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How to Avoid the Hurt of Hemorrhoids: Adopt lifestyle changes to prevent the pain of piles, and tell your doctor about bleeding or other symptoms.

Hemorrhoids aren't something you talk about. They aren't the stuff of polite dinner conversation or the reason to give your buddy a high-five at the gym.

Yet, everyone has them, although you might not realize it. It's not until hemorrhoids cause symptoms that they begin to affect your daily life. They literally can be a pain in the butt, making sitting difficult and bathroom visits an ordeal. And, they can have you seeing red (on the toilet paper) when they bleed.

"Hemorrhoids are normal structures. Everyone has them," says James Church, MD, with Cleveland Clinic's Department of Colorectal Surgery. "Although hemorrhoids are normal, it's not normal for them to cause symptoms."

In many instances, symptomatic hemorrhoids can be managed and even prevented with changes to your diet and bowel habits, along with simple over-the-counter treatments. But first, you need to find out the reason for your symptoms and rule out other, potentially more serious causes.

How Hemorrhoids Happen

Hemorrhoids are swollen veins, similar to varicose veins that occur in the legs, that form in the anus and the lower part of the rectum. Medical experts categorize hemorrhoids as follows:

* External hemorrhoids are a plexus of veins that form under the skin around the anus. Also known as piles, these hemorrhoids can itch and bleed. They can pose a particular problem when they rupture and a blood clot develops, creating a thrombosed hemorrhoid that causes severe pain, swelling, inflammation and a hard lump in the anus.

* Internal hemorrhoids are "cushions" containing arteries and veins that form under the lining of the lower rectum, just above the anus. Normally, these hemorrhoids cannot be seen or felt, nor do they cause pain.

However, they fill with blood whenever you sit on the toilet and can bleed when you bear down to pass a stool.

Internal hemorrhoids are held in place in the rectal lining by small fibrous bands of tissue. Over time, these bands can become lax or break, causing the hemorrhoid to fall, or prolapse, outside the anus. This prolapse can allow mucous and some stool to leak from the anus and cause itchiness and slight incontinence. Usually, the hemorrhoid moves back on its own into the rectum or can be pushed back in with no difficulty.

"Most often, they prolapse a little, they bleed, and they can be a little painful if they come down too far," Dr. Church explains. "Sometimes you can't push them up. That's really an emergency because the hemorrhoids can become gangrenous and life threatening."

Help for Hemorrhoids

As is the case for just about any medical condition, the best treatment for hemorrhoids is prevention. Oftentimes, avoiding constipation by consuming sufficient dietary fiber and fluids, coupled with making other lifestyle and behavioral changes, can prevent an initial or recurrent episode of hemorrhoids or lessen their severity (see What You Can Do for tips).

In addition, you can try simple at-home treatments--such as an over-the-counter hemorrhoidal cream, like Preparation H, suppositories containing hydrocortisone or lidocaine, and the astringent witch hazel--to help ease itching and burning. Soaking in a sitz bath or bathtub filled with warm water can provide relief as well. And, you can reduce swelling and inflammation by applying ice to your anal region--Dr. Church recommends sitting on a package of frozen peas.

To provide relief from a throm-bosed external hemorrhoid, a doctor can remove and drain the blood clot during a simple in-office procedure. For bothersome internal hemorrhoids, the physician may recommend another type of office-based procedure, such as rubber band ligation, in which tiny rubber bands placed at the base of the hemorrhoid cut off its circulation, causing it to shrivel and fall off. Other in-office treatments entail injecting a sclerosing agent into the hemorrhoid to shrink it or targeting the hemorrhoid with laser or infrared light to make it shrivel.

Surgery to remove more problematic hemorrhoids is necessary in only about 5 percent of cases, Dr. Church explains. The operation may be done on an outpatient basis or may require a hospital stay.

The key, he emphasizes, is not to put off seeking help for bothersome hemorrhoids.

"If you have prolapsing or slightly bleeding internal hemorrhoids, you might just put up with them. People might be scared that the doctor ultimately will want to cut the hemorrhoids out, which is painful, so they'll put up with internal hemorrhoids for years," Dr. Church says. "One of the common remarks that patients say to me after surgery is, 'I wish I hadn't waited that long. I feel so much better now, and I've put myself through all these years of misery for no good reason.'"

If You See Red, Don't Ignore It

If you notice bright-red blood on the toilet paper and you strain to pass stool, your anus is sore, or you can feel a lump there, chances are the blood is coming from a hemorrhoid, Dr. Church notes.

However, if you have no pain or other hemorrhoid symptoms and you notice darker-colored blood or blood in your stool, it's more likely to be a sign of a more serious problem, such as anal cancer or colorectal cancer or polyps.

Regardless, see your physician if you experience any rectal or anal bleeding. Based on your symptoms, your physician may recommend a colonoscopy to determine the cause of any bleeding, especially if you haven't had a colonoscopy recently.

"All bleeding needs to be checked out. You can't assume anything," Dr. Church cautions. "You can triage the bleeding according to the color, where it is and whether there's something going on in the anus as well, but it's not an excuse not to get it checked out.... If it's cancer, a six-month delay by assuming it's hemorrhoids can be the difference between life and death."


* Don't put off the urge to go to the bathroom. "What men do is they get the urge but don't want to go," Dr. Church says. "They put off the bathroom trip. They then go later, when the urge is not so strong. Now, they have to bear down and strain and push as hard as they can, and that is really going to destroy the anus. Hemorrhoids will prolapse and continue to get worse."

* Eat a high-fiber diet to make stools easier to pass. Consume foods like bran, raisins, apples (with skin), peas, oatmeal and other whole grains; consider fiber supplements if necessary.

* Stay well hydrated; drink plenty of water and other healthful fluids.

* Don't sit on the toilet too long, which can increase pressure in the anus and contribute to hemorrhoids.

* Avoid prolonged sitting. Get up and move periodically to prevent/relieve constipation.

Caption: Hemorrhoids are swollen veins that develop in the anus and the lower part of the rectum. They're categorized as external (occurring around the anus) or internal (forming under the lining of the lower rectum).
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Title Annotation:Digestive Health
Publication:Men's Health Advisor
Date:Jun 1, 2018
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