Everyone has hemorrhoids, but we don’t usually refer to them as such until they become problematic. Hemorrhoids are blood vessels located around the outside of the anus and extending inside the anal canal approximately 2 inches. These blood vessels can pull away from the internal wall of the rectum, becoming dilated, overfilled with blood and can create an obstacle for stool to normally pass through the rectum.
- Chronic constipation, diarrhea, straining during bowel movements
- Advanced age
- Heavy Lifting
- Prolonged sitting
- Overuse of laxatives
- Spending long periods of time on the toilet
There are two types of hemorrhoids—internal and external.
- Internal hemorrhoids are usually not painful but may bleed. Sometimes, an internal hemorrhoid may stretch, pushing through the anus, becoming “prolapsed.” A prolapsed hemorrhoid can retreat inside the rectum on its own, or it can be gently pushed back in. If the prolapsed hemorrhoid cannot be pushed back inside, they could possibly lead to painful, external hemorrhoids. Consult with your gastroenterologist about treatment options.
- External hemorrhoids are caused by untreated internal hemorrhoids. The pain is caused by the vein developing a blood clot and becoming “thrombosed.” The clot pushes against the very sensitive skin and nerves around the anus causing pain and itching, sometimes causing cracking and bleeding. You may see bright red blood on the toilet paper or in the toilet after a bowel movement. (Remember, ANY type of rectal bleeding should ALWAYS be evaluated by a physician. Don’t assume it’s “just a hemorrhoid.”)
- Until you can be seen for treatment, the pain and pressure of thrombosed hemorrhoids can be minimized by taking an over-the-counter pain reliever, taking a warm sitz bath several times per day, and taking stool softeners to minimize pressure on the tissue.
- While many treatment techniques exist, the best is removal of problematic hemorrhoids. A quick and effective method for treating internal hemorrhoids is rubber band ligation. This quick, in-office procedure uses a rubber band to stop blood flow at the hemorrhoid’s base. The hemorrhoid will fall off within a couple of days.
- External thrombosed hemorrhoids may require a minor surgical procedure performed in the gastroenterologist’s office to relieve pain and pressure. Your GI specialist will discuss the most effective treatment options for you.
The best way to prevent hemorrhoids is to keep stools soft, so they pass easily. Try these tips to keep your digestive system running smoothly:
- Drink plenty of fluids—Drink six to eight glasses of water and other healthy liquids (not alcohol) each day.
- Eat high-fiber foods—Eat more fruits, vegetables and whole grains.
- Consider fiber supplements—If you are unable to get the recommended 20-30 grams of daily fiber in your diet. When adding fiber supplements, do it slowly. Start with half the starting dose and work your way up to a full dose. When adding fiber to your diet, increased fluid intake is critical. Increasing fiber without increasing fluid intake can cause or worsen constipation.
- Don’t strain—Straining and holding your breath when trying to pass a stool creates pressure in the veins in the lower rectum.
- Use the restroom as soon as you feel the urge—If you wait to pass a bowel movement and the urge goes away, your stool can become drier and more difficult to pass.
- Do not sit on the toilet for more than about 2 minutes—If you cannot complete evacuation in that time, get up and try again later.
- Exercise—Staying active can help prevent constipation and reduce pressure on veins, which can occur during long periods of standing or sitting. Exercise also helps you lose excess weight that might contribute to hemorrhoids.
- Avoid long periods of sitting—Staying seated too long, particularly on the toilet, increases pressure on the veins in the anus and can lead to hemorrhoids.
Most major medical insurance plans cover hemorrhoid treatment, but checking your individual plan and coverage is always the best practice. However, don’t postpone hemorrhoid treatment—especially if you’re experiencing symptoms that aren’t relieved by home treatments such as over-the-counter pain medications, changing your diet, taking fiber supplements or taking warm baths.