GastroEast Physicians, Louisville, KY

Hemorrhoids

Hemorrhoids are large veins that are found around the anus. These veins can become swollen, irritated, and inflamed. Hemorrhoids are frequently caused by straining during bowel movements. Other factors that contribute to the formation of hemorrhoids are pregnancy, constipation, and obesity.

Types
Two types of hemorrhoids exist, the internal hemorrhoid and the external hemorrhoid. External hemorrhoids can be seen protruding from the anus and are frequently painful. Internal hemorrhoids are inside the anus, are not visible, and are not painful.

Symptoms of hemorrhoids
Many people who have hemorrhoids are asymptomatic, but for those that have symptoms, the most common symptom is bright red blood from the rectum. Blood usually is seen on the toilet paper or surrounding the stool. Occasionally the hemorrhoid may protrude out from the rectum and cause pain after it becomes inflamed. Pain from a hemorrhoid may occur if a clot forms in the hemorrhoid. This is called a thrombosed external hemorrhoid.

Diagnosis
If a patient has bright red blood from the rectum, hemorrhoids very well may be the cause; but, this should be brought to a physician’s attention so that a proper history, physical exam, and diagnostic testing can be performed. After the patient provides a medical history to the physician, a thorough exam of the anus will be performed. The physician will use a gloved, lubricated finger to examine the anus and the anal canal looking for hemorrhoids. A physician may also use a tool called an anoscope to examine the anal canal and lower end of the rectum. The anoscope is a small thin tube which is placed 3-5 inches into the anus to directly view the lining of this area to look for hemorrhoids.

Occasionally, depending on the medical history and physical exam, anoscopy will not provide a thorough enough exam; therefore, flexible sigmoidoscopy or colonoscopy may be necessary, not only to look for internal hemorrhoids, but also to rule out other pathology in the colon. If a colonoscopy is going to be performed, a rectal exam will be done at the time of colonoscopy and it may not be done in the office.

Very rarely, bright red blood from the rectum can be due to colorectal cancer and if age appropriate, a patient with bright red blood per rectum may be referred to a gastroenterologist for colonoscopy.

Treatment
Treatment for hemorrhoids always begins with medicines and lifestyle changes. If a patient is suffering from hemorrhoids during pregnancy, one can rest assured that the hemorrhoids will likely dissipate during the post partum period.

If hemorrhoids are due to other causes, lifestyle modifications such as increasing the amount of fiber in your diet, adding a fiber supplement, and increasing the amount of daily water intake may be enough to render the hemorrhoids asymptomatic. This works by decreasing constipation through reducing the amount of straining. Stool softeners may be employed to soften the consistency of stool to decrease local irritation and pressure on the hemorrhoids. Warm tub baths may also be employed to decrease the size of the hemorrhoids. Hemorrhoidal cream or suppository can also be purchased over the counter to decrease inflammation from hemorrhoids. If Hemorrhoidal creams or suppositories do not provide relief, surgical intervention may be necessary.

Surgical intervention
Surgical intervention requires rubber band ligation, sclerotherapy, laser treatment or hemorrhoidectomy. Rubber band ligation requires the placement of a rubber band around the irritated hemorrhoid. This band destroys the hemorrhoid by cutting off blood flow. Eventually the Hemorrhoidal tissue dies and falls off. The hemorrhoid is then obliterated. If hemorrhoids are severe, a hemorrhoidectomy may be necessary. The hemorrhoids will be excised in the operating room by a surgeon skilled in anorectal disease.