Hemorrhoids

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What are hemorrhoids? 

Hemorrhoids are swollen veins in the rectum. They can cause itching and pain. Sometimes they can also make you bleed during a bowel movement.

In some cases, you can see or feel hemorrhoids around the outside of the rectum. In other cases, you cannot see them because they are hidden inside the rectum.

Symptoms of hemorrhoids can include the following:

Painless rectal bleeding

Anal itching or pain

Tissue bulging around the anus

Leakage of feces or difficulty cleaning after a bowel movement

Should I see a doctor? — You should see a doctor if you have any bleeding or if your bowel movements look like tar. Bleeding could be caused by something other than hemorrhoids, so you should have it checked out.

How does Dr.Paul Kattupalli treat hemorrhoids? 

For mild hemorrhoids, he recommends the following: There are measures you can take at home to relieve hemorrhoid symptoms. One of the most important steps in treating hemorrhoids is avoiding constipation (hard or infrequent stools). Hard stools can lead to rectal bleeding and/or a tear in the anus, called an anal fissure. In addition, pushing and straining to move your bowels can worsen existing hemorrhoids and increase the risk of developing new hemorrhoids.

Fiber supplements — Increasing fiber in your diet is one of the best ways to soften your stools. Fiber is found in fruits and vegetables. The recommended amount of dietary fiber is 20 to 35 grams per day.

Several fiber supplements are available, including psyllium (sample brand names: Konsyl, Metamucil), methylcellulose (sample brand name: Citrucel), polycarbophil (sample brand name: FiberCon), and wheat dextrin (Benefiber). Start with a small amount and increase slowly to avoid side effects.

Laxatives — If increasing fiber does not relieve your constipation, or if side effects of fiber are intolerable, you can try a laxative.

Take medicines called stool softeners such as docusate sodium (sample brand names: Colace, Dulcolax) or bulk-forming laxatives. Bulk-forming laxatives include psyllium seed (sample brand names: Metamucil, Konsyl), methylcellulose (sample brand name: Citrucel), polycarbophil (sample brand name: FiberCon), and wheat dextran (sample brand name: Benefiber). These medicines increase the number of bowel movements you have. They are safe to take and they can prevent problems later.

Many people worry about taking laxatives regularly, fearing that they will not be able to have a bowel movement if the laxative is stopped. Laxatives are not “addictive” and using laxatives does not increase your risk of constipation in the future. Instead, using a laxative may actually prevent long-term problems with constipation.

Warm sitz baths — During a sitz bath, you soak the rectal area in warm water for 10 to 15 minutes two to three times daily. Sitz baths are available in most drugstores. It is also possible to use a bathtub and sit in 2 to 3 inches of warm water. Do not add soap, bubble bath, or other additives in the water. Sitz baths work by improving blood flow and relaxing the muscle around the anus, called the internal anal sphincter.

Topical treatments — Dr.Paul first starts with topical creams if you have mild hemorrhoids. 

MINIMALLY INVASIVE TREATMENT — If you have bothersome hemorrhoids after using conservative measures, you may want to consider a minimally invasive procedure. Most procedures are performed as a day surgery. The following procedures are intended for treatment of internal hemorrhoids.

Rubber band ligation — Rubber band ligation is the most widely used procedure. It is successful in approximately 70 to 80 percent of patients.

Rubber bands or rings are placed around the base of an internal hemorrhoid. As the blood supply is restricted, the hemorrhoid shrinks and degenerates over several days. Many patients report a sense of “tightness” after the procedure, which may improve with warm sitz baths. Patients are encouraged to use fiber supplements to avoid constipation.

Delayed bleeding may occur when the rubber band falls off, usually two to four days after the procedure. In some cases, a raw and sore area develops five to seven days following the procedure. Other less common complications of rubber band ligation include severe pain, thrombosis of other hemorrhoids, and localized infection or pus formation (abscess). Rubber band ligation rarely causes serious complications.

Laser, infrared, or bipolar coagulation — These methods involve the use of laser or infrared light or heat to destroy internal hemorrhoids.

Sclerotherapy — During sclerotherapy, a chemical solution is injected into hemorrhoidal tissue, causing the tissue to break down and form a scar. Sclerotherapy may be less effective than rubber band ligation.

HEMORRHOID SURGERY — If you continue to have symptoms from hemorrhoids (such as bleeding, pain, or prolapse) despite medical therapies or office-based procedures, you may require surgery.

Options for surgical treatment for hemorrhoids include hemorrhoidectomy (surgically removing excess hemorrhoidal tissues), which works for both internal and external hemorrhoids, and other procedures (eg, stapled hemorrhoidopexy and hemorrhoidal arterial ligation), which only work for internal hemorrhoids. If you need surgery, Dr.Paul can help you figure out which procedure is best for you.

If you have hemorrhoids, first get evaluated by Dr.Paul Kattupalli and then follow his recommendations.

Image Credit: By WikipedianProlific and Mikael Häggström – File:Hemorrhoid.png by WikipedianProlific, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=21410543

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