What are hemorrhoids?
Hemorrhoids are enlarged veins in the anal area that are covered by the lining of the rectum or anal skin. They are similar to varicose veins in the leg. They may be located inside the anus (internal hemorrhoids) or outside the anus (external hemorrhoids). It is fairly common for people to have both internal and external hemorrhoids at the same time. There are usually three internal and three external hemorrhoids.
Why do people get hemorrhoids?
There is no easy answer to this question. While everyone has veins in this area, not everyone develops hemorrhoid problems. The enlargement of the veins may be due to constipation, prostate trouble in men, or chronic cough, all of which cause straining and increased pressure on the abdomen. They may be related in part to a diet without bulk food and roughage (such as bran, fresh fruit and fresh vegetables). There may be a hereditary factor in some cases, or, there may be no specific explanation at all. Some people develop hemorrhoids for as yet undiscovered reasons.
Are hemorrhoids caused by heavy lifting, prolonged sitting, or other work-related activities?
While these activities can sometime make hemorrhoids more bothersome or noticeable, they do not cause hemorrhoids.
How do hemorrhoids bother people?
Hemorrhoids can be troublesome in several ways. Internal hemorrhoids may cause bleeding, and/or may fall out of the anal canal, requiring a person to push them back up inside after bowel movements. External hemorrhoids may become swollen and painful. While these are not usually serious or life-threatening problems, bleeding, in particular, needs careful evaluation to see whether blood is coming from a hemorrhoid or from another problem, higher up, such as cancer, a polyp or inflammation of the bowel.
Should hemorrhoids always be treated?
Not necessarily. If symptoms are mild or infrequent, often no treatment is required. For more severe symptoms, the goals are relief of pain, and the restoration of normal function. Bleeding, however, whether painful or not, should always be evaluated and usually should be treated. A change in bowel habits should likewise be evaluated, because of the possibility of cancer or other bowel disease.
What types of treatment are used?
This depends on the severity and location of the hemorrhoids.
For mild or intermitten symptoms
For mild or intermittent symptoms, usually sitz baths (soaking the hemorrhoid area in plain warm water, with no additives, for 20 minutes at a time, two to four times a day) and a special cream are all that is necessary.
For external hemorrhoids
For external hemorrhoids which develop painful clots (called "thrombosis"), removal of the external hemorrhoid in the office, using a Novocain-type anesthetic usually brings dramatic relief. Removal of the external hemorrhoid prevents the problem from re-occurring in the same place in the future.
For people with internal hemorrhoids alone
For people with internal hemorrhoids alone (with no external hemorrhoids), tiny rubber bands can be placed around the base of the hemorrhoids, causing them to shrink and fall off. This procedure is done in the office, and usually causes minimal discomfort.
For people with larger, more severe hemorrhoids
For those persons with larger, more severe hemorrhoids (usually external and internal hemorrhoids together, surgical removal of the hemorrhoids may be the simplest permanent solution. This does not require an overnight stay in the hospital.
What about other types of treatment for hemorrhoids?
Other therapies for hemorrhoids gain popularity from time to time, such as electric cautery (burning), cryotherapy (freezing), laser therapy, and stretching the anus. These techniques have not had nearly the permanent long-term relief of hemorrhoids which rubber-banding or surgery offer, are often actually more painful, and are more complicated than necessary for simpler hemorrhoid problems.
Will hemorrhoids come back after treatment?
For the external hemorrhoid removal and rubber band methods, recurrences occasionally occur, usually after several years, but can often be treated again with similar conservative techniques. After surgical removal of hemorrhoids, it is rare for hemorrhoids to ever come back.