Hemorrhoids

Hemorrhoids are swollen veins in the lower rectum or anus. By age 50, about half of the population will have experienced this sometimes painful condition, which results from an increase in the pressure inside the veins of the rectum. Common causes include constipation, pregnancy, childbirth, obesity, heavy lifting, sitting for long periods and diarrhea.

There are two types of hemorrhoids based on location. Internal hemorrhoids occur inside the lower rectum and often can’t be seen or felt. As this form is typically painless, the only symptoms you may notice are small amounts of bright red blood (on your toilet paper or inside the toilet bowel) or a feeling of fullness following a bowel movement. Occasionally, internal hemorrhoids can push through the anal opening. This is known as a prolapsed, or protruding, hemorrhoid. Sometimes these swollen veins remain prolapsed temporarily; in other cases, they become permanent. If the hemorrhoid remains outside the anus, it can cause pain, itching, bleeding and the formation of excess skin (skin tags). External hemorrhoids can occur as bulges or lumps around the anus. Because of the sensitive nerve fibers in the area, these enlarged veins are often painful, especially when sitting. They also may bleed and itch. Should blood pool in an external hemorrhoid, a blood clot referred to as a thrombosed hemorrhoid may develop and cause severe pain.

The less common of the two forms, external hemorrhoids are often incorrectly self-diagnosed because many people mistake internal hemorrhoids – or the skin tags they can produce – for external hemorrhoids. Always consult a physician to determine whether you have the internal or external type.

What treatments are available for hemorrhoids?
An occasional episode of symptoms from hemorrhoids can be treated using local measures, suppositories, diet, fiber and adequate oral liquids. However, further treatment is needed in some cases. Banding of hemorrhoids with the CRH O’Regan banding device is an essentially painless method of treatment designed to get rid of hemorrhoids.

Local measures:
The best treatment is prevention by taking enough dietary fiber and liquids by mouth (see below for further discussion). The addition of a topical cream (no difference between most of the emollient creams, so go cheap) is usually sufficient. The use of a steroid cream or analgesic ointment should generally not be used for longer than a week. Suppositories can be helpful.

An important change that will help is not spending longer than 2 minutes on the toilet to have a bowel movement, and going back a few hours later if you cannot have a bowel movement then. Regular exercise helps to promote normal bowel habits.

Diet
Adequate water intake:We recommend 7-8 (12oz) glasses of water or other clear liquids per day.

Enough Soluble Fiber: For colorectal health a minimum of 30 grams of soluble and insoluble fiber a day is required.

Lack of fiber is implicated in constipation, high cholesterol, diverticulosis, higher risk of colo-rectal cancer, maturity onset diabetes and obesity among other diseases. In the morning you should take 2 -4 tablespoons of oat or wheat bran or ground flax or Metamucil or Benefiber. These can be added to your cereal in the morning or mixed in with yogurt or put in soup. You must take in 7 to 8 (12 ounce) glasses of water daily for this to work properly.

There can be problems with the regimen if you have kidney problems or are on water pills (diuretics) and your doctor will change this plan for you.

Some may have an allergy to wheat, for this reason we prefer oat bran rather than wheat bran as a soluble fiber supplement.

Water soluble fiber is preferred and is found in oats, beans, cabbage, squash, carrots, apples, citrus fruits, prunes, strawberries, pears, etc. Soluble fiber forms a viscous gel that increases the amount of water that stays in the colon and coats the intestinal walls which decreases cholesterol absorption and serves as a substrate for fermentation by colonic bacteria. Insoluble fiber passes through the digestive system largely intact. They improve bowel consistency by increasing the water in the stool. Cellulose and lignin are forms of insoluble fibers that increase stool bulk by increasing the microbial mass. The cells are 80% water and this is the main way fruits and vegetables increase the stool size and make them softer. Cellulose is found in whole wheat, bran, cabbage, peas, green beans, wax beans, broccoli, cucumber skins, peppers, apples, and carrots. Lignin is found in cereals, bran, strawberries, eggplant, pears, green beans, and radishes. Brussel sprouts and beet root contain hemicellulose that also increases water holding capacity. They improve stool consistency by increasing the amount of water that stays in the colon and by increasing viscosity. These viscous solutions decrease the rate of gastric emptying, which leads to a slowing of digestion and increased absorption of nutrients.

Increase the amount of fresh fruit and leafy vegetables in your diet. Oatmeal, oat bran, nuts, dried peas, beans, lentils, apples, pears, strawberries, blueberries should be added to your diet for soluble fiber. Use more whole fiber grains, breads, and cereals. It may take up to six weeks to see a benefit. The amount and type of fiber that benefits you the most is variable and must be determined by trial and error. Many sources contain both soluble and insoluble fiber.

Supplements You can add fiber with two tablespoons of whole oat bran or wheat bran, psyllium (a seed native to Iran and India), ground flax seed, Metamucil, Citrucel, or Benefiber.

If these measures do not work, you will likely be sent to a specialist who will first of all make sure that hemorrhoids are the only problem. If there is a family history of cancer, or if there is weight loss or blood mixed in with the stool or a lot of pain, other causes such as inflammatory bowel disease, fissure or even bowel cancer will need to be ruled out.