Understanding Hemorrhoids

What are hemorrhoids?

Hemorrhoid tissues are a network of blood vessels located near the anal canal that play an important role during bowel movements. When you have a bowel movement, these blood vessels swell and enlarge to cushion the anal canal as your body eliminates waste. After the bowel movement, the hemorrhoid tissues stop swelling and return to their normal size.

Hemorrhoids can remain swollen or inflamed if there is too much pressure on the anal canal. This can cause discomfort and pain.

 Symptoms of swollen hemorrhoids include:

  • Itching around the anus
  • Bleeding during bowel movement
  • Paining or a burning sensation
  • Protrusion of tissue from the anus

The increase in pressure on the anal canal is often caused by chronic constipation, straining during bowel movements, diarrhea, strenuous exercising or heavy lifting, aging, or pregnancy and childbirth.

Problem hemorrhoids

Swelling of the hemorrhoids can occur both inside and outside the anal canal. When hemorrhoids remain swollen inside the anal canal, they are called internal hemorrhoids. And when swollen hemorrhoids develop outside the anal open, they are called external hemorrhoids.

Internal Hemorrhoids
Internal hemorrhoids often form in clusters around the wall of the anal canal. Most of the time they are painless. Due to straining or pressure from hard stool, they may prolapse, or stick out of the anus. They may reduce, or go back inside the body once the bowel movement ends. They might also discharge mucus.

External Hemorrhoids
External hemorrhoids are located beneath the skin of the anal opening. These tissues are usually painless unless they thrombose, or form a blood clot. A thrombosed external hemorrhoid looks like a hard, bluish bump and can cause sharp, severe pain. The clot may disappear on its own with time and leave a “skin tag”, tissue stretched by the clot.

Hemorrhoid tests and treatments

Tests

In order to learn about your symptoms and rule out alternative medical causes, your doctor will perform an evaluation. This will include a patient history and exam. Your doctor may perform a visual exam, digital rectal exam, and an anoscopic exam which uses a special viewing tube called an anoscope.

Diagnostic tests may be performed to rule out other medical causes such as polyps and colorectal cancer. These tests require a fecal occult blood test which looks for blood in stool.

Sigmoidoscopy: A thin, lighted tube called a sigmoidscope is used to view the rectum and lower colon. The test is performed in the doctor’s office and it only takes a few minutes.
Colonoscopy: A long, thin, lighted, flexible tube called a colonoscope is used to view the entire colon. Your doctor will perform this test in a hospital. You are given medications to help you relax during the procedure.
Barium Enema: A radiologist injects a liquid barium solution into the colon. The barium acts as a dye that allows the colon to become easily viewed on x-rays. The test is performed at a hospital or radiology center.
Virtual CT scan: For those people who cannot tolerate colonoscopy or barium enema, a CT scan in the radiology department may be the answer.

After examining the results of your exam and any tests, your doctor will provide you with treatment options. Often just making small changes in your diet and bowel habits can relieve your symptoms. However, if they are severe, your doctor may advise removing your hemorrhoids.

Treatments

If your symptoms do not go away with lifestyle changes, your doctor may advise removing the hemorrhoid. Depending on location and symptoms, your treatment plan may differ.

Thrombosed External Hemorrhoids
To relieve your pain, your doctor may remove the blood clot. The procedure only takes a few minutes and you can expect a quick recovery. You will be asked to lie or kneel on an exam table. You doctor will inject a local anesthetic into the hemorrhoid. He or she will make a small incision and remove the blood clot. The incision is then left open to heal on its own.

Internal Hemorrhoids
To treat an internal hemorrhoid, your doctor will remove or shrink the tissue. You will be asked to lie or kneel on an exam table. Your doctor will insert an anoscope in order to see the anal canal. Your doctor will then perform one of these methods:
• The banding method uses tight elastic bands placed at the base of the hemorrhoid to cut off blood supply. The hemorrhoid will then fall in about a week.
• Sclerotherapy uses a chemical that is injected into the tissue around the hemorrhoid to shrink the hemorrhoid.

Surgical treatment for hemorrhoids is also an option in severe cases.

If you have questions about hemorrhoids, let us know. 
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