All About Hemorrhoids – An Affliction Affecting Many Of Us

October 10, 2022 at 9:14 p.m.


This past week has been more busy than usual as I am currently helping to write an article for Quality Progress magazine, a foreword for a new packaging handbook and my usual column.  

For the latter, I could say because I am behind in my work, this would be a good time to provide a column about hemorrhoids.  

Hemorrhoids  (piles) is one topic that rarely comes up in conversation yet afflicts a large proportion of Americans.  According to the New York Times, at least half of U.S. adults over 50 have endured unpleasant symptoms from these swollen clusters of blood vessels in their butts.

What Are They?

Hemorrhoids are actually swollen, inflamed veins around the anus or the lower part of your rectum.  There are two types, external and internal.  External hemorrhoids form under the skin around the anus and internal hemorrhoids form in the lining of the anus and lower rectum.

Categories

Doctors categorize internal hemorrhoids in stages one to four, depending on their physical characteristics and severity.  For minor hemorrhoids — grade 1, which don’t protrude outside the anus, and grade 2 hemorrhoids which may protrude but then go back in by themselves. Grade 3 means the hemorrhoid protrudes but can be manually pushed back in, and grade 4 is when the hemorrhoid is constantly outside of the anus.  Grades 3 and 4 may require surgery.

Causes

Hemorrhoids occur when there is too much pressure on the veins around the anus.  This can be caused by straining during bowel movements, sitting on the toilet for long periods of time, chronic constipation, low fiber diet, weakening of the supporting tissues in your anus and rectum which can happen with aging and pregnancy or frequently lifting heavy objects.

Symptoms

It is only when hemorrhoids become engorged (swollen) and inflamed that they can cause unpleasant symptoms. They can include anal itching, burning, bleeding, anal pain when sitting and sometimes protrusion outside of the body.  But even if you have symptoms, rectal bleeding and pain can be caused by other problems. This includes anal fissures (tears in the anus), anal fistulas (infected tunnels between the anus and skin) and rectal cancer. Too much straining, rubbing or cleaning around the anus can make the symptoms even worse. If the symptoms do not ease, an office-based procedure can help.

Treatment

You can treat symptoms at home by eating foods that are high in fiber. (Most commercial foods contain the percentage of fiber.) Others include taking a stool softener or a fiber supplement and drinking enough fluids each day. Do not strain during bowel movements or sit on the toilet for long periods of time. It helps to take warm Epsom salt baths for 15 minutes several times a day to relieve pain.   

Using over-the-counter hemorrhoid creams, ointments or suppositories can help relieve mild pain, swelling and itching of external hemorrhoids.

According to the New York Times, OTC products often do not help as much as people expect them to.  They might briefly ease symptoms, but do not resolve the underlying problem.

Pregnant women with hemorrhoids should talk to their physicians about safe treatment options. One popular treatment is rubber band ligation, in which the doctor uses a tool to place a rubber band around the base of the hemorrhoid, which stops blood flow to the inflamed tissue and causes it to die and fall off within one to four days. It is fast, relatively painless and requires very little downtime for the patient, although multiple treatments may be required.  

Another less common office treatment is infrared photocoagulation, in which the physician uses infrared light to cut off blood supply to the bothersome tissue, causing it to shrink.

When To See A Doctor

You should see a doctor if you still have symptoms after one week of at home treatment. In addition, consult a doctor when you have bleeding from the rectum. It is important to know that other conditions can also cause bleeding, including Crohn’s disease, ulcerative colitis, colorectal and anal cancer.

Can Hemorrhoids Be Prevented?

You can help prevent hemorrhoids by taking the following steps:  (1) eat foods that high in fiber, (2) taking a stool softener or a fiber supplement (e.g. Metamucil), (3) drinking enough fluids every day, (4) not straining during bowel movements and (5) not sitting on the toilet for long periods of time.

Final Thoughts

 On a personal note and because of my age, I keep a Fleet’s enema, Dulcolax suppositories and tablets and a stool softener in my medicine cabinet for emergencies due to constipation.

Max Sherman is a medical writer and pharmacist retired from the medical device industry.  His new book “Science Snippets” is available from Amazon and other book sellers. It contains a number of previously published columns.  He can be reached by email at  [email protected]

This past week has been more busy than usual as I am currently helping to write an article for Quality Progress magazine, a foreword for a new packaging handbook and my usual column.  

For the latter, I could say because I am behind in my work, this would be a good time to provide a column about hemorrhoids.  

Hemorrhoids  (piles) is one topic that rarely comes up in conversation yet afflicts a large proportion of Americans.  According to the New York Times, at least half of U.S. adults over 50 have endured unpleasant symptoms from these swollen clusters of blood vessels in their butts.

What Are They?

Hemorrhoids are actually swollen, inflamed veins around the anus or the lower part of your rectum.  There are two types, external and internal.  External hemorrhoids form under the skin around the anus and internal hemorrhoids form in the lining of the anus and lower rectum.

Categories

Doctors categorize internal hemorrhoids in stages one to four, depending on their physical characteristics and severity.  For minor hemorrhoids — grade 1, which don’t protrude outside the anus, and grade 2 hemorrhoids which may protrude but then go back in by themselves. Grade 3 means the hemorrhoid protrudes but can be manually pushed back in, and grade 4 is when the hemorrhoid is constantly outside of the anus.  Grades 3 and 4 may require surgery.

Causes

Hemorrhoids occur when there is too much pressure on the veins around the anus.  This can be caused by straining during bowel movements, sitting on the toilet for long periods of time, chronic constipation, low fiber diet, weakening of the supporting tissues in your anus and rectum which can happen with aging and pregnancy or frequently lifting heavy objects.

Symptoms

It is only when hemorrhoids become engorged (swollen) and inflamed that they can cause unpleasant symptoms. They can include anal itching, burning, bleeding, anal pain when sitting and sometimes protrusion outside of the body.  But even if you have symptoms, rectal bleeding and pain can be caused by other problems. This includes anal fissures (tears in the anus), anal fistulas (infected tunnels between the anus and skin) and rectal cancer. Too much straining, rubbing or cleaning around the anus can make the symptoms even worse. If the symptoms do not ease, an office-based procedure can help.

Treatment

You can treat symptoms at home by eating foods that are high in fiber. (Most commercial foods contain the percentage of fiber.) Others include taking a stool softener or a fiber supplement and drinking enough fluids each day. Do not strain during bowel movements or sit on the toilet for long periods of time. It helps to take warm Epsom salt baths for 15 minutes several times a day to relieve pain.   

Using over-the-counter hemorrhoid creams, ointments or suppositories can help relieve mild pain, swelling and itching of external hemorrhoids.

According to the New York Times, OTC products often do not help as much as people expect them to.  They might briefly ease symptoms, but do not resolve the underlying problem.

Pregnant women with hemorrhoids should talk to their physicians about safe treatment options. One popular treatment is rubber band ligation, in which the doctor uses a tool to place a rubber band around the base of the hemorrhoid, which stops blood flow to the inflamed tissue and causes it to die and fall off within one to four days. It is fast, relatively painless and requires very little downtime for the patient, although multiple treatments may be required.  

Another less common office treatment is infrared photocoagulation, in which the physician uses infrared light to cut off blood supply to the bothersome tissue, causing it to shrink.

When To See A Doctor

You should see a doctor if you still have symptoms after one week of at home treatment. In addition, consult a doctor when you have bleeding from the rectum. It is important to know that other conditions can also cause bleeding, including Crohn’s disease, ulcerative colitis, colorectal and anal cancer.

Can Hemorrhoids Be Prevented?

You can help prevent hemorrhoids by taking the following steps:  (1) eat foods that high in fiber, (2) taking a stool softener or a fiber supplement (e.g. Metamucil), (3) drinking enough fluids every day, (4) not straining during bowel movements and (5) not sitting on the toilet for long periods of time.

Final Thoughts

 On a personal note and because of my age, I keep a Fleet’s enema, Dulcolax suppositories and tablets and a stool softener in my medicine cabinet for emergencies due to constipation.

Max Sherman is a medical writer and pharmacist retired from the medical device industry.  His new book “Science Snippets” is available from Amazon and other book sellers. It contains a number of previously published columns.  He can be reached by email at  [email protected]

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