Hemorrhoids are swollen veins in the anal canal. In their normal state, these veins provide cushioning during bowel movements. They can, however, swell after lifting, straining, constipation, passing of hard stools or diarrhea, or pregnancy. Hemorrhoids are not life-threatening, but they can be painful. If swelling persists, the veins may become permanently stretched (prolapsed).
Types of Hemorrhoids
There are two kinds of hemorrhoids: internal and external. The dentate line along the circular anus muscle divides the interior nerve canal, which has no nerve endings, from the anal opening and exterior areas, which do have nerve endings. Hemorrhoids that form in the anal canal are thus called internal hemorrhoids, whereas those outside the anal opening are called external hemorrhoids. External hemorrhoids are typically more uncomfortable at first because there are nerves present in the area where they form. However, internal hemorrhoids often swell beyond the dentate line, causing pain and other problems.
Symptoms of Hemorrhoids
Hemorrhoid symptoms vary in type and severity depending on such factors as a person's age, anatomy and heredity, and the duration of the problem. The most common symptoms are bleeding, itching, burning, discomfort during bowel movements, and a feeling of fullness or of a mass in or on the anus.
Treatment for Hemorrhoids
Hemorrhoids should be treated only if they are painful or cause complications. To choose an appropriate treatment, the cause or causes need to be determined. Making changes to diet and fluid intake, toilet habits and exercise can relieve symptoms and prevent recurrence. Relief can also be found by treating related problems, such as diarrhea and constipation, that irritate the hemorrhoid(s) and affected areas.
Beyond this, treatment depends on the type and severity of the hemorrhoid, as well as how it has responded to any previous treatment. Hemorrhoids are divided into four grades (stages) depending on their history. Grade I and II hemorrhoids are usually treated nonsurgically, whereas Grades III and IV are more likely to be treated surgically.
Rubber Band Ligation (RBL)
An elastic band is wrapped around the hemorrhoid, cutting off its blood supply, and causing the tissue to die and drop off. External hemorrhoid and early-stage internal hemorrhoids can be treated with RBL.
Infrared Photocoagulation (IPC) or Electrocoagulation
The hemorrhoid is exposed to a warm, painless infrared light or electrical current during a series of treatment sessions.
A sclerosing solution injected into the blood vessels causes the hemorrhoids to shrink.
Surgery is usually reserved for very advanced cases with a large amount of protrusion. The hemorrhoid is removed with a scalpel, cautery device or laser. Local or general anesthesia may be used, and hospitalization is usually required, with recovery taking up to 2 weeks.
This recently introduced procedure involves the insertion of a circular stapler into the rectum that pushes internal and external hemorrhoids and surrounding tissue up into the anal canal and staples them in place, cutting off blood supply.
More than half of adults in America have hemorrhoids. Few report them to their doctors, however, whether out of embarrassment or the belief that the only treatment is surgical removal. Patients should keep in mind that, the sooner hemorrhoids are diagnosed, the greater the chance that they can be treated with an in-office, nonsurgical procedure.