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Hemorrhoids - Everything you wanted to know (But were afraid to ask!)

Last Modified: April 10, 2013

Family Medicine

Hemorrhoids. A pain-in-the-behind for millions of Americans.

Believe it or not, hemorrhoids are the number one trending health issues on Google search for 2012, per Zeitgeist. Since it is so highly searched, I'm guessing that folks have many unanswered questions about hemorrhoids. So let's try to answer them here.

What are hemorrhoids?

Hemorrhoids are normal blood vessels (hemorrhoidal veins) that become engorged and distended with blood. This typically happens for one of several reasons:

  • Constipation, with straining to have a bowel movement
  • Diarrhea
  • Prolonged sitting (including spending too much time on the toilet)
  • Heavy lifting
  • Childbirth

When the blood vessels become enlarged, they start to cause symptoms.

Types of hemorrhoids and symptoms

There are two main types of hemorrhoids: internal and external. Internal hemorrhoids tend to cause bleeding but are not painful. External hemorrhoids typically itch, burn and cause pain but do not bleed. Sometimes external hemorrhoids develop a blood clot; this is called a thrombosed external hemorrhoid, and it is extremely painful.

How do I know if I have hemorrhoids?

It is best to be checked out by a doctor. I recommend starting with your primary care provider. Often, your family practice doctor can diagnose and provide some relief right in the office. If not, he or she may refer you to a surgeon. Both general surgeons and colorectal surgeons have expertise in hemorrhoid diagnosis and treatment.

Diagnosis involves examining the area around the anus and sometimes looking up inside the anal canal with a small, clear plastic device called an anoscope. The anoscope is about the length of a ball-point pen with a slightly larger diameter than a finger. This exam is important, especially with rectal bleeding, since there are many things besides hemorrhoids that can cause bleeding. Any rectal bleeding should be checked out by your doctor – never assume it's hemorrhoids, since cancer and other serious problems cause bleeding, too.

How are hemorrhoids treated?

Home remedies include over-the-counter creams and Sitz baths. Sitz baths are a fancy name for sitting in a few inches of warm water in the tub and soaking. If you have internal hemorrhoids, your primary care provider may prescribe steroid suppositories. A surgeon might treat internal hemorrhoids with an office procedure using a small rubber band. More involved surgeries are sometimes necessary.

Prevention of hemorrhoids

The best prevention involves two things. The first is a diet full of fiber and fluids. Aim for 25 to 30 grams of fiber daily, with plenty of water. The second preventive measure is to avoid the things that trigger hemorrhoids (constipation, diarrhea, repetitive heavy lifting, prolonged sitting, and straining).

I hope you'll take a moment to watch the video of my interview with Dr. Virendra Parikh, a colon and rectal surgeon with Parkview Physicians Group – Colon & Rectal Surgery, for more detailed information regarding hemorrhoids. And feel free to leave comments and suggestions of your own for dealing with hemorrhoids.




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