Hemorrhoids.

What Are Hemorrhoids?

Hemorrhoids are swollen veins. Each of us has veins around the anus that tend to stretch under pressure, somewhat like varicose veins in the legs. When these veins swell, we call them "hemorrhoids." One set of veins is inside the rectum (internal), and another is under the skin around the anus (external). (See figure 1.)

Hemorrhoids are also known as "piles." As a rule, they do not cause pain or bleeding. Problems can occur, however, when these veins become swollen because pressure is raised in them. Increased pressure may result from straining to move your bowels, from sitting too long on the toilet, or from other factors such as pregnancy, obesity, or liver disease.

What Are the Symptoms of Hemorrhoids?

The only sign you may notice from internal hemorrhoids is bright red blood on the toilet paper or in the toilet bowl. Sometimes, however, these veins stretch, and may even fall down (prolapse) through the anus to outside the body (protruding hemorrhoids). (See figure 2.) When this happens, the vein may become irritated and painful.

The set of veins around the anus causes problems when blood clots form in them, and they become large and painful. (These are called thrombosed external hemorrhoids.) You may notice bleeding and a tender lump on the edge of the anus. Bleeding starts when the swollen veins are scratched or broken by straining or rubbing. People who have external hemorrhoids may feel itching at the anus too. This might result from draining mucus and irritation caused by too much rubbing or cleaning of the anus.

How Common Are Problems With Hemorrhoids? Hemorrhoidal problems are very common in men and in women. About half of people have hemorrhoids to some extent by the age of 50. Many people have bleeding from hemorrhoids sometimes, but most often it is not serious. Women may begin to have problems during pregnancy. The pressure of the fetus in the abdomen, as well as hormonal changes, cause hemorrhoidal veins to enlarge. These veins are also placed under severe pressure during the birth of the baby. For most women, however, such hemorrhoids are a temporary problem.

What Is the Treatment?

Often all that is needed to reduce symptoms is to include more fiber in your diet to soften the stool. Eat more fresh fruits, leafy vegetables, and whole grain breads and cereals (especially bran). Drinking six to eight glasses of fluid (not alcohol) each day will also help. Softer stools make it easier to empty the bowels and lessen pressure on the veins.

Good hygiene is also important. Bathe the anus gently after each bowel movement using soft, moist toilet paper or a commercial moist pad. Avoid a lot of wiping. If necessary, you can even use the shower as an alternative to wiping. After bathing, dry the anus gently.

When Do I Need To See My Doctor?

It is a good idea to see your doctor anytime you see bleeding from the anus. This is important to make sure you don't have cancer or some other disease of the digestive system. You will need an examination of your anus and rectum, and possibly further examination of the bowel. If the doctor finds hemorrhoids, you may be advised to change your diet, or to use a laxative that provides fiber and softens the stool. Your doctor might only recommend ice, warm soaks (sitz baths), or rest in bed.

If you know you are having pain from hemorrhoids, you might try putting cold packs on the anus, followed by a sitz bath, three or four times a day. To protect against irritation, cleanse the anus carefully and apply zinc oxide paste (or powder) or petroleum jelly to the area. Medicated suppositories are also available at the drug store. Any of these home treatments may relieve the symptoms, and no other treatment may be needed. If symptoms persist, see your doctor.

In some cases, internal hemorrhoids that have fallen outside of the anus (prolapsed), or that bleed too much, must be removed. Your doctor may be able to remove them during an outpatient visit to his office or to the hospital.

A number of methods besides the usual surgery with a scalpel can be used to remove or reduce the size of hemorrhoids. The surgeon may decide to use a technique in which a rubber band is. put around the base of the hemorrhoid. The band cuts. off circulation, and the hemorrhoid withers away within a few days. This technique is used only for internal hemorrhoids. Sometimes a chemical is injected around the vein to shrink the hemorrhoid. Other methods include the use of freezing, electrical or laser heat, or infrared light to destroy the hemorrhoidal tissue.

How Can You Prevent Hemorrhoids?

The best way to prevent the problem is to pass your bowel movements as soon as possible after the urge occurs. Also, don't sit on the toilet too long. This is the only time that the anus truly relaxes, allowing the veins there to fill with blood. The longer you sit, the longer pressure is put on the hemorrhoids. To avoid constipation, be active. Move around, walk, exercise to help move the stools through your body. Also, adding fiber to your diet reduces straining by helping to produce stools that are softer and easier to pass.

Remember, hemorrhoids usually do not pose a danger to your health. In most cases, hemorrhoidal symptoms will go away naturally within a few days.

Additional Reading

About Intestinal Disorders. 1982. This pamphlet, illustrated with simple drawings, describes the functioning of the digestive tract and various digestive ailments including hemorrhoids. Available from Channing L. Bete Company, Inc., 200 State Road, South Deerfield, Massachusetts 01373.

Bleeding in the Digestive Tract. 1986. This fact sheet discusses many common causes of bleeding in the digestive tract and related diagnostic procedures and treatment. Available from the National Digestive Diseases Information Clearinghouse, Box NDDIC, Bethesda, Maryland 20892.

Finkel, Asher J., and Jeffrey R.M. Kunz, editors. The American Medical Association Family Medical Guide. New York: Random House. 1987. General medical guide with sections on hemorrhoids and other digestive diseases. Widely available in libraries and bookstores.

Rosenfeld, Isadore. Second Opinion: Your Comprehensive Guide to Treatment. New York: Bantam Books. 1988. General medical guide with sections on hemorrhoids and other digestive diseases. Available in many libraries.

Same Day Surgery:- Rectal Procedures. 1985. This pamphlet describes rectal surgery procedures, including removal of hemorrhoids. Available from Krames Communications, 312 90th Street, Daly City, California 94501.

Smith, Lee E. "Hemorrhoids: A Review of Current Techniques and Management." Gastroenterology Clinics of North America, 16:1 (March 1987) 79-91. This review article for physicians is written in technical language. Available in medical libraries.

National Digestive Diseases Information Clearinghouse

Box NDDIC

Bethesda, Maryland 20892

[phone]

The National Digestive Diseases Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, under the U.S. Public Health Service. The clearinghouse was begun by Congress to focus a national effort on providing information to the public, patients and their families, and doctors and other health care workers. The clearinghouse works with organizations to educate people about digestive health and disease. The clearinghouse answers inquiries; develops, reviews, and sends out publications; and coordinates informational resources about digestive diseases.

Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, appropriateness of content, and readability. Publications produced by sources other than the clearinghouse also are reviewed for scientific accuracy and are used, along with clearinghouse publications, to answer requests.

This publication is not copyrighted. The clearinghouse urges users of this fact sheet to duplicate and distribute as many copies as desired.

This fact sheet was prepared by Jim Fordham, M.A. Office of Health Research Reports National Institute of Diabetes and Digestive and Kidney Diseases NIH Publication No. 89-3021 January 1989