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Self-Help Strategies Can Ease the Discomfort of Hemorrhoids: You're more likely to develop hemorrhoids as you age.

The word "hemorrhoid" is actually a medical term for cushions of tissue that surround blood vessels in the anal area. But what most of us would call a hemorrhoid occurs when this tissue prolapses through the sphincter muscle, exposing the delicate skin lining the rectum. Unfortunately you become more vulnerable to hemorrhoids as you get older--in fact they are one of the most common medical conditions in the elderly population. However, they aren't dangerous, and there are strategies you can try to ease any discomfort they may cause.

Constipation a Major Cause It isn't entirely clear what causes hemorrhoids, but there are some factors that increase your risk of developing them--examples include obesity, extended time spent standing or sitting, and chronic constipation. "The latter is a major risk factor for hemorrhoids, since it tends to result in you straining to expel stool," explains Mount Sinai geriatrician Patricia Bloom, MD. "The force of bearing down subjects the veins in the rectal area to pressure that causes them to enlarge." Chronic constipation is common in seniors, and can result from a poor diet (particularly a low intake of fiber), limited fluid intake, and too little physical exercise. Health conditions like stroke, diabetes, Parkinson's disease, and underactive thyroid also make you more susceptible to constipation, as can certain medications.

Diagnosing Hemorrhoids The chief symptom of a hemorrhoid is bright red blood seen on toilet tissue or in the toilet bowl. "However, hemorrhoids may not be painful or otherwise noticeable unless they protrude through the anus," Dr. Bloom says. "Excessive straining, rubbing, or cleaning around the anus may cause irritation, bleeding, or itching, which starts a vicious cycle."

Discomfort in the anal area and rectal bleeding can be due to a number of different causes, so mention these symptoms to your doctor. An examination of your anus and rectum will be conducted to look for swollen blood vessels. Your doctor may also look closely at the rectum with an anoscope (a lighted tube useful for viewing internal hemorrhoids), a proctoscope (which can be used to examine the entire rectum), or a sigmoidoscope (to look at the rectum and lower colon). Sigmoidoscopy requires that you undergo "colon prep," which involves fasting and taking laxatives to ensure that your colon is clear. "If you are age 50 or older and have not yet had a routine colonoscopy to screen for colorectal cancer, your doctor may suggest you have this test instead, since you will have undergone the necessary colon prep," Dr. Bloom says.

Self-Help Strategies The primary recommendation for easing hemorrhoids is to boost your fiber intake and drink plenty of fluids, since this will help alleviate constipation. You can best increase your consumption of fiber by eating more fresh fruits and vegetables, and choosing whole grains (wholewheat bread, brown rice) over refined (white) grains. "Also increase your physical activity levels, avoid straining on the toilet, and if you take daily medications, ask your doctor whether any of them are known to cause constipation," Dr. Bloom advises. "A different drug or an adjustment in the dose might help." If these measures don't ease your constipation, Dr. Bloom suggests that you discuss with your doctor whether a short course of laxatives may help.

If your hemorrhoids are causing discomfort, careful cleansing of the anal area daily and after each bowel movement should help. "Warm baths or sitz baths can be soothing, as can using a cold compress on the area," Dr. Bloom says. "Topical creams that include witch hazel or corticosteroids can relieve irritation, but you should avoid long-term use of corticosteroid creams."

Medical Treatment For second- and third-degree hemorrhoids, as well as first-degree hemorrhoids that aren't helped by conservative therapy, your doctor may suggest a procedure to destroy the hemorrhoidal tissue. "Rubber band ligation, which involves tying off the hemorrhoid until it comes away on its own, is generally agreed to be the most effective of the less-invasive approaches," Dr. Bloom notes. "However, it is more painful than other methods." The procedure can be performed in your doctor's office, but is not suitable for people who take blood thinners, such as warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). Other options include sclerotherapy, in which a solution is injected around the blood vessel to shrink the hemorrhoid, and infrared coagulation, in which a device is used to burn the hemorrhoidal tissue.

If nonsurgical procedures are not effective, the hemorrhoids are particularly severe, or other conditions in the anal area warrant surgery (such as a tear), the swollen tissue may need to be surgically removed--however, only about five to 10 percent of people need surgery.


Hemorrhoids can occur inside the anus (internal) or under the skin around the anus (external), and are classified into four groups:

* First-degree These hemorrhoids bleed, but cause no other symptoms.

* Second-degree These protrude from the anus during a bowel movement, but retract on their own.

* Third-degree These protrude, and must be pushed back into the anal canal.

* Fourth-degree These cannot be pushed back into the anal canal.

Caption: Eating plenty of fruits and vegetables can help you avoid constipation, which is a major cause of hemorrhoids.
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Title Annotation:WELLBEING
Publication:Focus on Healthy Aging
Date:Sep 1, 2018
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