What Causes Hemorrhoids?
Hemorrhoids are areas in a vein located in or around the rectum in which one way valves have been damaged and allow the blood to pool. This stagnation of the blood supply causes the veins to swell and become inflamed, reduces the amount of toxins and wastes that can be removed from the area, and causes itchiness and pain. Most of these hemorrhoids can be treated with some simple changes to the diet and bowel habits. They do not usually require surgery or other invasive treatments unless they become very large and painful. (1)
Hemorrhoids Treatment
The first treatment recommendations will be to make changes to your diet that will make the stool softer and easier to pass. These recommendations include increasing the amount of fiber in the diet through fruits, vegetables and whole grains or taking a fiber supplement. If you can’t get enough fiber from your diet and decide to use fiber supplements, it is very important to drink at least 8 glasses of water each day or the stool could get harder and more difficult to pass. This is because the fiber works to draw more water into the stool, making it bulkier and softer. Without water, the resulting stool is more compact, hard and difficult to pass.
It is also important not to strain while having a bowel movement. Straining occurs when you hold your breath while pushing. This causes an increase in pressure in the veins in and around the anus, which increases the risk of developing hemorrhoids or worsening the symptoms of those which you already have. Instead, learn to breath through pushing out stool and work to soften the consistency, which will decrease the work required to have a bowel movement. See treatment of constiption.
People who exercise consistently have an easier time with their bowel movements because exercise helps the intestinal tract to move more consistently. Doctors can also recommend over the counter creams and ointments that can help to reduce mild discomfort. These products contain ingredients like witch hazel or hydrocortisone that help to reduce pain, swelling and itching. However, you shouldn’t use these over the counter preparations without first talking with your primary care physician to be sure they don’t interfere with any underlying medical condition and to determine the length of time you should take the medication.
If other treatment protocols should be considered, the physician may start with a nonsurgical procedure, called a fixative procedure. These are designed to reduce the blood supply to the hemorrhoid so it shrinks or goes away. Scar tissue will remain that has the function of supporting the surrounding tissue and preventing any further hemorrhoids from developing in the area.
Fixative procedures include tying off the hemorrhoid with a rubber band or coagulation using heat, laser or electrical current. Using the rubber band ligation, the doctor places one or two tiny rubber bands around the base of the internal hemorrhoid to cut off the circulation. The hemorrhoid falls off within a few days. It can be uncomfortable and can cause bleeding which is usually rarely severe.
The coagulation procedures – infrared, laser or bipolar – are techniques that cause small, bleeding, internal hemorrhoids to harden and shrivel. While it is quicker and less painful than the rubber band procedure it has a higher incidence of recurrence, or the hemorrhoid coming back. Another procedure which may be considered, sclerotherapy, is also used on varicose veins or spider veins in other areas of the body. It causes little pain but is usually less effective than the rubber band ligation.
Two other surgical treatments are possible for those who suffer from hemorrhoids – the hemorrhoidectomy and stapling. In a hemorrhoidectomy the surgeon removes most of the excess tissue that causes the bleeding. There are several variations that can be used based on the particular situation and overall health of the individual. The surgery can be done with a local anesthesia or combined with sedation and spinal or general anesthesia. This is the most effective and complete way of removing hemorrhoid tissue. Unfortunately, it also has the highest rate of complications which can include difficulty emptying the bladder or urinary tract infections. Many people also experience pain that can be controlled with medication and warm baths.
Stapling is a procedure that blocks the blood flow to the hemorrhoidal tissue and generally results in less pain than a hemorrhoidectomy. Stapling is associated with a greater risk of recurrence and rectal prolapse.
Before deciding on any procedure to treat your hemorrhoids it is important that you do your own research and talk with your physician and surgeon about the side effects, complications and long-term results. Only after weighing the pros and cons and evaluating those against your current health, lifestyle choices and severity of disease can you make a choice about treatment protocols.
Hemorrhoid Prevention
Hemorrhoids are another form of varicose veins that occurs inside, or protruding outside, of the rectum. Varicose veins develop when the one-way valves in the veins are damaged and allow the blood to pool. This pooling causes the veins to become distended, causing itchiness, pain, discomfort and bleeding. This condition also doesn’t allow the body to remove toxins and waste products from the cellular structure effectively. (1)
In the case of hemorrhoids, the pressure builds when you strain to have a bowel movement, sit on the toilet for long periods of time, sit in the office for long periods of time or strain to lift heavy objects. As with varicose veins in the legs, there is also a genetic predisposition to the development of these varicose veins in the rectum. Those who know that family members suffer from this condition should take special precautions to prevent the development of hemorrhoids.
There are three different types of hemorrhoids depending upon the location of the inflamed and swollen vein. There are internal hemorrhoids which involve the veins inside the rectum and are not as painful as those which extrude. They may bleed painlessly. A prolapsed hemorrhoid can stretch until they bulge outside the anus. It can go back inside the rectum on its own or you can gently push it back inside. An external hemorrhoid involves the veins that are outside the anus and are often itchy, painful and sometimes will crack and bleed.
Those who have a hemorrhoid may feel a tender lump on the edge of the anus or see blood on the toilet paper or in the toilet after a bowel movement. Many will find relief from using preventative measures, such as taking warm baths, using moist towelettes or ice packs to relieve the swelling. Your doctor can prescribe a steroid cream or suppository to help reduce the inflammation and pain.
One of the primary ways of preventing the development of hemorrhoids is to reduce the stress and strain of having a bowel movement. This means producing soft stool that can be excreted easily. You do this using several methods in combination.
Eat more fruits and vegetable to increase the high-fiber content of your diet. This helps to soften the stool and increase the bulk. This reduces straining that causes hemorrhoids or worsens the symptoms from already existing hemorrhoids. If you are not used to eating fiber in your diet you should introduce it slowly and gradually to reduce the amount of gas that your bowel will produce.
People who are used to eating fiber have no difficulty with increasing their fiber but intestines that aren’t used to digesting the products they are supposed to may increase the amount of gas produced until the body is able to manufacture enough of the right enzymes to completely digest the food. This is a natural process and high fiber should NOT be stopped just because you have a bit of gas.
Drink plenty of fluids during the day. Most individuals should drink between 7 to 9 eight ounce glasses of water each day unless they live in a hot climate and should then drink more. Fluids help to keep the stool soft and the body from retaining water.
Go to the bathroom as soon as you feel the urge to have a bowel movement. Don’t hold it because the stool can become dry and harder to pass. This causes a person to strain while stooling, which in turn results in hemorrhoids. When you strain, or hold your breath when passing stool, it creates a greater pressure in the veins in the lower rectum. This straining will increase the damage to the veins and the potential to develop hemorrhoids.
Sitting on the toilet, to read or relax, will also cause an increased pressure in the veins which in turn results in hemorrhoids. This same situation happens when sitting in a chair for long periods of time. For this reason it is important to use the toilet only to have a bowel movement and get up immediately. Avoid sitting for long periods of time in a chair. If you are able to get up, even to stand and stretch next to your chair, do so at least every 20 minutes. While this will help reduce the potential to develop hemorrhoids, it will also reduce the potential for varicose veins in the legs and increase your productivity by increasing your blood flow.
If you don’t get enough fiber in your diet consider a fiber supplement. The FDA suggests 20-35 grams of fiber in your diet each day. (2) Over the counter supplements can improve the overall symptoms of hemorrhoids and help to keep the stool soft and regular. If you choose to use these supplements you MUST drink at least 8 glasses of water each day or the supplement will make the constipation worse. See treatment of constiption.
References
(1) National Digestive Diseases Information Clearinghouse: Hemorrhoids
www.digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids
(2) Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino acids
http://www.iom.edu/Global/News%20Announcements/~/media/C5CD2DD7840544979A549EC47E56A02B.ashx