The rectum is the last foot of your colon, and it naturally stretches to hold stool. Hemorrhoidal piles are natural clusters of blood vessels that help the rectum and anal canal stretch to hold stool and allow bowel movements to eliminate feces.
Hemorrhoids are abnormally swollen blood vessels in the rectum. Too much pressure in the rectum causes hemorrhoids by forcing blood to stretch and bulge the walls of the veins, sometimes even rupturing them.
Hemorrhoids can become like varicose veins you might see on a person’s legs.
Most people will develop a flare of hemorrhoids in their lifetime. When bulging hemorrhoidal veins are irritated, they can swell, burn, itch, cause pain, and bleed. Most flares will calm down gradually within a few weeks.
However, once hemorrhoids are created, they are difficult to get rid of completely and tend to flare more easily than the first flare. Fortunately, good habits and simple medical hemorrhoids treatment usually control hemorrhoids well, and surgery is needed only in severe cases.
Types of Hemorrhoids:
Internal hemorrhoids usually don’t initially hurt or itch; they are deep inside the rectum and usually have no sensation. If they begin to push out (prolapse), pain and burning can occur. However, internal hemorrhoids can bleed. Anal bleeding should not be ignored since bleeding could come from a dangerous source like colorectal cancer, so persistent rectal bleeding should be investigated by a doctor, sometimes with a colonoscopy.
External hemorrhoids cause most of the symptoms – pain, burning, and itching. Nonirritated hemorrhoids can look like small skin tags coming out of the anus.
Thrombosed hemorrhoids can form when a hemorrhoid blood vessel bursts and causes the hemorrhoid to suddenly swell. A purple blood clot can form in it and become an excruciatingly painful lump at the anus. Because of these unpleasant symptoms, immediate incision and drainage by a surgeon at an office visit can provide much relief of the pain.
Avoiding the most frequent causes listed below will prevent most cases of hemorrhoids:
- Hard stools
- Constant sitting
- Straining with bowel movements
- Sitting on the toilet for a long time
- Severe coughing episodes
- Pregnancy / Childbirth
- Heavy Lifting
Sometimes avoiding the above triggers is difficult: How can you avoid sitting all day if you have a seated job? Also, we try to avoid coughing and diarrhea, but sometimes it’s beyond your control. Still, there are some practical hints to help:
- Keep the anal and genital area clean. Moistened tissues such as flushable wet wipes are less irritating than toilet paper. Using irrigating showers or bottle irrigation washing gently cleans this sensitive area.
- Avoid dry toilet paper when cleaning after bowel movements.
- Keep the anal and genital area dry. Lightly pat the rectal area dry. Avoid rubbing. Talcum or baby powders can help GET YOUR STOOLS SOFT. This is the most important way to prevent irritated hemorrhoids. Hard stools are like sandpaper to the anorectal canal and will cause more problems.
- The goal: ONE SOFT BOWEL MOVEMENT A DAY! BMs from every other day to 3 times a day is a tolerable range
- Treat coughing, diarrhea and constipation early since irritated hemorrhoids may soon follow.
- If your main job activity is seated, always stand or walk during your breaks. Make it a point to stand and walk at least 5 minutes every hour and try to shift frequently in your chair to avoid direct rectal pressure.
- Always exhale as you strain or lift. Don’t hold your breath.
- Do not delay or try to prevent a bowel movement when the urge is present.
- Exercise regularly (walking or jogging 60 minutes a day) to stimulate the bowels to move.
- No reading or other activity while on the toilet. If bowel movements take longer than 5 minutes, you are too constipated.
Drink plenty of liquids (1 1/2 to 2 quarts of water and other fluids a day unless fluid restricted for another medical condition). Liquids that contain caffeine (coffee, tea, soft drinks) can be dehydrating and should be avoided until constipation is controlled. Consider minimizing milk, as dairy products may be constipating.
Eat plenty of fiber (30g a day ideal, more if needed). Fiber is the undigested part of plant food that passes into the colon, acting as “natures broom” to encourage bowel motility and movement. Fiber can absorb and hold large amounts of water. This results in a larger, bulkier stool, which is soft and easier to pass.
Eating foods high in fiber – 12 servings – such as:
- Vegetables: Root (potatoes, carrots, turnips), Leafy green (lettuce, salad greens, celery, spinach), High residue (cabbage, broccoli, etc.)
- Fruit: Fresh, Dried (prunes, apricots, cherries), Stewed (applesauce)
- Whole grain breads, pasta, whole wheat
- Bran cereals, muffins, etc.
Consider adding supplemental bulking fiber which retains large volumes of water:
- Psyllium ground seeds –available as Metamucil, Konsyl, Effersyllium, Per Diem Fiber, or the less expensive generic forms.
- Citrucel (methylcellulose wood fiber)
- FiberCon (Polycarbophil)
- Polyethylene Glycol – and “artificial” fiber commonly called Miralax or Glycolax. It is helpful for people with gassy or bloated feelings with regular fiber
- Flax Seed – a less gassy natural fiber
Laxatives can be useful for a short period if constipation is severe
- Osmotics (Milk of Magnesia, Fleets Phospho-Soda, Magnesium Citrate)
- Stimulants (Senokot, Castor Oil, Dulcolax, Ex-Lax)
- Laxatives are not a good long-term solution as they can stress the bowels and cause too much mineral loss and dehydration. Avoid taking laxatives for more than 7 days in a row.
Switch to liquids and simpler foods for a few days to avoid stressing your intestines further.
Avoid dairy products (especially milk & ice cream) for a short time. The intestines often can lose the ability to digest lactose when stressed.
Avoid foods that cause gassiness or bloating. Typical foods include beans and other legumes, cabbage, broccoli, and dairy foods. Every person has some sensitivity to other foods, so listen to your body and avoid those foods that trigger problems for you.
Adding fiber (Citrucel, Metamucil, FiberCon, Flax seed, Miralax) gradually can help thicken stools by absorbing excess fluid and retrain the intestines to act more normally. Slowly increase the dose over a few weeks.
Too much fiber too soon can backfire and cause cramping & bloating.
Probiotics (such as active yogurt, Align, etc) may help repopulate the intestines and colon with normal bacteria and calm down a sensitive digestive tract. Most studies show it to be of mild help, though, and such products can be costly.
- Bismuth subsalicylate (ex. Kayopectate, Pepto Bismol) every 30 minutes for up to 6 doses can help control diarrhea. Avoid if pregnant.
- Loperamide (Immodium) can slow down diarrhea. Start with two tablets (4mg total) first and then try one tablet every 6 hours. Avoid if you are having fevers or severe pain. If you are not better or start feeling worse, stop all medicines and call your doctor for advice.
Call your doctor if you are getting worse or not better. Sometimes further testing (cultures, endoscopy, X-ray studies, bloodwork, etc) may be needed to help diagnose and treat the cause of the diarrhea.
Treatment for Hemorrhoid Flares
If these preventive measures fail, you must take action right away! Hemorrhoids are one condition that can be mild in the morning and become intolerable by nightfall.
Most hemorrhoidal flares take several weeks to calm down. These hemorrhoids treatment suggestions can help:
Warm soaks. This helps more than any topical medication. Use up to 8 times a day. Usually sitz baths or sitting in a warm bathtub helps. Sitting on moist warm towels is helpful. Switching to ice packs/cool compresses can be helpful.
Normalize your bowels. Extremes of diarrhea or constipation will make hemorrhoids worse. One soft bowel movement a day is the goal. Fiber can help get your bowels regular.
Wet wipes instead of toilet paper.
Pain control with a NSAID such as ibuprofen (Advil) or naproxen (Aleve) or acetaminophen (Tylenol). Narcotics are constipating and should be minimized if possible.
Topical creams contain steroids (hydrocortisone) or local anesthetic (xylocaine) can help make pain and itching more tolerable.
If hemorrhoids are still causing problems, you could benefit by an evaluation by a surgeon. The surgeon will obtain a history and examine you. If hemorrhoids are diagnosed, some therapies can be offered in the office, usually with an anoscope into the less sensitive area of the rectum:
- Iinjection of hemorrhoids (sclerotherapy) can scar the blood vessels of the swollen/enlarged hemorrhoids to help shrink them down to a more normal size.
- Rubber banding of the enlarged hemorrhoids to help shrink them down to a more normal size.
- Drainage of the blood clot causing a thrombosed hemorrhoid, to relieve the severe pain.
While 90% of the time such problems from hemorrhoids can be managed without preceding to surgery, sometimes the hemorrhoids require a operation to control the problem (uncontrolled bleeding, prolapse, pain, etc.). This involves being placed under general anesthesia where the surgeon can confirm the diagnosis and remove, suture, or staple the hemorrhoid(s). Your surgeon can help you treat the problem appropriately.