Aleksandr Kavokin, MD Yale Cardiology -- This is a very sensitive area of your body. Too private. Nobody likes when something is wrong over there. However it happens.
Hemorrhoids occur practically in everyone. Though hemorrhoids cause problems in 1 out of 25 people. Mostly those are people between 45 and 65 years of age.
You find a blood on toilet tissue. Bright red blood. Ok, now what? You do not know why you bleed. It could be rectal cancer by the way. It could be hemorrhoids.
So? What are the hemorrhoids?
They look like cushions. They contain blood vessels, some muscle and elastic fibers. People often call them piles.
Not everything over there is a hemorrhoid. There could be other problems. Fissure, abscess, fistula, pruritus (itching), condylomata (sort of hanging skin caused by viral infection), viral and bacterial skin infections can happen in that, so sensitive area.
It is worth to talk to your doctor.
How would a scenario of hemorrhoids look?
A 46-year-old female presents with complaints on rectal discomfort, occasional bright red blood on toilet tissue and prolapsing tissue in of anal area. This is probably internal hemorrhoid.
Another scenario brings a patient who complains on severe rectal pain and prolapsed tissue. The severe pain happens in external hemorrhoids. The pain follows thrombosis (thrombosis is the blood clot in your blood vessels).
There are four degrees of internal hemorrhoids.
It may be interesting for you to know because first, second and sometime third degree can be treated by banding only. Fourth degree and sometime third degree requires surgery.
Do not forget non-hemorrhoid causes of symptoms. To check with your doctor is worthwhile because there could be other problems, including cancer or anal fissure. (By the way for anal fissure medical treatment alone may heal it in 90% of cases).
How are hemorrhoids treated?
Well first you need to understand how do hemorrhoids happen. Several reasons lead to hemorrhoids:
Constipation and extra straining
Chronic Diarrhea and loose stools
Long sitting or standing
Weight lifting
Obesity
Pregnancy and childbirth
Inherited tendency to hemorrhoids.
So, avoid all this and you are free.
Obviously this list of reasons is too wide.
The list of measures is wide too.
Increase the fiber in your diet.
Eat more cereals, fruits, vegetables, grains, etc
Psyllium and methylcellulose are supplemental types of fiber.
Exercise, avoid long standing or sitting, don't strain, keep the anal area clean.
Increase liquids in your diet.
Use stool softeners, stool-bulking agents (not a tasty ones, but what can you do).
Treat diarrhea with anti-motility drugs and fiber.
Not every of these methods are proved scientifically. Nonetheless they are included in the standard recommendations for hemorrhoids treatment.
To treat itching or discomfort you may use suppositories, ointments, creams, and gels. You may find that all in your local pharmacy.
These products contain protectant and anesthetics (pain relievers). Local anesthetics numb the area and decrease burning and itching.
Remember that local anesthetics may cause allergy.
Analgesics (menthol, camphor) relieve pain and itching as well
Vasoconstrictors reduce swelling in the perianal area. Though they may have side effects. Better discuss with your doctor.
Protectants (kaolin, cocoa butter, lanolin, mineral oil, starch, zinc oxide or calamine, glycerin, etc) create a physical barrier to prevent contact of stool and the skin. This reduces irritation, itching, and burning.
Similarly, some agents - astringents - dry the skin. That helps to relieve burning, itching, and pain as well.
To kill or at least suppress bacteria and other organisms use antiseptics. Boric acid, phenol, resorcinol and many others can be used. Again better to discuss with your doctor or at least pharmacist. Many of these drugs are sold over-the-counter.
Corticosteroids. Corticosteroids decrease inflammation and relieve itching, but may cause skin damage. They should be used for few days only.
Sitz bath may also help in relieving the symptoms.
When those methods fail your doctor may perform one of the following:
Sclerotherapy (causes scarring of the hemorrhoid).
Rubber band ligation. The rubber band cut off blood supply and hemorrhoid heals with scarring.
Side effects of any of the treatment may be infection of fat and other tissues surrounding the anal canal, especially if patient has diabetes cancer, AIDS.
Another option - electrotherapy and infrared photocoagulation. Works the same way, cause scarring of the tissue. Cryotherapy uses cold to cause inflammation and scarring. Practically the same, though more time consuming.
Let say your medical treatment fails. What do you do then? Well, you go to surgeon and treat it surgically.
Operations are done in less than 10% of patients. Though it depends.
Surgical procedures include Dilation. It is when surgeon stretches your anal sphincter.
Ligation. Often a Doppler probe helps to measures blood flow and finds the individual artery.
The doctor ties off the artery.
Sphincterotomy. It is when sphincter is partially cut. Whole idea is to reduce the pressure.
Hemorrhoidectomy. Hemorrhoidectomy makes sense for patients with third- or fourth-degree hemorrhoids. The hemorrhoids are cut out.
Stapled hemorrhoidectomy. Stapler cuts off the ring of expanded hemorrhoidal tissue.
There are different considerations why to do this and not that type of treatment. And vice versa.
There are complications (pain, difficulty urinating, bleeding several days after surgery, scarring, infection, stool incontinence). Complications happen relatively rare, but they are still there. Better talk to you surgeon.
I hope you be OK.
You were not alone.
It looks like Napoleon Bonaparte, Carter, Hemingway, Tennyson, Lewis Carroll also were suffering from hemorrhoids.
Aleksandr Kavokin, MD1994 Russia,PhD1997 Russia - Immunology and Allergy, postdoc at Cancer Center at Med U of South Carolina, postdoc at Yale - Cardiology, Molecular Medicine. http://www.geocities.com/hemorrhoids_disease/ http://www.kavokin.com
