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Pain, Itching, Bleeding?

There Are Effective Non-Invasive Treatments for Hemorrhoids.

By Daniel Lindenberg, MD, PA –

By age 50, about half of adults have had to deal with the itching, discomfort and bleeding that can signal the presence of hemorrhoids. “Weak” veins — leading to hemorrhoids and other varicose veins — may be inherited.

It’s likely that extreme abdominal pressure causes the veins to swell and become susceptible to irritation. The pressure can be caused by obesity, pregnancy, standing or sitting for long periods, straining during bowel movements, coughing, sneezing, vomiting, and holding your breath while straining to do physical labor.

Diet has a pivotal role in causing — and preventing — hemorrhoids. People who consistently eat a high-fiber diet are less likely to get hemorrhoids, but those who prefer a diet high in processed foods are at higher risk. A low-fiber diet or inadequate fluid intake can cause constipation, which can contribute to hemorrhoids in two ways: It promotes straining during a bowel movement and it also aggravates the hemorrhoids by producing hard stools that further irritate the swollen veins.

What Are Hemorrhoids?
Hemorrhoids are swollen blood vessels of the rectum. The hemorrhoidal veins are located in the lowest area of the rectum and the anus. Sometimes they swell so that the vein walls become stretched, thin, and irritated by passing bowel movements. Hemorrhoids are classified into two general categories: internal and external.

Internal hemorrhoids lie far enough inside the rectum that you can’t see or feel them. They don’t usually hurt because there are few pain-sensing nerves in the rectum. Bleeding may be the only sign that they are there. Sometimes internal hemorrhoids prolapse, or enlarge and protrude outside the anal sphincter. When this happens, you may be able to see or feel them as moist, pink pads of skin that are pinker than the surrounding area. Prolapsed hemorrhoids may hurt because the anus is dense with pain-sensing nerves. They usually recede into the rectum on their own; if they don’t, they can be gently pushed back into place.

Classification of Internal Hemorrhoids — Internal hemorrhoids have been graded across a spectrum of severity, which has proven useful for guiding treatment options, Grade I: The hemorrhoids do not prolapsed, Grade II: The hemorrhoids prolapse upon defecation but reduce spontaneously, Grade III: The hemorrhoids prolapse upon defecation and must be reduced manually, Grade IV: The hemorrhoids are prolapsed and cannot be reduced manually.
External hemorrhoids lie within the anus and are usually painful. If an external hemorrhoid prolapses to the outside (usually in the course of passing stool), you can see and feel it. Blood clots sometimes form within prolapsed external hemorrhoids, causing an extremely painful condition called a thrombosis. If an external hemorrhoid becomes thrombosed, it can look rather frightening, turning purple or blue, and could possibly bleed. Despite their appearance, thrombosed hemorrhoids are usually not serious but can be painful. They will resolve themselves in a couple of weeks. If the pain is unbearable, your health care provider can remove the thrombosed hemorrhoid, which stops the pain.

Internal Hemorrhoids are usually first combated with some regiment of home treatment.  There are several common strategies for addressing internal hemorrhoid symptoms with treatments beginning with changes to your diet.  Adding fiber, either dietary or bulk, is typically the first course of action recommended, which includes increased consumption of water as well as a greater consumption of fruits, grains, and vegetables.  Employing stool softeners to assist with easier bowel movements and applying ointments to stop the itching associated with internal hemorrhoids are also frequently recommended, in addition to bathing in warm water several times a day, which assists to alleviate internal hemorrhoid symptoms such as swelling and itching.  In the event your hemorrhoids are of a more severe degree, a physician’s intervention might be required.  In the event your condition does not respond to a home hemorrhoid treatment, minimally invasive procedures are available that can be performed in the doctor’s office or outpatient setting.

Minimally invasive procedures
If a blood clot has formed within an external hemorrhoid, your doctor can remove the clot with a simple incision, which may provide prompt relief.

For persistent bleeding or painful hemorrhoids, your doctor may recommend another minimally invasive procedure. These treatments can be done in your doctor’s office or other outpatient setting.

• Rubber band ligation. Rubber band ligation is the most widely used technique for treatment of symptomatic internal hemorrhoids that are refractory to conservative treatment. This procedure has been available since the early 1960s and is effective, inexpensive, requires no anesthesia, is easy to perform, and only rarely causes serious complications. The technique may be used for first, second, and selected third degree hemorrhoids. Your doctor places one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation. The hemorrhoid withers and falls off within a week. This procedure — called rubber band ligation — is effective for many people.

Hemorrhoid banding can be uncomfortable and may cause bleeding, which might begin two to four days after the procedure but is rarely severe.

• Injection (sclerotherapy). In this procedure, your doctor injects a chemical solution into the hemorrhoid tissue to shrink it. This therapy is available for treatment of grade one and two degree hemorrhoids.  While the injection causes little or no pain, it may be less effective than rubber band ligation.

• Coagulation (infrared, laser or bipolar). Coagulation techniques use laser or infrared light or heat. They cause small, bleeding, internal hemorrhoids to harden and shrivel. This approach is available to those with both grade one and two degree hemorrhoids.  While coagulation has few side effects, it’s associated with a higher rate of hemorrhoids coming back (recurrence) than is the rubber band treatment.

Surgical procedures
If other procedures haven’t been successful or you have large hemorrhoids, your doctor may recommend a surgical procedure. Surgery can be performed on an outpatient basis or you may need to stay in the hospital overnight.

• Hemorrhoid removal. During a hemorrhoidectomy, your surgeon removes excessive tissue that causes bleeding. Various techniques may be used. The surgery may be done with a local anesthetic combined with sedation, a spinal anesthetic or a general anesthetic. Most people experience some pain after the procedure. Medications can relieve your pain. Soaking in a warm bath also may help.

• Hemorrhoid stapling. This procedure, called stapled hemorrhoidectomy or stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. Stapling generally involves less pain than hemorrhoidectomy and allows an earlier return to regular activities. Compared with hemorrhoidectomy, however, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus.

If you believe you are suffering from hemorrhoids and at home remedies are not successful in creating symptoms relief it is important to seek professional attention and examine your options for relief.  To learn more about treatment options and those best suited for your individual needs contact Dr. Lindenberg 561-316-6120.

 

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