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In the Spotlight

June 23, 2000

Hemorrhoids: Reducing The Pain

By Michael Woo-Ming, MD, MPH
Personal MD.com Contributing Editor



Hemorrhoids are an extremely common health problem all over the world. Even though it's considered somewhat of a funny topic, for millions of Americans suffering from the condition, it's truly no laughing matter. Thought to affect three out of four individuals, they can evoke a lot of pain and discomfort. In addition to the many over-the-counter products, there are some healthy practices you can do to avoid or improve a hemorrhoid problem.

What Are Hemorrhoids?

Essentially, veins in your rectum can become enlarged and the blood in them clots. The smooth muscles, connective tissue and blood vessels actually serve a purpose of support around the anus and lower rectum, thereby preserving anal function. Hemorrhoids result when this support is disrupted. They typically occur due to months or years of straining, while passing hard stools. Pregnant women get them due to the increased strain in the area. Hemorrhoids appear to be familial in origin. The symptoms of hemorrhoids are pain, rectal bleeding and itching.

What Else Can Cause Hemorrhoids?

Any type of straining can cause them. Obesity, sitting or standing for long periods of time, chronic diarrhea, stress and lifting heavy objects notoriously lead to hemorrhoids.

Classification Table:
Grade I: Hemorrhoids project into the anal canal but don't prolapse. They have minimal bleeding or may be asymptomatic.

Grade II: Hemorrhoids protrude beyond the anal margin with straining or defecating and reduce spontaneously when straining ceases.


Grade III: Hemorrhoids protrude spontaneously or with straining and require manual reduction.


Grade IV: Hemorrhoids chronically prolapse and, if reducible, fall out again. Others prolapse out of the anus and are irreducible (strangulated), creating a surgical emergency.

Are Hemorrhoids Serious?

Luckily they are not, but rectal bleeding may be. Passing hard stools may lead to tears in the rectal lining leading to anal fissures. Infections can also further lead to weakness in the anal wall. In case of rectal bleeding it's extremely important that a physician examine you, especially if you bleed a lot, maroon colored stool or black tarry stool, representing a bleed higher up in your gastrointestinal tract. Other signs of concern are symptoms of continuing blood loss, such as an increased heartbeat, fatigue, dizziness or lightheadedness. A doctor will often use a small device known as an anoscope to help diagnose the problem.

That's All Well And Good, But What About The Treatment?

Treatment is usually based on whether you either have external or internal hemorrhoids. External hemorrhoids are hemorrhoids that are found outside a designated portion of the anal canal known as the dentate line, where pain fibers are present. Because of the severe discomfort from the pain, external hemorrhoids are often removed surgically using a local anesthesia.

For sufferers of internal hemorrhoids, there are many more options. Internal hemorrhoids are often classified by their severity in terms of how much they protrude and collapse spontaneously. This classification usually dictates what kind of treatment is needed. Mild internal hemorrhoids may benefit from over-the-counter creams, but one should be wary that many of these products are useful only to relieve itching and mild irritation. For more moderate kinds of hemorrhoids excisional procedures such as rubber band ligation and sclerotherapy are used. Elective hemorrhoidectomy-requiring general anesthesia- is often reserved as a last resort.

What About Laser Therapy?

Recently a lot of attention has been focused on laser therapy treatment for hemorrhoids, claiming to be less painful than the standard treatments. Laser therapy is a rather expensive treatment compared to standard practice; besides, there have been few clinical trials to substantiate laser therapy's claims of success.

Tips For Hemorrhoidal Improvement
* Avoid standing or sitting for long periods of time. Keep active by taking quick brisk walks at work;

* Increase fiber in your diet. This is probably one of the most important things you can do. Besides decreasing your risk for colon cancer, fiber has the added bonus of keeping stool soft to prevent straining;

* Avoiding sitting on the toilet seat for prolonged periods;

* To aid with pain, sit in a warm bath for ten minutes or try using ice packs.


Copyright © 2000 PersonalMD.com. All rights reserved.






 
     
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