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.
It is believed generally that
constipation and straining to have bowel movements promote hemorrhoids and that
hard stools can traumatize existing hemorrhoids. It is recommended, therefore,
that individuals with hemorrhoids soften their stools by increasing the
fiber in
their diets. Fiber is found in numerous foodstuffs including fresh and dried
fruits, vegetables, grains, and cereals. Generally 20-30 grams per day of fiber
are recommended whereas the average American diet contains less than 15 grams of
fiber. Supplemental fiber (psyllium, methylcellulose, or calcium polycarbophil) also may be used to increase the
intake of fiber. Stool softeners and increased drinking of liquids also may be
recommended. Nevertheless, there is no strong, scientific support for the
benefits of fiber, liquids, or stool softeners.
Diarrhea is believed to aggravate the symptoms of hemorrhoids and it is
recommended that diarrhea be controlled with fiber and anti-motility drugs.
Over-the-counter medications for hemorrhoids
Many over-the-counter products are sold for the treatment of hemorrhoids. These
often contain the same drugs that are used for treating anal symptoms such as
itching or discomfort. There are few studies showing that they do anything for
hemorrhoids. They probably only reduce the symptoms of hemorrhoids. It is
possible, however, that their effectiveness relates to their treatment of anal
conditions other than hemorrhoids, for example, idiopathic anal itching, that
often accompany hemorrhoids.
Products used for the treatment of hemorrhoids are
available as ointments, creams, gels, suppositories, foams, and pads. Ointments,
creams, and gels - when used around the anus - should be applied as a thin covering. When applied to the anal canal, these products should be inserted with
a finger or a "pile pipe." Pile pipes are most efficient when they have holes on
the sides as well as at the end. Pile pipes should be lubricated with ointment
prior to insertion.
Suppositories or foams do not have advantages over ointments, creams, and gels.
Most products contain more than one type of active ingredient. Almost all
contain a protectant in addition to another ingredient. Only examples of
brand-name products containing one ingredient in addition to the protectant are
discussed below.
Local anesthetics: Local
anesthetics temporarily relieve pain, burning, and itching by numbing the nerve
endings. The use of these products should be
limited to the perianal area and lower anal canal. Local anesthetics can cause
allergic reactions with burning and itching; therefore, if burning and itching
increase with the application of anesthetics, they should be discontinued.
Local
anesthetics include:
Benzocaine 5% to 20% (Americaine Hemorrhoidal,
Lanacane Maximum Strength, Medicone)
Vasoconstrictors: Vasoconstrictors are chemicals that resemble epinephrine, a
naturally occurring chemical. Applied to the anus, vasoconstrictors make the
blood vessels become smaller, which may reduce swelling. They also may reduce
pain and itching due to their mild anesthetic effect. Vasoconstrictors applied
to the perianal area - unlike vasoconstrictors that are taken orally or by
injection - have a low likelihood of causing serious side effects, such as
high blood
pressure, nervousness, tremor, sleeplessness, and aggravation of diabetes
or hyperthyroidism.
Protectants: Protectants prevent irritation of the perianal area by forming a
physical barrier on the skin that prevents contact of the irritated skin with
aggravating liquid or stool from the rectum. This barrier reduces irritation,
itching, pain, and burning. There are many products that are themselves
protectants or that contain a protectant in addition to other medications.
Protectants include:
Aluminum hydroxide gel
Cocoa butter
Glycerin
Kaolin
Lanolin
Mineral oil (Balneol)
White petrolatum
Starch
Zinc oxide or calamine
(which contains zinc oxide) in concentrations of up to 25%
Astringents: Astringents cause coagulation (clumping) of proteins in the cells
of the perianal skin or the lining of the anal canal. This action promotes
dryness of the skin, which in turn helps relieve burning, itching, and pain.
Astringents include:
Calamine 5% to 25%
Zinc oxide 5% to 25% (Calmol 4, Nupercainal,
Tronolane)
Antiseptics: Antiseptics
inhibit the growth of bacteria and other organisms. However, it is unclear
whether antiseptics are any more effective than soap and water.
Keratolytics: Keratolytics are chemicals that cause the outer layers of skin or
other tissues to disintegrate. The rationale for their use is that the
disintegration allows medications that are applied to the anus and perianal area
to penetrate into the deeper tissues.
The two approved keratolytics used are:
Aluminum chlorhydroxy allantoinate (alcloxa) 0.2% to
2.0%
Resorcinol 1% to 3%
Analgesics: Analgesic
products, like anesthetic products, relieve pain, itching,
and burning by depressing receptors on pain nerves.
Examples of analgesics include:
Menthol 0.1% to 1.0% (greater than 1.0% is not
recommended)
Camphor 0.1% to 3% (greater than 3% is not
recommended)
Juniper tar 1% to 5%
Corticosteroids: Corticosteroids reduce inflammation and can relieve itching,
but their chronic use can cause permanent damage to the skin. They should not be
used for more than short periods of a few days to two weeks. Only products with
weak corticosteroid effects are available
over-the-counter. Stronger corticosteroid products that are available by
prescription should not be used
for treating hemorrhoids.
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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