Hemorrhoids

Hemorrhoids (or piles) are swollen veins in the lower rectum and anus, the opening at the end of the rectum through which a bowel movement passes. Veins around the anus tend to stretch under pressure. Hemorrhoids are one of the most common problems of the lower digestive tract.

There are two types of hemorrhoids:

• Internal hemorrhoids
  are caused by a set of veins found about an inch inside the rectum. They are painless and sometimes cause a lot of bleeding. These internal veins can stretch and even fall down (prolapse) through the anus to the outside of the body. The veins may then become irritated and painful. Most hemorrhoids are nonprolapsing and internal
• External hemorrhoids
  can easily be seen or felt. When the swollen veins are scratched or broken by straining or rubbing, they begin to bleed. External hemorrhoids may also protrude, or prolapse, through the anus.

How do hemorrhoids occur?
Hemorrhoids occur as a result of too much pressure on the veins in the rectum. Factors that contribute to increased pressure in these rectal veins include:

• Straining during a bowel movement
• Holding back or delaying the urge to empty the bowels
• Diarrhea
• Sitting for a long time on the toilet, which causes strain on anal structures
• Pregnancy and the strain of childbirth
• Obesity
• Coughing and sneezing for long periods of time
• Sitting for long periods of time
• Liver disease

Pregnant women should do their best to avoid constipation because pregnancy is associated with a tendency to have hemorrhoids. In the last trimester of pregnancy, the enlarged uterus pressing on blood vessels in the anal area can cause hemorrhoids. Also, the strain of childbirth itself sometimes leads to postpartum hemorrhoids.

Flare-ups of hemorrhoids may occur during periods of stress or as a result of the overuse of alcohol. Flare-ups can range from mild to severe.

What are the symptoms of hemorrhoids?

• Itching, mild burning, and bleeding from the anus
• Swelling and pain during bowel movements (in inflamed prolapsing hemorrhoids)
• Painful lumps varying in size from a pea to a walnut around the anus from a blood clot (in severe cases of external hemorrhoids)

How are hemorrhoids diagnosed?
Your doctor will examine your rectum and anus with a gloved hand. He or she will also want to examine your rectum using a proctoscope or anoscope, which are hollow, lighted viewing instruments.

Your doctor will want to investigate rectal bleeding thoroughly. Usually rectal bleeding is from hemorrhoids. However, there are other, potentially dangerous causes of rectal bleeding such as a colonic polyp or colon cancer, which your doctor will want to rule out.

How are hemorrhoids treated?
The following approach will usually help to relieve most cases of hemorrhoids.

A high-fiber diet:
You will want to eat more high-fiber foods, which will help you from becoming constipated. Good sources of fiber include whole fresh fruit, raw or cooked vegetables (especially asparagus, cabbage, carrots, corn, and broccoli), and whole-grain cereals with bran.

Fluids:
It is important to drink plenty of fluids, especially water. Drink six to eight 8-oz. glasses of fluid (not alcohol) a day. Fluid helps to assure looser stools that are easier to pass.

Sitz baths and cold packs:
Sitting in lukewarm water two or three times a day for 15 minutes cleans the area and may relieve the discomfort of hemorrhoids. Also, you might try putting cold packs on the anus to relieve the pain.

Rest:
Raise your bottom when you are resting if you have external thrombosed or prolapsed hemorrhoids.