed on the basis of a careful examination
of the anus and anal canal. If necessary, scrapings of the anus to diagnose
infections and biopsies of the perianal skin to diagnose skin diseases can be
done.
External hemorrhoids appear as a bump and/or dark area surrounding the anus. If
the lump is tender, it suggests that the hemorrhoid is thrombosed. Any lump
needs to be carefully followed, however, and should not be assumed to be a
hemorrhoid since there are rare cancers of the perianal area that may masquerade
as external hemorrhoids.
The diagnosis of an internal hemorrhoid is easy if the
hemorrhoid protrudes from the anus. Although a rectal examination with a gloved
finger may uncover an internal hemorrhoid high in the anal canal, the rectal
examination is more helpful in excluding rare cancers that begin in the anal
canal and adjacent rectum. A more thorough examination for internal hemorrhoids
is done visually using an anoscope. An anoscope is a three-inch long, tapering,
metal or clear plastic hollow tube approximately one inch in diameter at its
viewing end. The anoscope is lubricated and inserted into the anus, through the
anal canal, and into the rectum. As the anoscope is withdrawn, the area of the
internal hemorrhoid(s) is well seen. Straining by the patient, as if they are having a
bowel movement, may make the hemorrhoid(s) more prominent. Anoscopy also is a good
way for diagnosing anal fissures.
At times, indirect anoscopy may be helpful. Indirect
anoscopy uses a special mirror for visualizing a patient's anus while the
patient is seated and straining on a toilet. Indirect anoscopy allows the doctor
to see the effects of gravity and straining on the anus. For example, the
physician may be able to determine if what is prolapsing is a hemorrhoid, rectal
lining, a rectal polyp,
or the rectum itself (a condition called procidentia in which the rectum turns
inside out and protrudes from the anus).
Whether or not hemorrhoids are found, if there has been bleeding, the colon above the rectum needs to be
examined to exclude important causes of bleeding other than hemorrhoids. Other
causes include, for example, colon cancer,
polyps,
and colitis (inflammation of the rectum
and/or colon). This examination can be accomplished by either
flexible
sigmoidoscopy or colonoscopy, procedures that
allow the doctor to examine approximately one-third or the entire colon,
respectively.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Constipation is defined medically as fewer than three stools per week and severe constipation as less than one stool per week. Constipation usually is caused by the slow movement of stool through the colon. There are many causes of constipation including medications, poor bowel habits, low fiber diets, abuse of laxatives, hormonal disorders, and diseases primarily of other parts of the body that also affect the colon.
A skin tag is a small benign growth of skin that projects from the surrounding skin. Skin tags can vary in appearance (smooth, irregular, flesh colored, dark pigment, raised). Skin tags generally do not cause symptoms unless repeatedly irritated. Treatment for skin tag varies depending on the location on the body.
Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Causes include everything from irritating foods we eat, to certain disease and infections. Treatment options include local anesthetics, vasoconstrictors, protectants, astringents, antiseptics, keratolytics, analgesics, and corticosteroids. If condition persists, a doctor examination may be needed to identify an underlying cause.
An anal fissure is a small tear or cut in the skin lining of the anus. Pain and/or rectal bleeding during bowel movements are common symptoms of anal fissures. Treatment involves increasing liquid intake, using stool softeners and avoiding foods that may not be well-digested.
Laxatives for treatment of constipation include over-the-counter preparations such as bulk-forming laxatives, stool softeners, lubricant laxatives, stimulant laxatives, saline laxatives, enemas and suppositories. Some over-the-counter laxatives are not recommended for patients with specific diseases or conditions. Some laxatives may have negative adverse effects if taken over long periods of time.
Portal hypertension is most commonly caused by cirrhosis, a disease in which results from scarring of a liver injury. Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from teh liver to the heart, and a parasitic infection called schistosomiasis.
Pregnancy can bring challenges like weight gain, stretch marks, varicose veins, heartburn, constipation, hemorrhoids, problems sleeping, and wondering if it is safe to have sex while pregnant. Learn how to manage and move through these challenges during pregnancy.
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