Treatments for Hemorrhoids
Hemorrhoids are varicose veins in the anal area. Essentially, blood vessels that have detached from the anal wall and not always visible or palpable. Hemorrhoids can be internal or external and graded based on severity. Grades I and II are usually internal and cause itching and bleeding when they flare up. Grades III and IV are external and can be painful and burn, as well as itch and bleed.
Chronic strenuous activity such as lifting, constipation, pregnancy and vaginal delivery are usually responsible for hemorrhoids. Many women with pre-existing hemorrhoids complain during pregnancy because they become more troublesome during this period. During pregnancy the amount of the blood in the body increases by two liters and in turn causes swelling of the blood vessels. Hormones of the pregnancy also cause the blood vessels to thin and bleed when irritated. Irritation of hemorrhoids can result from eating spicy foods, constipation, sitting for long periods of time and/or prolonged strenuous activity.
Hemorrhoids can be evaluated by using an anoscope during an office exam. It is important to eliminate other conditions that could have similar symptoms, such as an anal fissure, polyps and anal cancer. Once a hemorrhoid is identified and evaluated, the decision for treatment can be made.
Conservative management is always the best initial option. Avoiding conditions that irritate the hemorrhoids is an essential component of conservative management. Sitting for shorter periods at a time, avoiding spicy foods, eating lots of fiber (to avoid constipation) and avoiding strenuous activities that place direct pressure (i.e. biking) or indirect pressure (i.e. weight lifting) on the hemorrhoids is important. If a complete resolution is not achieved, then local treatment using a variety of medications is recommended.
A variety of office procedures are also available to eliminate the hemorrhoids and provide relief. Surgical removal is usually reserved for severe hemorrhoids that do not respond to conservative management or in-office treatments.
Cosmetic treatment of hemorrhoids are also common procedures that respond well to local or minimally invasive excision. Recovery for these treatments are short and usually well tolerated.
As usual, the most important message is:
The earlier you address the problem, the easier it is to treat.