What are hemorrhoids?

Hemorrhoids are enlarged or swollen veins in the rectal area.  They can occur outside the anus (at which point they may be able to be seen or felt) or more internally in the rectum.  Hemorrhoids are common and can occur in both males and females.  They occur more commonly in older people, during or after pregnancy, or in individuals with constipation or diarrhea.  Hemorrhoids are not usually a sign of serious disease.

What are the symptoms of hemorrhoids?

The most common symptoms of hemorrhoids are rectal bleeding, itching/irritation of the skin around the anus, and pain.  Bleeding from hemorrhoids is usually a small amount of bright red blood on the toilet paper, outside of the stool, or in the toilet bowl.  Hemorrhoids can become painful if a clot develops.  If this occurs, there is treatment available and you should call your healthcare provider.  Hemorrhoids that occur internally in the rectum may also prolapse, or slip forward into the anal canal, at which point you may be able to see or feel them.

How are hemorrhoids diagnosed?

Your provider will examine your rectum and anus.  He or she may insert a gloved finger into the rectum or insert a small tube called an Anoscope.  This allows for visualization of hemorrhoids that are inside the rectum.

How are hemorrhoids treated?

Medical Management

The primary management of all hemorrhoids involves medical treatments that address the passage of hard or large stools.  Pushing and straining with bowel movements can exacerbate hemorrhoid symptoms and increase the risk of developing new hemorrhoids.  Treatments for constipation include increasing the fiber in your diet (fiber is found in whole grains, fruits and vegetables; intake should total 25-30 grams daily), taking fiber supplements, and using laxatives.  Many people feel that regular laxative use can lead to problems with constipation in the future, but research has not shown this to be the case.

Warm sitz  baths are also used to treat hemorrhoids.  A sitz bath is a device that is placed on the toilet and allows you to soak the rectal area in warm water for 10-15 minutes 2-3 times per day.  This improves blood flow to the area and relaxes the anal sphincter muscle.  Sitz baths can be purchased at most drugstores.  You can also sit in 2-3 inches of warm water in a bathtub for a similar effect.

Topical creams and suppositories can also be used to treat hemorrhoids.  These are available over the counter as well as by prescription.

Procedural Treatments

If medical treatments are not effective for your hemorrhoids you may consider a minimally invasive procedure.  There are several procedural treatments available for hemorrhoids as noted below.

External Hemorrhoids

If you have a thrombosed external hemorrhoid excision of the clot may be recommended.

Internal Hemorrhoids

Minimally invasive procedures for internal hemorrhoids include rubber band ligation, infrared coagulation, and sclerotherapy.

Rubber Band Ligation

During this procedure a small rubber band is placed around the base of the internal hemorrhoid.  This removes the blood supply to the hemorrhoid, and over the next several days the hemorrhoid shrinks and degenerates.  This procedure has been shown to be successful in 70-80% of patients.

Infrared Coagulation

Infrared coagulation is another treatment for hemorrhoids, during which an infrared light is used to destroy the hemorrhoidal tissue.

Sclerotherapy

During this procedure a chemical solution is injected into the hemorrhoidal tissue, causing the destruction of the tissue and formation of a scar.

If minimally invasive procedures are not effective in treating your hemorrhoids you may require a surgical intervention such as a hemorrhoidectomy.  This involves surgical removal of the excess hemorrhoidal tissue.

If you think you have hemorrhoids, please call our office at 410-730-1000 to schedule an appointment for assessment.  Dr. Schub offers medical therapy for hemorrhoids, in addition to minimally invasive procedural treatments, including rubber band ligation.