HEMORRHOIDS (PART 2)

Diagnosis of Hemorrhoids

Diagnosis of hemorrhoids is usually made by history and physical examination by the doctor. Depending upon the situation, past medical history, medications and stability of the patient, treatment may follow with no further testing.

Inspection of the anus and a digital rectal examination are often performed. Sometimes anoscopy may be required where a small, lighted scope is introduced into the anus to examine the inner lining of the anus and rectum. The procedure is often performed in the doctor’s office without sedation. If there is the potential that the bleeding source originated above the rectum from other parts of the colon, tests by a gastroenterologist may be recommended.

Hemorrhoid Treatment

Self-Care at Home

Fortunately, many effective options are available to treat hemorrhoids. Most people can get relief from symptoms using home treatments and lifestyle changes.

1. Warm Sitz Baths

       Sitting in a few inches of warm water (not hot water) three times a day for 15-20 minutes may help decrease the inflammation of the hemorrhoids. It is important to dry off the anal area completely after each Sitz bath to minimize irritation of the skin surrounding the anus.

2. Dietary Changes

       Increased fluid intake and dietary fiber (roughage) will decrease the potential for constipation and lessen the pressure on the rectum and anus during a bowel movement, minimizing further swelling, discomfort, and bleeding. Dietary fiber supplements may also help bulk up the stools.

3. Stool Softeners

       Stool softeners may help but once hemorrhoids are present, liquid stools may cause inflammation and infection of the anus. Your doctor and pharmacist are good resources to discuss their use.

4. Activity Suggestions

       Individuals with hemorrhoids should not sit for long periods of time and may benefit from sitting on an air or rubber donut available at some pharmacies.

Exercise is helpful in relieving constipation and in decreasing pressure on the hemorrhoidal veins. Individuals should be encouraged to have a bowel movement as soon as possible after the urge arises. Once that urge passes, stools can become constipated and straining with a bowel movement may occur.

5. Over-the-Counter Medications

Many creams, ointments, and suppositories are available for symptom relief and may be used for comfort. However, they do not "cure" hemorrhoids. Analgesics like paracetamol may reduce pain. Avoid taking Ibruprofen and aspirin because they may worsen bleeding.

Medical Treatment

·         Prolapsed Internal Hemorrhoids

Most prolapsed internal hemorrhoids can be pushed back into the anus but occasionally your doctor may need to reduce them by gently pushing them with constant pressure.

If the hemorrhoids remain swollen and trapped outside the anus and nothing is done about it, the hemorrhoid tissue may not receive enough blood and can become infected. In such situations, surgery may be required to resolve the problem.

·         Thrombosed Hemorrhoids

Thrombosed external hemorrhoids can be extremely painful and are associated with a hard lump that is felt at the anus and cannot be pushed back inside. Most often the clot within the hemorrhoid will need to be removed with a small incision.

There may be some mild bleeding from the hemorrhoid for a couple of days. Sitz baths and over-the-counter pain medications may be recommended.

Sitting on a rubber or air rubber donut may help relieve the pain as well.

Preventing constipation is also a priority.

Surgical Treatment

A variety of surgical options exist for persistent pain or bleeding.

·         Rubber band ligation: Here the surgeon places a couple of tight rubber bands around the base of the hemorrhoidal vein causing it to lose its blood supply. Rubber band ligation of internal hemorrhoids can be done in the doctor’s office on an outpatient basis.  

·    Sclerotherapy: Sclerotherapy describes a procedure when a chemical is injected into the hemorrhoid causing it to scar.

·         Laser therapy: Laser therapy can be used to scar and harden internal hemorrhoids.

·      Hemorrhoidectomy: Hemorrhoidectomy is a surgical procedure done in the operating room with an anesthetic agent (general, spinal or local with sedation) where the whole hemorrhoid is removed (ectomy=removal). This is the most aggressive approach and there is a markedly decreased chance of the hemorrhoids returning. However, there is also an increase in the complication rate.

·         Stapled hemorrhoidectomy: Stapled hemorrhoidectomy is the newest surgical technique for treating hemorrhoids, and it has rapidly become the treatment of choice for third-degree hemorrhoids. Stapled hemorrhoidectomy is faster than traditional hemorrhoidectomy, taking approximately 30 minutes. It is associated with much less pain than traditional hemorrhoidectomy and patients usually return earlier to work.

Regardless of the surgery, Sitz baths and dietary suggestions for increased roughage are usually recommended.

Prevention of Hemorrhoids

·      Avoid sitting for many hours at a time, take a break and walk around for at least five minutes.

·         Regular exercise will help to keep your weight in check and make constipation less likely and at the same time improve your muscle tone.

·         Drink at least 8 glasses of water each day; more if you lead a very active lifestyle.

·         Watch your salt intake as excess salt may result in fluid retention which causes swelling of veins including hemorrhoids.

·         Eating a high fiber diet especially lots of fruits and vegetables will help prevent constipation.

·         Avoid straining when passing faeces.

·         Avoid toilet paper that is to irritating, try dampening it first or use alcohol free baby wipes.

·         Good anal hygiene is also very important in preventing hemorrhoids.

Dr. Olukayode Williams