You Wanted to Know: Hemorrhoids

White toilet bowl in a bathroom

For a problem that’s so common, hemorrhoids are not often talked about (perhaps because they don’t make for very good dinner conversation). But the fact is that by age 50, nearly half of Americans will deal with one or more symptoms of hemorrhoids, including itching, discomfort and bleeding. Chio asked me about solutions for this uncomfortable problem on Twitter:

hemorrhoids

Hemorrhoids form when veins in the anus and lower rectum become swollen and inflamed. There are two main types of hemorrhoids – internal and external. Internal hemorrhoids are located inside the rectum and are usually painless, even if they cause bleeding. External hemorrhoids form under the skin around the anus and are usually more uncomfortable since the skin may become irritated and erode. Symptoms of hemorrhoids include bleeding during bowel movements (you may notice bright red blood on the toilet paper or in the bowl), itching, pain or swelling around the anus, a lump near the anus, or even fecal leakage.

There are several risk factors for hemorrhoids. Chronic straining and extended time spent sitting on the toilet (as with constipation) may contribute to hemorrhoid formation by interfering with blood flow in the area and causing blood to pool and enlarge the veins. Pregnancy may also increase hemorrhoid risk, since the enlarging uterus puts pressure on the veins. And since connective tissues that help support the veins can weaken over time, increasing age also ups hemorrhoid risk. You can help prevent the formation of hemorrhoids by eating high-fiber foods or fiber supplements, drinking at least six to eight glasses of fluids a day, not straining or sitting too long on the toilet during a bowel movement and exercising regularly.

Mild hemorrhoids can be alleviated with some simple home remedies. For example, topical treatment with an over-the-counter cream or suppository that has hydrocortisone or witch hazel in it may help soothe irritation and decrease inflammation (be sure to follow instructions on the label and don’t use for longer than a week without asking your doctor). Keep the anal area clean by washing daily with warm water, but avoid soap, alcohol-based or perfumed wipes, which may be irritating. Afterwards, pat yourself dry or use a hair dryer to gently dry yourself. Wetting toilet paper before wiping or using moist, alcohol-free towelettes are better choices than dry toilet paper. Soaking the anal area in plain, warm water for 10-15 minutes, two to three times a day can also help by helping relax the anal muscles and facilitating blood flow to the area.

For hemorrhoids that bleed frequently or that are very painful, there are several medical procedures than can help. One minimally-invasive technique is called rubber band ligation, in which your doctor uses small rubber bands to cut off circulation to a hemorrhoid, causing it to eventually resolve. A second option, sclerotherapy, involves injecting a chemical into the affected vein to shrink it, and a third, coagulation, involves using a laser or heat to close off small bleeding vessels.

There are also surgical procedures that may help. Hemorrhoids can be removed in a surgical procedure called a hemorrhoidectomy, which is usually the most effective treatment for severe hemorrhoids. Alternatively, in hemorrhoid stapling, staples are used to cut off blood flow to affected veins, but this has been associated with higher recurrence compared to removal.

Though certainly unpleasant, hemorrhoids are not usually dangerous, but there are a few important things to watch out for. While hemorrhoids are a common cause of rectal bleeding, colorectal and anal cancer, as well as other serious medical conditions can also cause bleeding – so don’t write it off as hemorrhoids without seeing a doctor. Changes in stool appearance, black, maroon or very sticky stools or blood clots in the stool can also be a sign of a more serious condition and should prompt you to seek medical attention right away. You should also seek emergency attention for large amounts of rectal bleeding, especially if it is associated with lightheadedness or dizziness.