What are hemorrhoids?
If you’ve ever had hemorrhoids, you know that they can be very painful and irritating. If you haven’t, do your best to prevent them from happening. One in 20 Americans have hemorrhoids, and nearly half of adults over 50 have them.
At-home care and treatments can usually clear up hemorrhoids in about a week. After that time, you can talk to your doctor about other options.
What causes hemorrhoids?
Hemorrhoids are generally associated with too much strain on the rectal veins. These blood vessels can become swollen, creating hemorrhoids, as a result of:
Who can get hemorrhoids?
Anyone can get hemorrhoids because we all have blood vessels in the anorectal area. If you strain to lift heavy weights, sit too much, or strain on the toilet, you could be more at risk to develop hemorrhoids.
Diagnosis of hemorrhoids
You'll likely know you have hemorrhoids if you feel itching and burning on your anus after bowel movements or sitting too long. You might see small amounts of blood on the toilet paper or in your feces.
Your doctor will talk to you about your medical history and inquire about the history of your hemorrhoids. They will conduct a physical exam around your anus to identify any external hemorrhoids. To check for internal hemorrhoids, the doctor has to do a rectal exam to feel for lumps.
Your doctor might want to perform an anoscopy, where they insert an anoscope into your anus to view the lining of your rectum.
Treatments for hemorrhoids
Practice voiding your bowels without straining and not sitting on the toilet for long periods. If you’re in pain from hemorrhoids, a sitz bath can help reduce the inflammation of your hemorrhoids and promote healing.
Over the counter hemorrhoid ointments that relieve itching, burning, and pain can help calm the area down over time.
If you can stand it, you can use an ice cube in a damp washcloth or an ice pack and hold it on your hemorrhoids to reduce the inflammation.
If you still have hemorrhoid pain after a week or are bleeding during or after bowel movements, your doctor might have to perform surgery to remove the hemorrhoids. They elect to perform surgery based on the following criteria:
- Other anorectal issues that require surgery
- Internal hemorrhoids are strangulated
- A mix of internal and external hemorrhoids
- Blood clots (thrombosis) in hemorrhoids
- Minimally invasive procedures aren’t possible or effective
The surgery types for hemorrhoids are:
- Closed hemorrhoidectomy
- Open hemorrhoidectomy
- Stapled hemorrhoidectomy
- Rubber band ligation
- Lateral internal sphincterotomy
Doctors choose the procedure after talking to you and determining what you can tolerate and the best treatment. A closed hemorrhoidectomy is the most common treatment for internal hemorrhoids. The doctor removes the hemorrhoids with a scalpel, laser, or electrocauterization and then sutures the wound.
An open hemorrhoidectomy is the same procedure as the closed hemorrhoidectomy, but the doctor leaves the wound open if there is a risk of infection or if it's too difficult to suture. The doctor might staple the leftover tissue of a removed hemorrhoid.
A rubber band ligation is a procedure where the doctor uses an instrument to place a rubber band around the hemorrhoid, cutting off the circulation and causing hemorrhoids to wither.
In some cases, a doctor might need to widen the anal opening. This is called a lateral internal sphincterotomy (LIS), used by doctors if your inner anal muscles are too tight and cause you to strain during a bowel movement.
The rubber band ligation causes hemorrhoids to disappear within a few days, while the LIS might take a few weeks of rest.
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Possible complications or risks
Home treatments for hemorrhoids generally come with minimal risk, other than recurrence. As with any procedures, there might be some complications if your doctor performs surgery on your hemorrhoids. You might experience:
- Urine retention
- Anal stricture
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National Institute of Diabetes and Digestive and Kidney Diseases: “Symptoms & Causes of Hemorrhoids."
National Institute of Diabetes and Digestive and Kidney Diseases: “Treatment of Hemorrhoids."
University of California San Francisco: “Hemorrhoidectomy."
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