Hemorrhoids, the bane of existence of the middle and the old-age population in Singapore, is a lot more common than we all have previously believed. Technically speaking, every person has hemorrhoids, the puffy cluster of veins that are found just under the mucous membranes surrounding the lowest section of the rectum and the anus. Although it can be difficult to visualize that specific part of our anatomy (since we have always referred to hemorrhoids as the condition that occurs when the same veins become swollen and inflamed), the good thing is that hemorrhoids are not life-threatening. They can, however, be recurrent, painful, and very uncomfortable – the characteristics of a condition that demands immediate and effective treatment. The treatment for hemorrhoids is available in various forms, and together with other frequently-asked-questions about the topic, it will be discussed in this article.
What are hemorrhoids?
Another name for hemorrhoids is piles and these are the swollen veins that cause itching, pain, and bleeding in the anus and rectum. They can either be internal or external. The former refers to hemorrhoids found in the lower rectum and are not typically seen or felt, while the latter occurs on the outer skin of the anus. External hemorrhoids are more uncomfortable than internal hemorrhoids because the outward-facing skin often becomes irritated. Worse, the pain can increase suddenly and significantly when a blood clot develops inside an external hemorrhoid. Once the clot dissolves, an excess skin called a skin tag is left and may itch or become irritated from time to time.
Internal hemorrhoids are painless even when they are bleeding. You might only notice it, for example, if you see some fresh blood after wiping with a toilet paper. However, internal hemorrhoids have a tendency to prolapse or extend beyond the anus, which can cause further bleeding, pain, or both.
What is the difference between hemorrhoids and anal fissures?
These two share the same symptoms – pain, anal itching, and bleeding – but are quite different in nature. Hemorrhoids are caused by swollen veins while an anal fissure comes from a tear in the lining of the anus. A doctor can perform a physical exam to determine which condition is causing the symptoms.
What causes hemorrhoids?
Straining during bowel movement, which puts too much pressure in the anus or rectum, is the main cause of hemorrhoids. This is the reason why the condition is often associated with chronic constipation, diarrhea, sitting on the toilet for long periods of time, and engaging in constant heavy lifting – or basically all activities affecting the blood flow to and from the anus and rectum, which cause the blood to pool and enlarge the veins. Pregnancy is another factor since the enlarged uterus puts pressure in the vein the colon and causes it to bulge.
Hemorrhoids can also be passed in the family – if you have immediate family members who have hemorrhoids, there is a huge chance that you will get it at some point in your life. Obesity is a risk factor as well as old age. It is also widely accepted that you can get hemorrhoids from poor nutrition (having a low-fiber diet), prolonged straining, engaging in anal sex, and standing or sitting for too long.
How are hemorrhoids diagnosed?
The first things your doctor will ask about are your symptoms and medical history. Then they will perform a physical exam by looking at your anus and rectum to check for signs of swelling, lumps, or irritation. The doctor may also put on a pair of sterile gloves, apply lubrication, and insert a finger into your rectum to assess the muscle tone and determine if there are lumps or other problems.
In order to identify if the patient has internal hemorrhoids, or rule out other conditions, the doctor may perform other types of tests, such as anoscopy, colonoscopy, and sigmoidoscopy. Anoscopy uses a short plastic tube (called anoscope) to check the patient’s anal canal. Colonoscopy is a procedure that involves a colonoscope, a long and flexible tube that is inserted through the anus to allow the doctor to view the condition of the large intestine. A colonoscope is also designed to take samples of tissues (biopsy) and treat problems in the area. Last but not the least is sigmoidoscopy doctor uses a thin, lighted tube called a sigmoidoscope to look into the lower colon. Like a colonoscope, it can also take tissue samples from the lower colon, which will then be sent to the laboratory for testing.
What are the available treatment options for hemorrhoids?
Let us start with something simple, like home remedies. There are home treatments that you can use to relieve the mild pain and swelling of hemorrhoids: using an over-the-counter hemorrhoid cream (should contain hydrocortisone, witch hazel, lidocaine, or a similar numbing agent), taking oral pain relievers (ibuprofen, aspirin, or acetaminophen), or soaking in a warm bath. You should also eat more high-fiber foods such as fruits, vegetables, and whole grains to soften the stool and prevent straining during bowel movement. Make sure to drink lots of water, too!
If the symptoms get worse or more painful, or they start to affect your quality of life, you should talk to your doctor about the getting other treatments. Here are some non-surgical and surgical examples:
- Sclerotherapy: the doctor injects a chemical substance to the swollen vein to obliterate the hemorrhoid tissue
- Electrocoagulation: electric current is used to prevent blood flow to a hemorrhoid
- Rubber band ligation: a small rubber band is fitted around the base of the hemorrhoid to cut off the blood supply to the vein
- Infrared coagulation: a heat-transmitting probe is inserted into the rectum to destroy the hemorrhoid
- Hemorrhoid stapling: this surgery is used to remove an internal hemorrhoid or pull a prolapsed one back inside the anus and hold it there
- Hemorrhoidectomy: this surgery is recommended for removing large external hemorrhoids or prolapsed internal hemorrhoids
Changes in lifestyle and dietary habits are the best way to prevent hemorrhoids. You can start by taking care of your body – eating the right food, drinking plenty of water, and exercising regularly – to regulate the bowels. Be on the move and avoid sitting or standing for too long. And to prevent constipation, do not delay a bowel movement – go to the bathroom as soon as you feel the urge.
If you have a hemorrhoid that does not respond to home treatments, see your doctor for proper medical advice.
Andrea’s Digestive, Colon, Liver and Gallbladder Clinic
#21-11/12 Royal Square at Novena, 101 Irrawaddy Road, Singapore 329565
Tel: +65 6264-2836
Fax: +65 6264-2839