Ask The Doctor

Wide Range of Treatments For Hemorrhoid Relief

Dear Dr. Garner,

For the past month I have had itching and pain in my rectum. In addition, I bleed whenever I go to the bathroom. I am in good health otherwise, a little bit overweight, and 45 years old.  Do you think this could be hemorrhoids?  If so, what should I do about it?

Itching for an
Answer in Astoria

Dear Itching,

First, let me assure you that you are not alone in your agony. More than 50% of the population will have hemorrhoids by the time they are 50.

Most of the time, they are more of an annoyance than anything else, but occasionally, they can be disabling or a symptom of a more serious disease.

Many people are reluctant to discuss the topic, even with their doctor for fear of embarrassment.

Hemorrhoids, also called piles, are swollen and inflamed veins in the rectal region. They usually come about from straining during bowel movements.

They are made worse by constipation. Sitting for long periods of time, pregnancy, and obesity are also factors in developing hemorrhoids.

They can be located inside or outside the rectum.

When hemorrhoids become inflamed or develop blood clots inside them, there may be bleeding during bowel movements, itching or irritation, and pain or discomfort about the rectum.  There may even be lumps in this region representing the enlarged veins, with blood clots inside.

The most common sign of hemorrhoids is painless bleeding during bowel movements.  Unfortunately, bleeding may also be a sign of other disorders, such as colon cancer. It is, therefore, essential to follow-up any case of rectal bleeding with your physician, to rule out more serious causes. It is possible to become anemic, if the bleeding is frequent. This can cause harm to patients with heart problems and must be corrected with treatment of the hemorrhoids and possible iron ingestion.

When you visit your doctor, he or she will do a rectal exam to check for any masses or abnormalities. This will help determine what tests should be performed as part of the work up.

Treatment Options
If the hemorrhoids produce only mild discomfort, your doctor may suggest over-the-counter medications such as creams, or suppositories containing steroids, and local anesthetics, and witch hazel, which can be soothing and reduce pain and itching. If there is a clot formed within the hemorrhoid, your doctor may remove the clot with a simple incision.  A sitz bath several times a day is instrumental in the treatment, maintaining cleanliness and providing relief.

If the bleeding persists, there are surgical treatments that can be performed as an outpatient.  Some of these include:
1. Rubber band ligation.  This involves placing tiny rubberbands around the hemorrhoid to cut off the circulation. The hemorrhoid will eventually die and fall off.
2. Another technique is to inject a chemical solution into the hemorrhoid to shrink it.
3. An alternative is the laser, which can cause the blood supply of the hemorrhoid to disintegrate.
4. Your doctor may suggest you see a surgeon who can surgically remove the hemorrhoid.  This is actually the most effective way to remove hemorrhoids. It can be done at the same time as a colonoscopy, in which  you can kill two birds with one stone — assuring that you have no colon cancer, and also taking care of the hemorrhoid problem.
5. Some surgeons use staple guns to cut off the blood supply of the hemorrhoids.

A major part of the treatment will depend upon lifestyle changes. The lifestyle change will involve dietary changes, such as eating high fiber foods and drinking plenty of fluids. It is also important not to strain when passing stool.  Fiber supplements (over the counter) may be useful in tackling this problem.  Exercise is very important to maintain a normal constitution and limit the periods of constipation that one experiences.  If possible it is important to avoid long time periods of standing or sitting. If you are overweight, it is important to shed some of those extra pounds.

I suggest you visit your physician if any of the following occurs:
1.  Bleeding from the rectum for the first time.
2. Persistent bleeding that becomes more severe.
3.  A change in normal bowel movements for more than two weeks.
4. Persistent pain in the region.
5.  If the blood from the area becomes dark.
In summary, hemorrhoids are a very common problem.  People are reluctant to discuss the problem with others due to embarrassment. It is important to remember that more than half the population suffers from hemorrhoids.
If pain and bleeding becomes excessive, it is essential that you see your physician. This can help rule out other more serious causes of bleeding. Blood loss and discomfort can be stopped and you can resume a normal existence.

The longer you delay visiting your physician, the worse the problem may become.

There are a wide range of treatment options, ranging from over-the-counter medications, and home remedies, to surgery.

I hope this has been helpful and will encourage others with similar symptoms to seek help.[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET, Tuesdays at 8 p.m. on Ch. 97 Time Warner and Ch. 30 Cablevision.

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