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Hemorrhoids: What are they?

Hemorrhoids are swollen veins in the lower rectum and anus area. The condition is rather common and primarily affects adults between the ages of 45 and 65. It can also affect those outside that age range and is more common in those with recurrent diarrhea or constipation. 

Hemorrhoids are often caused by repetitive or prolonged straining. This puts downward stress on the vascular hemorrhoidal cushions, leading to the disruption of the supporting tissue. That results in elongation, dilation, and engorgement of the hemorrhoidal tissues. 

Hemorrhoids can be either internal or external, and both types cause problems.

Internal hemorrhoids

Internal hemorrhoids are generally considered to be the less painful of the two, but that doesn't mean they occur without complications. Internal hemorrhoids can bleed during and after bowel movements, which may cause you some distress. They can also swell and extend out of the anus, causing further problems. 

Internal hemorrhoids that begin to protrude can collect small amounts of mucus or fecal particles, causing strong itching sensations. Excessive wiping or scratching in response to the itch often worsens the situation.

External hemorrhoids

External hemorrhoids are generally more painful than internal hemorrhoids. As the name suggests, external hemorrhoids are covered with anal skin that is pain sensitive. This skin is full of nerve endings that sense pain, hence the significant discomfort caused by external hemorrhoids. The sensitive skin can become irritated, producing an exceedingly strong itchy feeling. 

A blood clot can also form within external hemorrhoids and may cause severe pain. These blood clots are usually broken down by your body over time, however, in rare cases, a skin tag may occur. Alternatively, the clot may evacuate spontaneously and leave a small ulcer.

Medications

Mild cases of hemorrhoids can be treated with a range of over-the-counter (OTC) medications, creams, ointments, or wipes. 

Creams and ointments

OTC creams often contain vasoconstrictors. These substances cause blood vessels to constrict and reduce bleeding, such as Phenylephrine in Preparation-H.

Vasoconstrictors restrict the flow of blood to hemorrhoids, causing them to shrink in size. This helps alleviate both pain and pressure. 

Hemorrhoid preparations may also include local anesthetics such as lidocaine. Lidocaine provides a gentle numbing action to reduce pain and itching. Further options include astringents such as witch hazel or zinc oxide, or corticosteroids.

Suppositories

Suppositories are solid medications that are meant to be inserted into the rectum. They then dissolve, releasing the medicine into the surrounding tissues. Usually, suppositories are a combination of an oil or cream along with medication. 

Over-the-counter suppositories are best for mild cases of hemorrhoids, and there are several different types you can choose from. Some suppositories are made to reduce swelling to minimize the size of hemorrhoids. Others work by lubricating the area and reducing constipation.

Wipes

People with hemorrhoids can benefit from using moist wipes instead of traditional toilet paper. The moisture allows the wipe to move with less friction, making it less painful to wipe. 

Excess friction can pull on your hemorrhoids and abrade the tissue, making it raw and painful. Wipes are commonly available in supermarkets and can be found in the same aisle as toilet tissue. 

Pain relief

Pain relief from acetaminophen or ibuprofen can help make you more comfortable while you have hemorrhoids. Bear in mind, though, this alleviates only the pain and discomfort and doesn’t address the root cause. Pain relievers are best used in combination with a treatment that targets hemorrhoids directly.

Itch relief

Hemorrhoids can be very itchy, excessively so for many. To treat itchiness from hemorrhoids, you can use a gentle topical corticosteroid cream found in your local pharmacy. 

Witch hazel is also a great remedy for relieving itchiness caused by hemorrhoids. Your doctor may instruct you to dab small cotton pads hydrated with witch hazel on hemorrhoid. This will help to relieve your itching.

Your doctor may also prescribe a 1% hydrocortisone cream to relieve itching. It’s important only to use this for short periods of time, as prolonged use can result in thinning of the skin around the anus. Be sure only to use hydrocortisone cream outside the anus and not internally.

Home remedies

While medications may be needed for more severe cases of hemorrhoids, you can start with some home remedies before seeking a doctor or pharmacist.

Cold compress

You can use a cold compress to relieve some of the discomfort caused by hemorrhoids. A towel moistened with cold water can help reduce excess blood flow and inflammation in the area. You can also use an ice pack, but be sure to wrap it in a towel so that it isn’t too cold to the touch.

Sitz bath

A sitz bath is simply a shallow bath of warm water. Fill a tub with three or four inches of water, ensuring it is only warm and not hot. You can add half a cup of Epsom salts to your Sitz bath to improve the effects. Sit in the bath for around 15 minutes—this gives the warm water a chance to cleanse the area.

A sitz bath can help clean the anal region, promote healthy blood flow, and provide relief for inflamed and irritated tissue. The warm water may also help relax the sphincter muscle in the anus, which often becomes clenched due to the pain and discomfort of the hemorrhoids. 

High fiber diet

One of the more common causes of hemorrhoids is straining while trying to pass a bowel movement. Straining is much more common in those with low-fiber diets. Increasing the amount of natural fiber in your diet can help reduce straining and make your bowel movements less strenuous.

Common sources of dietary fiber include fruits like apples and bananas, and grains like brown rice, along with nuts and seeds. A handful of nuts and an apple go a long way toward upping your daily fiber intake.

Other treatments

Minimally invasive procedures

Most cases of mild hemorrhoids can be relieved by using one or more of the above treatments. Wipes can help reduce friction when wiping, sitz baths can relieve some of the swellings and keep the area clean, and OTC medications or suppositories can reduce or eliminate your hemorrhoids. 

Surgical procedures

In rare cases, surgical intervention is needed to provide relief from severe hemorrhoids. This is not something to be too concerned about, as surgical options are fairly non-invasive compared to other surgical procedures. 

Your doctor may suggest an injection into hemorrhoid. This will sting slightly, as all needles do, but can provide significant relief. The injection contains a solution to create a scar, effectively cutting hemorrhoid off from its blood supply.

Rubber band ligation is also a good treatment option for prolapsed hemorrhoids, which are internal hemorrhoids that have slipped out of the anus. This involves putting a very small rubber band around hemorrhoid. Like other treatments, this limits blood flow to hemorrhoid, resulting in it drying up and falling off.

The lowdown

Hemorrhoids are a common medical issue, and many of us will experience them at least once in our lives. The good news is that hemorrhoids are usually easily treated, and you can avoid them entirely by having a good diet and bathroom habits. If you are having trouble with hemorrhoids, your doctor or pharmacist can provide helpful advice or treatments to ease your discomfort.

Frequently asked questions

What causes hemorrhoids?

There are multiple contributing factors that cause hemorrhoids to develop. It is often a combination of a few, such as excessive straining, sitting too long, old age, or a low-fiber diet.

What is the best over-the-counter hemorrhoid treatment?

It is difficult to say what the absolute best OTC hemorrhoid treatment is; all cases vary, as do individual responses to the treatment. Depending on the severity of the hemorrhoids, the best course of action may be a sitz bath, or it may be time to see a doctor about surgical intervention.

What is a thrombosed hemorrhoid?

A thrombosed hemorrhoid is hemorrhoid in which a blood clot has formed. This is not dangerous, but it can be very painful. 

What is the treatment for a thrombosed hemorrhoid?

Treatment for a thrombosed hemorrhoid usually involves a small incision into hemorrhoid to relieve pressure and the blood clot. Your doctor can provide a numbing medication to reduce any pain you may experience during this procedure. 

What do doctors prescribe for severe hemorrhoids?

There are a number of different medications or procedures your doctor may recommend for severe hemorrhoids. Depending on your specific case, it may be a medicated suppository, or it may be a surgical procedure like rubber band ligation or a small incision.

When should I go to the doctor for hemorrhoid?

If you are experiencing significant discomfort, it may be time to see your doctor or healthcare professional. You can try an at-home remedy like a cold compress, sitz bath, or an OTC alternative like a medicated suppository, but nothing can replace the informed advice of a medical professional.

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