Hemorrhoids are venous structures that exist within the anus. Everyone has them and they assist in helping control continence and keeping stools inside. They can become enlarged, typically after prolonged episodes of straining as seen with constipation and childbirth. The term “hemorrhoid” is often misapplied to other problems of the anorectal area and many inexperienced individuals apply the term to include everything from anal warts to fistulas to anal cancer.
Diagnosis requires evaluation by an experienced physician. The most common complaints of hemorrhoids are itching, discomfort and rectal bleeding. Hemorrhoids may enlarge enough to prolapse out of the anal canal and some individuals experience a “ball” that must be pushed back inside after bowel movements.
All individuals who experience bleeding should undergo endoscopic evaluation to exclude other causes, as cancers, polyps and inflammatory bowel disease can also cause bleeding very similar to hemorrhoids. A small scope inserted through the rectum will allow your doctor to visualize the hemorrhoids directly.
Hemorrhoids are treated by a variety of mechanisms. There are a variety of creams available over the counter to treat hemorrhoids, but these often provide relief only for a short time. Many of them contain topical steroids which relieves some of the itching and discomfort of hemorrhoids but does nothing long term. In fact, they may cause thinning of the skin with prolonged use.
The mainstay of treatment for hemorrhoid disease is the increase of dietary fiber, increased water consumption and increased exercise. Avoidance of constipation and spending less time sitting on the toilet will also improve symptoms.
Some individuals with more severe or enlarged hemorrhoids require surgery. There are many different procedures that can be performed, including hemorrhoid banding (placement of a rubber band on the hemorrhoids that causes scarring), stapling of the hemorrhoids internally or formal surgical excision by cutting them out. Each option has potential advantages and disadvantages and only your provider can best advise which option may be best for you.