Hemorrhoids

GENERAL INFORMATION:

What are hemorrhoids? Hemorrhoids are blood vessels surrounded by cushions of skin tissue inside your anus or rectum. Your anus is the opening where the stool from your bowel movements (BM) leaves your body. Your rectum is the lower part of your bowel just behind your anus. You may have hemorrhoids disease when these blood vessels become swollen and slip out of place. Hemorrhoid disease can occur inside your rectum (internal hemorrhoids), around your anus (external hemorrhoids), or both (mixed hemorrhoids). Sometimes a hemorrhoid may prolapse, which means it extends out of your anus. Having your hemorrhoids treated may make them smaller and less painful. Your hemorrhoids may be removed or may go back inside your rectum.

What causes hemorrhoids? Certain factors may increase your risk of having hemorrhoids:

• Frequent or prolonged straining (pushing): You may strain during a bowel movement when your stools are hard and dry. Not having enough fiber in your diet may cause your stools to be hard. You may also strain if your bowel movements are loose and watery.
  
  
• Increased pressure inside your abdomen: You may have increased pressure in your abdomen if you are pregnant or have recently had a baby. You may also have increased pressure inside your stomach, such as too much fluid.
  
  
• Weakness of skin tissue around the rectum and anal canal: The skin tissue in your rectum and anal canal may become weaker as you get older. You may also have been born with a condition that makes your anal area weak.
  
  
• Other possible causes: Sometimes, people who have anal intercourse (sex) get hemorrhoids. You may also get hemorrhoids if you do not clean your anus well enough.

What are the signs and symptoms of hemorrhoids? You may have any of the following:

• Bleeding from your anus. You might see bright red blood in your stool. You might also see blood on your toilet paper or in the toilet bowl.
  
  
• Bulging of skin tissue out of your anus.
  
  
• Discharge of a thick fluid from your anus.
  
  
• Incontinence (being unable to control your urine or bowel movements).
  
  
• Inflammation (swelling and redness) around your anus.
  
  
• Itching around your anus.
  
  
• Pain inside your rectum or around your anus.

How are hemorrhoids diagnosed? Your caregiver will ask you about your symptoms. He will ask you how long you have had your symptoms and what they feel like. He may also ask about your diet and your bowel movements. Your caregiver will ask whether you have had problems with your bowels before. He may also ask you if anyone in your family has had bowel problems, including cancer. Your caregiver will then look at your anus to check for swollen blood vessels. Your caregiver may do certain tests and look for other causes of rectal bleeding. You may need the following:

• Digital rectal exam (DRE): During a DRE, your caregiver will put a gloved finger inside your anus to feel for hemorrhoids. He will use lubrication, which is a gel-like substance that helps his finger gently enter your anus.
  
  
• Anoscopy: This test helps your caregiver look inside your anus and rectum. During this test, a clear jelly-like lotion is put onto a short plastic or metal tube. The tube is then gently put into your anus and up the rectum.

How are hemorrhoids treated? Hemorrhoids may be treated at home, in your caregiver's office, or at the hospital.

• At home: Your caregiver may ask you to eat more high-fiber foods and drink more liquids. This will help soften your stool to prevent you from straining during your BM. Your caregiver may also tell you to put ice on your hemorrhoid to decrease pain and swelling. Your caregiver may tell you to soak in a warm tub or take a sitz bath. A sitz bath is a pan that fits on the toilet bowl with warm water in it. Your caregiver may give you medicines that you put on your skin to help decrease pain and swelling. You may also need medicine to soften your stools.
  
  
• At your caregiver's office: Your caregiver may decide you need a procedure that causes the hemorrhoid to return to the rectal wall. These procedures may also cause the hemorrhoid to break off from the rectal wall entirely. Photocoagulation uses special light to stop blood flow to your hemorrhoids and shrink them. During rubber band ligation, your caregiver will place a rubber band around your hemorrhoids to stop blood flow. During sclerotherapy, a special chemical will be given as a shot into your hemorrhoids to make them smaller. Your caregiver may insert a long, thin tube into your rectum. This tube has a camera on one end to help your caregiver see your hemorrhoids better.
  
  
• At the hospital: If other treatments do not work, or if your hemorrhoids get worse, you may need surgery. A hemorrhoidectomy is surgery to remove your hemorrhoids or to cut off blood flow to make them shrink. A stapled hemorrhoidopexy procedure removes your hemorrhoids using special staple wires. Ask your caregiver for more information about surgery choices and other procedures.

What are the risks of having my hemorrhoids treated? Treatment for hemorrhoids may cause pain, infection, or incontinence. After a rubber band ligation, the band may slip out or cause a tear in skin tissue. Surgery may cause scarring or cause damage to the tissue in your anal canal or rectum. Sclerotherapy may cause liver problems. It may also make it hard for some males to have an erection. With all of these treatments, you may have bleeding that is not easily stopped. Without treatment, your hemorrhoids may become bigger, more painful, or develop a blood clot. Call your caregiver if you have questions or concerns about your condition, treatment, or care.

How can I decrease my chances of getting hemorrhoids?

• Bowel habits. Avoid pushing too much during a BM. Avoid reading on the toilet or otherwise sitting on the toilet too long. Also, be sure to clean your anus after each BM.
  
  
• Exercise. Exercise such as walking may be good for your health and make it easier to have a BM.
  
  
• Fiber. Foods high in fiber such as fruits, vegetables, and whole grains may help prevent hemorrhoids. Ask your caregiver if you should change your diet.
  
  
• Intercourse (sex). Avoid anal intercourse.
  
  
• Liquids Follow your caregiver’s advice if you should change the amount of liquid you drink.

When should I call my caregiver? Call your caregiver if:

• You have frequent and painful bowel movements.
  
  
• You notice blood in the toilet bowl or on the toilet paper after a BM.

When should I seek immediate help? Seek care immediately or call 911 if:

• You have very bad pain in your rectum or around your anus.
  
  
• You have bleeding from your anus that does not stop.

Where can I find support and more information? Contact the following:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• American Society of Colon and Rectal Surgeons
  85 W. Algonquin Rd., Suite 550
  Arlington Heights, IL 60005
  Phone: 1-847-290-9184
  Web Address: http://www.fascrs.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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