Hemorrhoid

Related Topics:
Hemorrhoids

Hemorrhoids (also known as haemorrhoids or piles) are varicosities or swelling and inflammation of veins in the rectum and anus.

Types and symptoms of hemorrhoids

Two of the most common types of hemorrhoids are external and internal hemorrhoids. ICD-10 codes are provided below.

(I84.3-I84.5) External hemorrhoids are those that occur outside of the anal verge (the distal end of the anal canal). They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom from external hemorrhoids, is more commonly due to skin irritation.
- (I84.3) If the vein ruptures and a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.

(I84.0-I84.2) Internal hemorrhoids are those that occur inside the rectum. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated.

(I84.1) Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids.
- Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside of the anus.
- If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside of the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.

Prevalence

Hemorrhoids are very common. It is estimated that approximately one half of all Americans have had this condition by the age of 50. However, only a small number seek medical treatment. Annually, only about 500,000 people in the U.S.A. are medically treated for hemorrhoids, with 10 to 20% of them requiring surgeries.

Causes

The causes of hemorrhoids include genetic predisposition (weak rectal vein walls and/or valves), straining during bowel movements, and too much pressure on the rectal veins due to poor muscle tone or poor posture: Hemorrhoids are very rare in nations where people squat to defecate and it has been shown that less straining is required to defecate in the squatting position . Constipation, chronic diarrhea, poor bathroom habits (sitting for unusually long periods of time reading on the toilet or excessive cleaning attempts), pregnancy, postponing bowel movements, and fiber-deprived diet can also contribute.

Insufficient hydration (caused by not drinking enough water, or by drinking too much diuretic liquid such as coffee or cola) can cause a hard stool, which can lead to hemorrhoidal irritation.

An excess of lactic acid in the stool, a product of excessive consumption of milk products such as cheese, can cause irritation and a reduction of consumption can bring relief.

Additional factors that can cause hemorrhoids (mostly by increasing rectal vein pressure), especially for those with a genetic predisposition, are obesity and a sedentary lifestyle.

Prevention

Prevention of hemorrhoids includes drinking more fluids, eating more dietary fiber, exercising, practicing better posture, and reducing bowel movement strain and time. Hemorrhoid sufferers should avoid using laxatives and should strictly limit time straining during bowel movement. Wearing tight clothing and underwear will also contribute to irritation and poor muscle tone in the region and promote hemorrhoid development. Some sufferers report a more comfortable experience without underwear or wearing only very lightweight panties, etc.

Straining can be lessened by defecating in a standing position, knees slightly bent. This position seems to use the muscles of the abdomen to expel feces preventing a strain on the anus. Fluids emitted by the intestinal tract may contain irritants that may increase the fissures associated with hemorrhoids. Washing the anus with cool water and soap may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluid.

Examination

After visual examination of the anus and surrounding area for external or prolapsed hemorrhoids, a doctor would conduct a digital examination. In addition to probing for hemorrhoidal bulges, a doctor would also look for indications of rectal tumor or polyp, enlarged prostates and abscesses.

Visual confirmation of hemorrhoids can be done using a medical device called an anoscope. This device is basically a hollow tube with a light attached at one end that allows the doctor to see the internal hemorrhoids, as well as polyps in the rectum.

If warranted, more detailed examinations, such as sigmoidoscopy and colonoscopy can be performed. In sigmoidoscopy, the last 25 inches of the colon and rectum are examined whereas in colonoscopy the entire bowel is examined.

A pathologist will look for dilated vascular spaces which exhibit thrombosis and recanalization.

Videos of Hemorrhoidectomy being performed

Treatments

Treatments for hemorrhoids vary in their cost, risk, and effectiveness. Different cultures and individuals approach treatment differently. Some of the treatments used are listed here in increasing order of intrusiveness and cost.

Temporary relief

For many people, hemorrhoids are mild and temporary conditions that heal spontaneously or by the same measures recommended for prevention. There is no medicine that will cure hemorrhoids, but local treatments such as warm sitz baths, using a bidet, extendable showerhead, cold compress, or topical analgesic (such as Nupercainal), can provide temporary relief. Consistent use of medicated creams (such as Anusol) during the early stages of a hemorrhoid flare-up will also provide relief and may stave off further development and irritation. Keep the area clean and dry, with some lubrication provided by hemorrhoidal creams. Suppositories, although they sound like the right thing, add very little since all of the symptoms come from the external tissues and not up in the rectum where the suppository goes.

Natural treatments

Some people successfully apply natural procedures for treatment or reversal of chronic conditions. These procedures largely echo the prevention measures. They include:

Reducing regional pressure in such ways as improving posture and muscle tone
Taking herbs and dietary supplements that strengthen vein walls, such as butcher's broom, horse chestnut, bromelain, and Japanese pagoda tree extracts. Drinking 99% pure aloe juice can also relieve itching and swelling.
Topical application of natural astringents and soothing agents, such as Witch hazel (astringent), cranesbill and aloe vera
Eating fiber-rich bulking agents such as plantain and Psyllium seed husks to help create soft stool that is easy to pass to lessen the irritation of existing hemorrhoids.
Using the squatting position for bowel movements. (See external links below)

Oral dietary supplementation can help to treat and prevent many complications of hemorrhoids, and natural botanicals such as Butchers Broom, Horse Chestnut, and bioflavonoids can be an effective addition to hemorrhoid treatment..

Butcher's Broom: Butcher’s broom extract, or Ruscus aculeatus, contains ruscogenins that have anti-inflammatory and vasoconstrictor effects. Supplementation with Butcher’s Broom helps tighten and strengthen veins. Butcher’s broom has traditionally been used to treat venous problems including hemorrhoids and varicose veins.JE and Murray MT, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 829.G. Improving venous tone and capillary sealing: effect of a combination of ruscus extract and hesperidine methyl chalcone in healthy probands in heat stree. Fortschr Med 1989 107(19):55-.R et al. Use of extract of ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res 1988 14(4):277-83.

Horse Chestnut: Horse chestnut extract, or Aesculus hippocastanum, contains a saponin known as aescin, that has anti-inflammatory, anti-edema, and venotonic actions. Aescin improves tone in vein walls, thereby strengthening the support structure of the vein. Double blind studies have shown that supplementation with horse chestnut helps relieve the pain and swelling associated with chronic venous insufficiency. MH, Ernst E. Horse Chestnut seed extract for chronic venous insufficiency: a criteria-based systematic review. Arch Dermatol 1998;134:1356-60.C et al. Comparison of leg compression stocking and oral horse chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet 1996;347:292-4.

Bilberry Bioflavonoid: Bilberry extract, or Vaccinium myrtillus, is an anthocyanoside bioflavonoid. Supplementation with this potent flavonoid protects and maintains venous strength and function. MT. Encyclopedia of Nutritional Supplements, NY: Three Rivers Press, 1996: 326.

Medical treatments

Some people require the following medical treatments for chronic or severe hemorrhoids:

Hemorrhoidolysis/Galvanic Electrotherapy: desiccation of the hemorrhoid by electrical current.
Dilation: stretching of the anal sphincter muscle. Although no longer popular due to potential side effects, this treatment can be successfully applied to select cases of strangulated hemorrhoids. Rarely used anymore.
Rubber band ligation: elastic bands are applied onto an internal hemorrhoid to cut off its blood supply. Within several weeks, the withered hemorrhoid is sloughed off during normal bowel movement.
Sclerotherapy (injection therapy): sclerosant or hardening agent is injected into hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up.
Cryosurgery: a frozen tip of a cryoprobe is used to destroy hemorrhoidal tissues. Rarely used anymore because of side effects
Laser, infared or BICAP coagulation: laser, infrared beam, or electricity is used to cauterize the affected tissues. Laser is now much less popular.
Hemorrhoidectomy: a true surgical procedure to excise and remove hemorrhoids.
Stapled Hemorrhoidectomy: Also called the procedure for prolapse and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the blood flow to the hemorrhoids. It is generally less painful than complete removal of hemorrhoids and also allows for faster recovery times. It's meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions.

For some people, surgery may be the only treatment option for very severe cases, chronic or resistant cases of hemorrhoids, such as prolapsed, thrombosed, or strangulated hemorrhoids.

Diseases with similar symptoms

Symptoms associated with rectal cancer, anal fissure, anal abscess, fistula, and other diseases may be similar to those produced by hemorrhoids and may be reduced by the topical analgesic methods described above. For this reason, it is a good idea to consult with a physician when these symptoms are encountered, particularly for the first time, and periodically should the problem continue.

External links

NIDDK-NIH Hemorrhoid
eMedicine Hemorrhoids
MEDLINEplus Hemorrhoids
Hemorrhoids In Plain English
American Society of Colon & Rectal Surgeons
Squatting for the Prevention of Hemorrhoids Article published in the Townsend Letter for Doctors & Patients, Issue No. 159, October 1996, pp. 66-70
Videos of Hemorrhoidectomy being performed

References

Gastroenterology | Proctology

Gourt Home::Gourt :: Hemorrhoid