HemorrhoidsHemorrhoids are varicose veins of the anus. The lump at the external opening is a distended vein. The cause of hemorrhoids has not been truly established, but there are a number of associated considerations. They are probably related to the upright posture; four legged animals do not get this disease, although it is seen in baboons. Hemorrhoids often appear temporarily with the increased intra abdominal pressure of pregnancy and in some very constipated individuals who strain at stool. Yet many individuals in these categories don't get them. There is definitely a familial inherited predisposition to them, as there is in varicose veins of the legs.
What else could it be?I do have these hemorrhoids sticking out. You do have hemorrhoids. I want to be sure that you do not also have a tumor or an inflammation of the lower intestine.
The hemorrhoids stick out and cause some moisture and itching. Can this be relieved? Does it require surgery?The vast majority of hemorrhoids can be satisfactorily treated without surgery. The treatment requires attention to several factors. The constipation should be treated by diet and a medication that softens the irritating stool. Repeated bruising of the anal area should be avoided by substituting soapy cotton balls for toilet paper. Alcohol and spices should be used in moderation. Sitz baths, sitting in a tub of warm water for 10-15 minutes, twice a day, should be used for 7-10 days. A soothing ointment can be applied to the area in between times. Some such regime quickly relieves most hemorrhoidal complaints.
I see blood in the toilet bowl. Should these hemorrhoids be removed to stop that bleeding?The examination in the office is normal except for the hemorrhoids. However, even when hemorrhoids are present, the bleeding can still be coming from elsewhere in the intestine. Before a final decision is made, you should have a barium enema X-ray examination of the lower intestine. After that is done, you'll return for another examination of the area. The surgeon will make a final decision when all this information is available.
What is sigmoidoscopy? Why do you want to give it to me?Sigmoidoscopy is a method of directly inspecting the anus, the rectum and lower colon. This examination, done in the office, takes only a few minutes and is completely painless. The findings tell whether the hemorrhoids are the cause of the trouble or whether there is something else somewhat higher up.
Suppose you find something higher up? Will you do something about it now?Yes. If you have a small polyp, it can be removed at the time of the sigmoidoscopy. If there is a tumor, a piece of it (biopsy) can be extracted for microscopic examination.
Should bleeding hemorrhoids be removed?Only if the method discussed earlier does not improve the situation, if there is no other source of bleeding, and if the bleeding continues. Surgery should be done only after several careful evaluations and a trial of an anal hygiene routine. The vast majority of hemorrhoidal problems can be satisfactorily managed without operation.
Hurting From Hemorrhoids
What is an external hemorrhoid?This term is used to designate the flabby protuberant piece of skin that lies over a soft compressible hemorrhoid. This piece of skin can swell, be hot, itch, and be very sore. It interferes with walking and sitting. Usually it gets better if properly treated by local applications.
This time it's different. The hemorrhoid is sticking out, it is sore, very tender, and I can walk only with difficulty.
What you have is a thrombosed external hemorrhoid. A clot has formed in the vein that is sticking out. It is exceedingly painful. This can be taken care of in the doctors' office with a local anesthetic and a small incision to remove the clot. You will get almost instant relief.
When should hemorrhoids be operated on?An operation should be done only after repeated episodes of painful protrusion and bleeding have not been satisfactorily controlled by corrective bowel and diligent anal hygiene.
What do you do in the operation? What result should I expect?The hemorrhoidal tissues that are the veins are removed in three clumps. The superficial anal muscle is stretched to prevent postoperative muscle spasm. Normal anal tissue is left to heal between the areas of excision. The patient should expect to be cured completely of bleeding, protrusion and itching. Sometimes hemorrhoidal disease can be cured simply by a wide stretching of the area under anesthesia without removal of any tissue. Each specific problem is somewhat different, and the procedure is modified according to the disease. I've heard that the pain after the operation is terrible, and that it is torture to have the first postoperative bowel movement. If the operation is properly performed and if the postoperative care is correct, neither of these fears is justified. What about cases I've heard of where the hemorrhoids "grew back"? This can mean that the operation was incomplete or that the present problem is not due to hemorrhoids, or that the basic cause for the hemorrhoidal protrusion remains active.
I've heard of patients who had such a tight opening after this operation they had to be continuously stretched and finally had to have another operation. I've also heard of patients who could not control their bowels after this operation.
Both of these complications, a too tight and too loose opening, can occur. But they seldom happen if both the operation and postoperative care are carefully carried out.
What about infection treatments?The assumed advantage of this office treatment method is that it can be done without going to the hospital and without a major anesthetic. This advantage is sometimes offset by the fact that it is often an incomplete procedure. Injection treatments should be done only in carefully selected cases where the hemorrhoids are small and do not protrude and where there is no infection. If the treatment for bleeding is not effective after three injections, each given in a different area at weekly intervals, then it should be abandoned. The injection method can be accompanied by complications.
My job is selling; it requires sitting and walking. If I'm operated on, when can I go back to work?
It takes seven to ten days to be able to get back into full harness. In some people, where the procedure is simple, it is possible to return to work in three to five days. It is best to count on one week.