Hemorrhoids

Hemorrhoids are swollen veins in the anal canal. In their normal state, these veins provide cushioning during bowel movements. They can, however, swell from lifting, straining, being constipated, passing hard stools and having diarrhea, or from pregnancy. Hemorrhoids are not life-threatening, but they can be painful. If swelling persists, the veins may become permanently stretched (prolapsed).

Types of Hemorrhoids

There are two kinds of hemorrhoids: internal and external. The dentate line along the circular anus muscle divides the interior nerve canal, which has no nerve endings, from the anal opening and exterior areas, which do have nerve endings. Hemorrhoids that form in the anal canal are thus called "internal hemorrhoids," whereas those outside the anal opening are called "external hemorrhoids." External hemorrhoids are typically more uncomfortable at first because there are nerves present in the area where they form. However, internal hemorrhoids often swell beyond the dentate line, causing pain and other problems.

Symptoms of Hemorrhoids

Hemorrhoid symptoms vary in type and severity depending on factors such as a person's age and anatomy; heredity; and the duration of the problem. The most common symptoms are anal bleeding, itching and burning, discomfort during bowel movements, and a feeling of fullness, or of a mass, in or on the anus.

Treatment for Hemorrhoids

Hemorrhoids should be treated only if they are painful or cause complications. To choose an appropriate treatment, the cause(s) needs to be determined. In many cases, hemorrhoids can be treated with simple remedies, including making lifestyle changes to diet, fluid intake, exercise and toilet habits. Relief can also be found by treating related problems, such as diarrhea and constipation, that irritate the hemorrhoid(s) and affected areas.

Beyond this, treatment depends on the type and severity of the hemorrhoid, and how it has responded to any previous treatment. Hemorrhoids are divided into four grades (stages) depending on their history. Grades I and II are usually treated nonsurgically, whereas grades III and IV are more likely to be treated surgically.

Rubber-Band Ligation (RBL)

An elastic band is wrapped around the hemorrhoid, cutting off its blood supply, and causing it to die and drop off. External hemorrhoids and early-stage internal hemorrhoids can be treated with RBL (learn more).

Infrared Photocoagulation (IPC) or Electrocoagulation

The hemorrhoid is exposed to a warm, painless infrared light or electrical current during a series of treatment sessions.

Injection Sclerotherapy

A sclerosing solution is injected into the blood vessels, causing the hemorrhoids to shrink.

Surgical Hemorrhoidectomy

Surgery is usually reserved for advanced cases with a large amount of protrusion. The hemorrhoid is removed with a scalpel, cautery device or laser. Local or general anesthesia is used, and hospitalization is usually required, with recovery taking up to 2 weeks.

Stapled Hemorrhoidectomy

This recently introduced procedure involves the insertion of a circular stapler into the rectum that pushes internal and external hemorrhoids and surrounding tissue up into the anal canal and staples them in place, cutting off blood supply.

More than half of adults in America have hemorrhoids. Few report them to their doctors, however, whether out of embarrassment or the belief that the only treatment is surgical removal. It should be kept in mind that, the sooner hemorrhoids are diagnosed, the greater the chance that they can be treated with an in-office, nonsurgical procedure.

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