By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

MOST HEMORRHOIDS TREATED WITH MEDICATION, OFFICE-BASED SURGERY

Question: A friend of mine has hemorrhoids and will need surgery. Please tell me what hemorrhoids are and if they can be prevented. Are there any treatments other than surgery?

Answer: Over half of all adults over 50 have hemorrhoids. Only about one third of these people seek medical care for this problem. In some cases, this is probably due to inattention to symptoms that are only mildly annoying. This figure also reflects the fact that many people can have hemorrhoids without any symptoms at all.

The rectum is surrounded by a large number of veins, or hemorrhoidal vessels, which are all interconnected. When one of these hemorrhoidal vessels becomes swollen and dilated in a process similar to the development of a varicose vein in the leg, we call the condition a "hemorrhoid."

A hemorrhoid that arises above the line where the skin from the outside meets with the mucosal skin of the inside of the rectum is called an internal hemorrhoid. When the hemorrhoid originates below this junction, it is called an external hemorrhoid.

Regardless of the location, hemorrhoids are not life threatening, and usually, the symptoms will resolve spontaneously in a few days. The primary symptom of an internal hemorrhoid is bright red bleeding on the toilet tissue or in the toilet. It may also protrude to the outside and become painful and irritated. An external hemorrhoid is commonly first noticed as a painful swelling or lump in the rectal area. Frequently people with hemorrhoids complain of rectal itching, as well.

There are many factors that can lead to hemorrhoids. The human race as a whole is prone to them because of fact that we stand upright, which leads to increased pressure in hemorrhoidal vessels. Straining with a bowel movement as well as prolonged sitting on the toilet can lead to hemorrhoids. You should not read on the toilet. The toilet seat actually acts as a tourniquet and restricts blood flow to and from the rectal area. It’s not surprising, then that both chronic diarrhea and chronic constipation can lead to hemorrhoids.

Hemorrhoids are more common in people who are overweight and in those who have a family history of this disorder. Also, many pregnant women have problems with hemorrhoids late in pregnancy, but this is usually a temporary problem.

Treatment for hemorrhoids can be either medical or surgical. In most cases, medical treatment is successful. Some of these treatments are tub baths or sitz baths several times a day, allowing the rectal area to soak for about 10 minutes each time. Using some over-the-counter hemorrhoidal creams can also relieve symptoms. A high-fiber diet and lots of fluids help keep the stools soft, which lessens the pressure on the rectal area.

Surgical treatment is aimed at shrinking and/or removing the hemorrhoidal tissue. There are a number of techniques available today, and many are performed in the doctor’s office. Banding off the hemorrhoid, injecting chemicals into the hemorrhoid to shrink it, and using a laser to burn off the tissue are several office-based treatments. Some cases of severe hemorrhoids still need to be surgically removed in the hospital.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.