Hemorrhoids are vascular cushions in the submucosal space of the anal canal. They are made up of blood vessels, connective tissue and smooth muscles.
Everybody is born with hemorrhoids and that they are typically found in three positions; left lateral, right anterior and right posterior. Hemorrhoids tend to worsen due to venous congestion within the hemorrhoids. Venous congestion is caused by straining, constipation, pregnancy, chronic cough and pelvic floor dysfunction. By far the most common cause of venous congestion is chronic straining from either constipation or diarrhea.
Trouble from the internal hemorrhoids presents as:
Trouble from the external hemorrhoids presents as:
Your doctor typically makes a diagnosis by discussing your history of symptoms, particularly focusing on bowel habits. Your doctor will also use physical examination to confirm the diagnosis of hemorrhoids, including the use of anoscopy which can be used to rule out other potential problems like anal fissures, fistulas and rashes.
Medical treatment
The most significant method of treating hemorrhoids is modifying stool through increased fiber in the diet, 25g/day for women and 38 g/day for men. You can also use stool softener’s (docusate) and lubricant laxatives(mineral oil) or bulking agents (psyllium) to help prevent constipation.
Toileting behavior
Avoid straining in the restroom and do not spend more than 3 to 5 minutes having a bowel movement. Avoid reading in the restroom.
Sitz bathes
Place warm water in a bathtub or portable device for 15 minutes at a time for pain relief.
Medications
Your doctor may offer you topical creams including steroids or local anesthetics to help with hemorrhoid flares. These creams don’t cure the problem but relieve the symptoms and should not be used for more than a month at a time without seeing your doctor.
Rubber band ligation
This is the most common office procedure to treat internal hemorrhoids. Your doctor places a rubber band around the hemorrhoids to make them shrink and remove them. Typically this is done with only symptoms of pressure afterwards and dull ache but no severe pain.
Excision of thrombosed hemorrhoid
If you present to the doctor with signs of a thrombosed hemorrhoid that is very painful then this can be removed in the office under local anesthesia.
Operative procedures
If the hemorrhoids are significantly enlarged and it is necessary, your doctor will perform excisional hemorrhoidectomy. This is done as an outpatient surgery with you going home the same day.
