Hemorrhoids

Hemorrhoids are enlarged, bulging blood vessels in and about the anus and lower rectum. There are two types of hemorrhoids: External and Internal, which refer to their location.

External (outside) hemorroids develop near the anus and are covered with sensitive skin. If a blood clot develops in one of them, a painful swelling occurs. The external hemorrhoid feels like a hard, sensitive lump. It bleeds only if it ruptures.

Internal (inside) hemorroids develop within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptom. However, an internal hemorrhoid can cause severe pain if it is completely “prolapsed” – protrudes from the anal opening and cannot be pushed back inside.

What Causes Hemorroids?

An exact cause is unknown; however, the upright posture of humans alone forces a great pressure on the rectal veins, which sometimes causes them to bulge. Other contributing factors include:

  • Aging
  • Chronic constipation or diarrhea
  • Pregnancy
  • Heredity
  • Faulty bowel function due to overuse of laxatives or enemas, straining during bowel movements
  • Spending long periods of time on the toilet.

Whatever the cause, the tissues supporting the veins stretch. As a result, the veins dilate; their walls become thin and bleed. If stretching and pressure continue, the weakened veins protrude.

What are the Symptoms?

If you notice any of the following, you could have hemorroids:

  • Bleeding during bowel movements
  • Protrusion during bowel movements
  • Itching in the anal area
  • Pain
  • Sensitive lump(s)

Do hemorroids lead to cancer?

No. There is no relationship between hemorroids and cancer. However, the symptoms of hemorroids, particularly bleeding, are similar to those of colorectal cancer and other disease of the digestive system. Therefore, it is important that all symptoms are investigated by a physician specially trained in treating diseases of the colon and rectum. Do not rely on over the counter medications or other self-treatments. See a colorectal surgeon first so your symptoms can be properly evaluated and effective treatment prescribed.

How are hemorroids treated?
Mild symptoms can be relived frequently by increasing the amount of fiber (e.g., fruits, vegetables, bread and cereals) and fluids in the diet. Eliminating excessive straining reduces the pressure on hemorrhoids and helps prevent them from protruding. A sitz bath – sitting in plain warm water for about 10 minutes – can also provide some relief.

With these measures, the pain and swelling of most symptomatic hemorrhoids will decrease in two to seven days, and the firm lump should recede within four to six weeks. In cases of severe, persistent pain, your surgeon may elect to remove the hemorrhoid containing the clot with a small incision. Performed under local anesthesia as an outpatient, this procedure generally provides relief.

Severe hemorrhoids may require special treatment, much of which can be performed on an outpatient basis.

Ligation – The rubberband treatment – works effectively on internal hemorrhoids that protrude with bowel movements. A small rubberband is placed over the hemorrhoid, cutting off its blood supply. The hemorrhoid and the band fall off in a few days and the wound usually heals in a week or two. This procedure sometimes produces mild discomfort and bleeding.

Injection and Coagulation can also be used on bleeding hemorrhoids that do not protrude.
Both methods are relatively painless and cause the hemorrhoid to shrivel up.

Hemorrhoidectomy – surgery to remove the hemorrhoids – is the best method for the permanent removal of hemorrhoids. It is necessary when (1) clots repeatedly form in external hemorrhoids; (2) ligation fails to treat internal hemorrhoids; (3) the protruding hemorrhoid cannot be reduced; or (4) there is persistent bleeding. A hemorrhoidectomy removes excessive tissue that causes the bleeding and protrusion. It is done under anesthesia and may, depending upon circumstances, require hospitalization and a period of inactivity. Laser hemorrhoidectomies do not offer any advantage over standard operative techniques. They are also quite expensive, and contrary to popular belief, are no less painful.

Surgical Associates of Palm Beach County / Boca Care (SAPBC) is a multi-specialty surgical group practice with expertise in General, Breast, Vascular, Endovascular, Thoracic, Colon Rectal, and Surgical Oncology. Our office is located in Boca Raton Florida.

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