It comes as a surprise to many that every human comes equipped with hemorrhoids. They are a natural component of the lower intestinal tract and evolved as part of the normal mechanism for maintaining continence. People who suffer hemorrhoidal disease have prolapsed hemorrhoids, bleeding, itching, or a combination of these problems.
Hemorrhoids are cushions of vascular tissue found at the very end of the intestinal tract. When they become unusually engorged with blood, they can slip or prolapse and protrude through the anus. Any circumstance that causes an increase in the pressure within the abdomen can cause hemorrhoids to prolapse. Almost all pregnant women, with their enlarging uterus filling the abdominal cavity, experience prolapsed hemorrhoids. Usually prolapsed hemorrhoids readily return to their normal site with relief of the pressure. Following delivery with a return to normal weight, the prolapsed hemorrhoids of pregnancy regress.
If the increase in pressure is recurrent or unremitting, eventually the prolapse becomes a permanent feature. The most common causes for unrelenting pressure are obesity and the lack of bulk in the diet. Because they take time to develop, prolapsed hemorrhoids are a feature of the aging process.
The frequency of prolapsed hemorrhoids in the older population is high. Hemorrhoids, even when permanently prolapsed, are not invariably symptomatic. Nonetheless, the prolapse exposes a portion of the usually protected lining of the lower intestine to the environment, and thus the lining may become dry and abraded. This causes inflammation and ulceration, with pain, burning, and irritation.
With ulceration, bleeding can develop. This bleeding may be no more than a spot on the paper, or it may be brisk enough to cause the formation and passage of clots. With chronic bleeding one may become anemic.
Internal hemorrhoids need not become prolapsed to bleed. Hard stools may cause enough abrasion to induce bleeding. Although hemorrhoids are a common cause of bleeding, you should not assume that they are the cause of rectal bleeding. Other more serious causes should be considered as well.
Irritation may cause a clot to form inside of the distended hemorrhoid. This is a thrombosed hemorrhoid. Thrombosed hemorrhoids are usually intensely painful. They are sudden in onset and the pain usually is persistent. These often become an urgent problem that may bring the patient to an emergency room.
Important Points in Treatment
Treatment of prolapsed hemorrhoids is a stepwise process beginning with the initiative of the patient. It is better to prevent hemorrhoids than to treat them. Prevention is largely a matter of controlling obesity and maintaining a regular bowel habit by eating a diet with adequate bulk. Should prolapse occur, the same procedures may result in regression of the hemorrhoid. If the prolapse is serious enough and continues long enough, it may cause symptoms. Symptomatic hemorrhoids that do not respond to medical therapy may require surgery.
Should bleeding occur, the same procedures may result in regression of the hemorrhoid. If the bleeding is serious enough and continues long enough, it may cause anemia. Treatment usually involves the use of stool softeners or fiber to decrease the abrasion of the hemorrhoid by stool. Inflammation may need to be treated with creams or suppositories. Bleeding hemorrhoids that do not respond to medical therapy may require surgery.
Treatment of thrombosed hemorrhoids involves the removal of the clot through an incision. This requires local anesthesia. The incision gives rapid remarkable relief of the pain. Treatment with a warm soak (Sitz bath) several times daily will speed healing. It is better to prevent hemorrhoids than to treat them. Prevention is largely a matter of controlling obesity and maintaining a regular bowel habit by eating a diet with adequate bulk.
Notify Our Office If ...
- You experience rectal bleeding.
- You have rectal pain or soreness.
- You develop itching around the anus.