Paging Dr. Frischer: Hemorrhoids
Hemorrhoids are uncomfortable to talk about, and even more uncomfortable to encounter - but by age 50, there’s a 50% chance that you have had them! What are they? What causes them, and what symptoms should we look out for? How can we treat them and ensure that they don’t return?
Hemorrhoids are a type of varicose vein; swollen and distended and located in the anus and lower rectum. Internalhemorrhoids develop inside the rectum and don’t usually cause pain or discomfort unless they push through the anus. External hemorrhoids develop under the skin around the anus and are extremely uncomfortable, because the skin covering them gets irritated and raw. External hemorrhoids can also develop a blood clot (a thrombosed external hemorrhoid), which is painful and can be slow to heal.
Causes include straining from bowel movements, spending a long time on the toilet, prolonged or chronic constipation or diarrhea, obesity, pregnancy, anal intercourse, too little fiber in the diet, regular heavy lifting, lack of exercise, excessive alcohol consumption, inflammatory bowel disease, and of course…aging and your genes.
How do you know if you have hemorrhoids? The most common sign is painless rectal bleeding while having a bowel movement. The blood is typically bright red. You may also experience itching, pain, or discomfort around the anus, a mass or swelling around the opening of the anus, and increased pain when sitting or having a bowel movement. Your doctor would make the diagnosis by taking your history and conducting an exam.
Treatment involves getting rid of the hemorrhoids AND preventing them from returning, because once you have hemorrhoids, your risk of getting them again goes way up. Treatments include:
A sitz bath (a shallow bath with warm water and Epsom salts) after each bowel movement, to help reduce itching and swelling and to increase blood flow
Sitting on a cushion instead of a hard surface
Over-the-counter topical creams or suppositories (containing steroids, witch hazel, or a numbing agent) to help with comfort and to shrink the hemorrhoid
Ice packs or cold compresses to help reduce sensitivity and pain
In the event of severe pain or ongoing bleeding, medical treatments include rubber band ligation, sclerotherapy, infrared coagulation, radiofrequency ablation, and cryotherapy
In order to prevent future hemorrhoids, the key is to avoid forcing or straining to push out bowel movements:
Stay well-hydrated
Increase fiber intake with fruits, vegetables, whole grains or supplements
Exercise regularly
Use the toilet as soon as you feel the urge
As a very last resort, surgery is effective. However, surgery is invasive and can have complications, so it is reserved for advanced disease where no other treatments have been effective. Unfortunately, non-surgical approaches are not always effective, so I urge you to focus on the causes, and to make lifestyle changes that will reduce your hemorrhoid risk.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 10927 Downey Ave., Suite C, Downey, CA 90241.