Hemorrhoids: Painless Rectal Bleeding
Hemorrhoids are varicose kind veins of the anal area. They are very similar to a surgical glove squeezed in the fingers to create a large stick out. These bulges filled with blood coagulate and form clots. This particular stretching of the blood vessel causes pain, and the clot maintains stretching of the vein leading to continued soreness. New straining following initial creation of the clot, i.e. from constipation, bowel movements, work or some other kind of constriction of the stomach can further stretch this already expanded blood vessel and forms a new thin layer throughout the clot increasing the clot size causing more and more continuing pain.
This thin stretched vessel has pressure receptors in it that are perceived as pressure pain and can be swollen by sitting, direct trauma, toilet paper or restraining. In the event that you've ever had all of them, you know how uncomfortable they can be. Also referred to as "piles", they occur for a number of reasons. One cause is gravity. The veins from higher up on the anus start to drop down due to the laxity of the tissue as we grow older. Another cause is the pelvic congestion brought on by prolonged sitting, straining with heavy lifting or trying to have a bowel movement, or perhaps by the pelvic congestion of pregnancy. Initial symptoms can be a tad alarming. Maybe it's a small amount of fresh blood on the tissue paper after a bowel movement. Then there is the vague itching, generalized discomfort and downright pain that can accompany hemorrhoids. Add to that the discovery of "lumps" in the area by the patient, and you have the makings of a panic.
Imagine for a Moment that You are Looking Into the Anal Area Through an Anoscope
There is a circular line around the mucosa exactly where muscles attach to the outer anal sphincter called the "dentate" (or "pectinate") line. If hemorrhoids are above the dentate line, they are called "external," and should they be below the dentate line they are called "internal." The external ones are more easily seen and felt, while a person may be unaware that they have internal hemorrhoids.
We Don't Know for Sure What Percentage of the Population Will Get Hemorrhoids
In america the number who found for medical care of hemorrhoids are usually about 4%. In Great Britain, where they have Socialized Medicine, about 30% of patients present for treatment of this condition. We know in the us that the sale of over-the-counter products for them goes into the billions of dollars.
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People who have occupations that require prolonged sitting, for example like truck drivers, get hemorrhoids, as do people who do a lot of heavy lifting. Fighter pilots get hemorrhoids from gravity and fighting against G-forces. Pregnant ladies get hemorrhoids, as mentioned, from pelvic congestion, but later from moving the baby out during the latter part of labor. Probably the most common cause is straining at bowel movement secondary to chronic constipation.
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What are the treatments for hemorrhoids? Well, believe it or not, increasing fiber in the diet is an excellent treatment for all signs and symptoms.. Stool softeners have not been found to help that much. Fiber decreases bleeding and irritative symptoms. Witch Hazel and glycerin astringent wipes can be very soothing in order to swollen hemorrhoids and can often relieve irritation. Sometimes, warm sitz baths several times a day can help, as well as sitting on an inflatable "doughnut" support (decreases direct pressure and pinching). If there is an acute clot in a hemorrhoidal vein, it may respond to intermittent ice packs. Occasionally, the E.R. or doctor can make a tiny cut in the hemorrhoid and let the clot away, resulting in great relief as well as ultimate healing.
What are the physician treatment options of hemorrhoids? Certainly one of the most effective is the outpatient application of special rubber bands to the hemorrhoids. A patient can have up to three bands a week. A few physicians sclerose (inject this with irritant substance to be able to cause it to shrink) the hemorrhoids by injecting them with 5% slimy phenol, but the results are not as good as with banding.. Some clinics use infrared coagulation, cryotherapy (freezing), or various forms of cautery with mixed results. Any time hemorrhoids are too severe, either open or closed, hemorrhoidectomy is done in the operating room. The results are generally good, but the time in order to recovery could be lengthy. There have been some good operative results with simply tying from the hemorrhoidal artery.
So, what's the take-home message? Hemorrhoids are the most common cause of bright red anal bleeding, itching and pain, but this simply can't be assumed in every circumstance. The doctor is going to have to examine your own anus. There are plenty of other things that may cause these symptoms. Please leave your distress in the waiting room and tell the doctor what's been going on. The one thing to consider when sitting in the waiting room is you're not alone, and the more open you are with your doctor the better help he/she can provide for you to acquiring better. If you are over 50 or have risk factors for colon cancer, you probably need anoscopy and colonoscopy. These are very benign tests in this day and age. Once all the more serious options have been ruled out, then you can start a comprehensive program to treat and manage hemorrhoids, and you will "live happily ever after."
John Drew Laurusonis M.D.
Doctors Medical Center.