Too Embarrassed to Seek Treatment for Hemorrhoids?

Many people consider hemorrhoids too embarrassing to talk about – even to a doctor. In fact, it’s so embarrassing that there’s no accurate way to determine how many people may be affected by the condition.

What we do know is that over half of the population in the U.S. becomes afflicted with hemorrhoids at some time in their lives – especially occurring in those between 45 and 65 years of age.

Men and women are equally affected and the problem occurs more frequently in higher economic status Caucasians. The first hint of the disease came from the 1700 BC Egyptians on a papyrus paper which offers an ointment remedy for hemorrhoids of acacia leaves which are ground, titurated and simmered together.

The sufferer was then told to smear the mixture on a strip of fine linen and insert in the anus for a quick recovery. Other remedies for hemorrhoids have been discussed and recommended throughout history, but surgical procedures weren’t discussed seriously until the 13th Century.

European surgeons Lanfranc, Guy de Chauliac, Henri de Mondeville and John of Ardene made huge progress in surgical procedures for hemorrhoids during the 13th century and some of the techniques are still used today.

There are two types of hemorrhoids – internal and external – and about 40% of the population experience no symptoms. Some have a combination of the two types and only seek help when they experience bleeding or extreme pain.

Sometimes, bleeding of hemorrhoids cause anemia, but that’s not common and most of the time not life-threatening. Usually, you can diagnose hemorrhoids yourself, but a medical doctor may be necessary to help with treatments in extreme cases.

Imaging or lab tests aren’t required to diagnose hemorrhoids, which are obvious from the discomfort around the anus they cause and pain during bowel movements or when sitting.

You may also experience itching and bleeding around the anus area. Occurrences of hemorrhoids may be recurring, but the outlook of treating them without surgery is good. You may have symptoms off and on during your entire life.

Types of Hemorrhoids

External hemorrhoids are mostly annoying, but sometimes painful – especially during bowel movements. Thrombosed or clotted blood vessels are especially painful, but the pain and swelling usually dissipate within a few weeks.

Sometimes an external hemorrhoid may form a skin tag (protrusion from the skin) after it heals. You may also experience itching around the anus and it may be difficult to practice proper hygiene because of the pain.

External hemorrhoids are prolapsed, meaning they have dropped outside the pectinate line (this line divides the lower third and upper two thirds of the anal canal). Prolapse occurs when part of the large intestine drops outside the anus and are sensitive to temperatures and pain.

Internal hemorrhoids are classified as those which appear above the pectinate line and are divided into four classes – Grade 1 (no prolapse); Grade II (prolapse with straining, but can be reduced); Grade III (prolapse when straining and requires manual reduction); Grade III (prolapse when straining, but inability to reduce).

Some rectal bleeding may occur with internal hemorrhoids during or after a bowel movement. You may also experience a mucous discharge, itching and feel unable to produce a bowel movement.

You likely won’t experience pain with internal hemorrhoids unless they become prolapsed. Other rectal problems may be associated with or falsely referred to as hemorrhoids.

Rectal bleeding may also occur because of colitis, IBS (Inflammatory Bowel Disease) diverticulitis, colorectal cancer and angiodsplasia. If you’re also diagnosed as anemic, other medical problems should be considered.

Some conditions that may also be misdiagnosed as hemorrhoids include anal warts and skin tags, polyps, rectal prolapse and some blood pressure conditions (portal venous). Hypertension (high blood pressure) doesn’t increase your chances of having hemorrhoids.

Causes and Symptoms of Hemorrhoids

The actual cause of hemorrhoids isn’t known, but there are factors which increase the risk. Constipation or diarrhea, low fiber diets, pregnancies, genetics, prolonged straining during bowel movements, abdominal masses, aging, obesity, chronic coughing, anal intercourse, no valves within hemorrhoid veins and dysfunction within the pelvis may all contribute to increasing your chances of hemorrhoids.

Hemorrhoids aren’t veins or arteries, but are normal blood vessels (sinusoids). They’re found in the tissue surrounding the anus and rectum and may swell and dilate from pressure.

The swelling and dilation sometimes causes the hemorrhoid to bleed and prolapse (protrude from the anus) because the blood has more difficulty emptying from them. This can cause pain during bowel movements or prolonged sitting.

After a pregnancy, women are usually able to get rid of hemorrhoids – and losing weight is also a factor in reducing the risk. While it’s rare for children to experience hemorrhoids, the risk goes up at the age of 14 and continues to rise as we age.

External hemorrhoids lie just under the skin around the anus and may itch or bleed. Internal hemorrhoids are found inside the rectum and don’t usually cause discomfort unless you strain or irritate them during a bowel movement.

Sometimes, they can be pushed through the anal opening. Occasionally, a thrombosed hemorrhoid may bleed and form a clot which then swells and becomes inflamed. You may also notice a lump near your anal opening.

If you experience large amounts of bleeding or faintness, see a doctor immediately. Keep in mind that bleeding from the anus or rectum isn’t normal. Hemorrhoids tend to be the most common problem when there’s blood in the stool, but make sure you discuss the problem with your physician.

Some causes of bleeding from the rectum may be serious and include IBS (Inflammatory Bowel Disease) and cancer of the colon. Never ignore the bleeding, but seek help to get a diagnosis.

Also keep in mind that hemorrhoids don’t cause abdominal pain. If you’re experiencing bleeding and pain in the abdomen, seek medical care as soon as possible. Blood loss from hemorrhoids may cause weakness and lightheadedness if the loss is significant.

Seek medical help if that problem occurs – especially if you’re taking anticoagulation medications such as Pradaxa, Warfarin, Xarelto, Plavis or Lovenox. These meds may cause excessive bleeding from the rectum if you have hemorrhoids.

Prolapsed hemorrhoids can sometimes be gently pushed back through the anus, but if not, you should seek medical care. Also, thrombosed, external hemorrhoids may need medical care if you’re in extreme pain.

Management and Prevention of Hemorrhoids

A visual examination of the anus can diagnose hemorrhoids and a rectal exam might be necessary to diagnose polyps, rectal tumors, abscesses or an enlarged prostate. You may need sedation because of the pain involved.

Your doctor may decide to use tests which let him see the inner lining of your anus, the lower area of the large intestine or colon and the rectum. He can see if there are abnormal areas such as tumors or polyps, bleeding, diverticulosis, hemorrhoids and other types of inflammation.

These tests include using a sigmoidoscopy, proctoscopy or anoscopy to see various areas of the colon. A sigmoidoscopy is when a tube with a light (either rigid or flexible) is inserted into the anus and your doctor may remove tissue samples or small growths.

Before a sigmoidoscopy, you’ll be given an enema, laxative or possibly both to be sure the anal canal and colon are clear and emptied. A proctoscopy lets the doctor see into the rectum and lower area of the colon, but doesn’t reach as far as the sigmoidscope.

An anoscopy uses a rigid, short and hollow tube with a light to look into the nearest areas (last two inches) of the colon or anal canal. You won’t be required to prep for this test with laxatives or enemas.

These tests use different scopes look at different sections of the colon. You may also be screened for colon cancer during the procedure. You should talk to your doctor about your test preference and your risk for each.
If you’re in pain, you may receive the diagnosis of an external hemorrhoid or anal fissure rather than internal hemorrhoids. To manage hemorrhoids, you may be told to consume more foods high in dietary fiber or to drink plenty of water to keep yourself hydrated.

Sitz baths and nonsteroidal, anti-inflammatory medications and rest may also be recommended to improve the hemorrhoid situation. If it’s determined that you’re not getting enough fiber, supplements may be suggested.

Suppositories and topical creams and gels are also available to treat symptoms of hemorrhoids. If you use products which contain steroids for treatment, don’t use it for over 14 days because thinning of the skin may occur.

Other products may contain vasoconstrictors such as epinephrine, petroleum jelly and zinc oxide. Make sure you’re not allergic to any of the ingredients listed on the product before using it.

If you’re suffering from hemorrhoids while pregnant, be aware that they will usually go away after giving birth. If not, try one of the products of lifestyle changes to alleviate the symptoms.

Surgery or a number of other procedures may be performed if the hemorrhoids become very painful or if bleeding or interference in bowel movements occurs. There are several procedures to choose from and they’re usually safe with the exception of a rare occurrence of perianal sepsis.

Rubber band ligation is usually the first procedure recommended and can be performed in the doctor’s office rather than a hospital. This procedure involves elastic bands applied to an internal hemorrhoid to cut off the blood supply.

The hemorrhoid withers and falls off within 5 to 7 days. Cauterization is another effective method to get rid of hemorrhoids, but be aware that the problem may reoccur. Cauterization can be done using laser surgery, infrared radiation, cryosurgery (using extreme cold) or electrocautery.

The success rate for using sclerotherapy to get rid of hemorrhoids enjoys about a 70% success rate. This procedure is performed by injecting a sclerosing agent like phenol into the hemorrhoid, causing the vein to collapse.

The hemorrhoids then shrink and disappear. Invasive, surgical procedures include several techniques, but the complications should be considered. Bleeding, infection, inability to urinate and strictures on the anus may occur as well as inability to have a bowel movement.

These complications usually last for a small amount of time. Another surgical procedure involves using ultrasound Doppler to locate the blood inflow. Then, the arteries supplying the blood are tied and the tissue is then returned to its normal position by suturing.

Recurrence of the hemorrhoids may occur, but this procedure is less invasive than a hemorrhoidectomy. Stapled hemorrhoidectomy procedure involves removing most of the enlarged tissue, then placing it back in its normal position.

This procedure is usually less painful than a hemorrhoidectomy, but the hemorrhoids may return. A surgical excision of hemorrhoids is called an excisional hemorrhoidectomy and is usually performed in the most severe cases.

There’s likely to be pain and recovery time is from 2 to 4 weeks. The benefits of a surgical excision are better than that of the rubber band ligation – especially for those with thrombosed external hemorrhoids.

The doctor will usually recommend glyceryl trinitrate ointment use after the procedure to help with healing and to relieve pain. Preventive methods for hemorrhoids include avoiding constipation or diarrhea by consuming high-fiber diet (or taking fiber supplements) and drinking lots of fluids, avoiding straining during a bowel movement, losing weight if overweight, avoid heavy lifting and also avoiding reading and sitting on the toilet for long periods of time.

Exercise may also help to relieve constipation, which in turn decreases pressure on the hemorrhoids. Stool softeners may help alleviate the pain and the symptoms of hemorrhoids.

The outlook for reducing the pain and other symptoms of hemorrhoids is great. Usually, some small life changes in diet or habits along with some help from external or internal medications can relieve the symptoms and save you the embarrassment of seeking help for hemorrhoids at the doctor’s office.

Just make sure that if they’re extreme, such as bleeding continually, or so painful that over the counter or natural remedies aren’t working – you make an appointment with your physician so that they can help you find fast relief.

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