HAEMORRHOIDS
The
term haemorrhoids refer to a condition in which the veins
around the anus or lower rectum are swollen and inflamed.
Haemorrhoids may result from straining to move stool. Other
contributing factors include pregnancy, aging, chronic constipation
or diarrhea, and anal intercourse. Haemorrhoids are either
inside the anus (internal) or under the skin around the
anus (external).
Symptoms
Many
anorectal problems, including fissures, fistulae, abscesses,
or irritation and itching (pruritus ani), have similar symptoms
and are incorrectly referred to as haemorrhoids. Haemorrhoids
usually are not dangerous or life threatening. In most cases,
haemorrhoid symptoms will go away within a few days. Although
many people have haemorrhoids, not all experience symptoms.
The most common symptom of internal haemorrhoids is bright
red blood covering the stool, on toilet paper, or in the
toilet bowl. However, an internal haemorrhoid may protrude
through the anus outside the body, becoming irritated and
painful. This is known as a protruding haemorrhoid.
Symptoms
of external haemorrhoids may include painful swelling or
a hard lump around the anus that results when a blood clot
forms. This condition is known as a thrombosed external
haemorrhoid. In addition, excessive straining, rubbing,
or cleaning around the anus may cause irritation with bleeding
and/or itching, which may produce a vicious cycle of symptoms.
Draining mucous may also cause itching.
Diagnosis
A
thorough evaluation and proper diagnosis by the doctor is
important any time bleeding from the rectum or blood in
the stool occurs. Bleeding may also be a symptom of other
digestive diseases, including colorectal cancer. The doctor
will examine the anus and rectum to look for swollen blood
vessels that indicate haemorrhoids and will also perform
a digital rectal exam with a gloved, lubricated finger to
feel for abnormalities. Closer evaluation of the rectum
for haemorrhoids requires an exam with an endoscope, a hollow,
lighted tube useful for viewing internal haemorrhoids, or
a proctoscope, useful for more completely examining the
entire rectum. To rule out other causes of gastrointestinal
bleeding, the doctor may examine the rectum and lower colon
(sigmoid) with sigmoidoscopy or the entire colon with colonoscopy.
Sigmoidoscopy and colonoscopy are diagnostic procedures
that also involve the use of lighted, flexible tubes inserted
through the rectum.
Treatment
Medical
treatment of haemorrhoids is aimed initially at relieving
symptoms. Measures to reduce symptoms include:
-
Warm
tub baths several times a day in plain, warm water for
about 10 minutes.
-
Application of a haemorrhoidal cream or suppository
to the affected area for a limited time.
-
Preventing
of the recurrence of haemorrhoids will require relieving
the pressure and straining of constipation. Doctors
will often recommend increasing fibre and fluids in
the diet.
Eating
the right amount of fibre and drinking six to eight glasses
of fluid (not alcohol) result in softer, bulkier stools.
A softer stool makes emptying the bowels easier and lessens
the pressure on haemorrhoids caused by straining. Eliminating
straining also helps prevent the haemorrhoids from protruding.
Good
sources of fibre are fruits, vegetables, and whole grains.
In addition, doctors may suggest a bulk stool softener or
a fibber supplement such as psyllium (Metamucil) or methylcellulose
(Citrucel). In some cases, haemorrhoids must be treated
endoscopically or surgically. These methods are used to
shrink and destroy the hemorrhoidal tissue. The doctor will
perform the procedure during an office or hospital visit.
A number of methods may be used to remove or reduce the
size of internal haemorrhoids.
These
techniques include:
-
Rubber
band ligation. A rubber band is placed around the base
of the haemorrhoid inside the rectum. The band cuts
off circulation, and the haemorrhoid withers away within
a few days.
-
Sderotherapy.
A chemical solution is injected around the blood vessel
to shrink the haemorrhoid.
-
Infrared
coagulation. A special device is used to burn hemorrhoidal
tissue.
-
Hemorrhoidectomy.
Occasionally, extensive or severe internal or external
haemorrhoids may require removal by surgery known as
hemorrhoidectomy.
The
best treatment however is prevention. Keeping stools soft
will decrease pressure and straining. Do not resist the
urge to empty your bowels, for if you do, you increase the
likeliness of developing constipation and haemorrhoids.
Exercise, including walking, and increasing the fibre content
in your diet helps to reduce the likelihood of developing
constipation and straining, by producing stools that are
softer and easier to pass.
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