Treating Hemorrhoids: Here’s What You Should Know

If you’re 50 years old, it’s likely that you’ve had at least one experience with hemorrhoids. They’re quite common (affecting 1 in 20 Americans), so let’s talk about some of the symptoms of hemorrhoids and some of the methods of treating hemorrhoids.

It might have been the time you noticed blood on the toilet paper after wiping, or an unusual amount of blood in the toilet bowl after passing a stool. It could have been that occasion when you were sat on the commode and felt a strange noodle-like mass protruding from the anal canal that you’ve never experienced again.

Either occasion could have been a time when you were experiencing a classic hemorrhoid symptom but didn’t know you were. In fact, statistics show that about half of the U.S. population has had at least one experience with hemorrhoids by the age of 50, even though most people reported no pain or discomfort when they experienced the symptom.

We’re all born with hemorrhoids. They tend to become more prominent when we’re older because young people are less likely to suffer from chronic constipation. If you struggle to use the bathroom, that should be a flashing red light that you may soon experience hemorrhoids. If you do struggle when “going number 2”, it’s likely that you already have them, they just haven’t announced their presence yet.

When hemorrhoids do announce their presence, it’ll most likely be in the form of rectal pain, itching or bleeding in the rectal area, or a prolapse (that’s the strange noodle-like mass you may have encountered at some point as you’ve grown older).

Hemorrhoids aren’t really a health issue per se, but they can certainly be a pain in the bottom, as anyone who has experienced hemorrhoids will undoubtedly agree. There are two types of hemorrhoids — internal and external.

What’s the difference? 

Internal hemorrhoids occur in the lower rectum, while external hemorrhoids develop under the skin around the anus. External hemorrhoids can be extremely uncomfortable, especially if a blood clot forms inside one, which can cause people to experience severe and sudden pain. Eventually, the blood clot will dissolve and leave behind a skin tag (that’s a collection of excess skin) which can itch or become irritated.

Internal hemorrhoids, on the other hand, are usually painless. They can bleed a lot (that’s the blood spots or smears you see on the toilet paper after wiping or the drops of blood that you’ll see in the toilet bowl) and can also prolapse. When a hemorrhoid protrudes from the anus, it can lead to other potential health issues.

The prolapsing hemorrhoid can facilitate mucus, stool, and bacteria to irritate the anal skin. This can cause a condition known as pruritus ani. The literal translation of pruritus ani means “itchy anus” and patients who experience it will agree with the translation. The itching can be severe and has been known to cause severe depression in some patients.

Treating hemorrhoids can include some simple home remedies, minimally invasive treatments, or surgical procedures.

Here are some home remedies to consider

  • Patients who have chronic constipation may get some relief simply by adding more fiber to their diet. Fresh fruits and vegetables along with adequate hydration can soften stools and make them easier to pass.
  • Fiber supplements can also ease constipation because the supplements decrease hemorrhoidal bleeding, and reduce the inflammation and the enlargement of hemorrhoids.
  • Any type of exercise is a plus. Walking down the block or around the yard a couple of times can stimulate the bowels. If it works for your dog, why can’t it work for you, right?
  • When you do feel the urge to have a bowel movement, get to a bathroom and try to go. Waiting can cause a stool to back up and increase the pressure in the rectum. That can cause you to strain to defecate, which in turn causes the formation of hemorrhoids.
  • You might also try going to the bathroom at a specific time each day, effectively training your mind and sphincter muscles to be prepared to respond at that time each day. It may sound like a strange idea, but it’s been shown to work in many patients who suffer from chronic constipation.

Over-the-counter methods of treating hemorrhoids include creams that contain local anesthetics to ease the pain. Witch hazel wipes have long been recommended for their calming effect on painful hemorrhoids, and even an ice pack applied to the anal area for a few minutes several times a day can ease pain and swelling.

The most common minimally invasive way to treat persistent hemorrhoids is a technique known as rubber band ligation. Essentially, a small rubber band is placed around the base of a hemorrhoid, which causes the hemorrhoid to shrink and the adjacent tissue to scar. The scarring holds the tissue in place and reduces prolapse of the tissue. This treatment does not cause pain but sometimes needs to be repeated to be effective in eliminating the hemorrhoid.

There are other minimally invasive ways of treating hemorrhoids

Such as laser or infrared coagulation, sclerotherapy, and cryosurgery — but none of these are as effective at eliminating and preventing hemorrhoids as band ligation. Some of these are used for the treatment of internal hemorrhoids that are too small for rubber band ligation. Others are used for the safe and effective treatment of hemorrhoids during pregnancy.

In severe cases of hemorrhoids that include protruding ones, symptomatic external hemorrhoids, or internal hemorrhoids that reappear even after band ligation, a hemorrhoidectomy may be required. The procedure requires small incisions around the hemorrhoid and the removal of the blood vessel. It’s gonna hurt but the procedure is 95% effective in eliminating the hemorrhoid.

Finally, an option one may have heard of in traditional hemorrhoidectomy is a procedure called stapled hemorrhoidopexy, which is considered as an (ill-advised) treatment for bleeding or prolapsed hemorrhoids. During this procedure, the hemorrhoid is anchored in place with a stapling device. This procedure has a really bad side-effect profile and can lead to potential complications that cannot be fixed. The American Society of Colon and Rectal Surgeons has advised against offering this procedure to patients and as such my practice does not perform this procedure.

There are many safe options available when treating hemorrhoids, so contact our office to set up a consultation or to get more information. We look forward to helping you.

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