HEMORRHOIDS (Piles)

General Information

DEFINITION--Dilated (varicose) veins of the rectum or anus. Hemorrhoids may be located at the beginning of the anal canal (internal hemorrhoids), or at the anal opening (external hemorrhoids). Hemorrhoids may be present for years, but go undetected until bleeding occurs.

BODY PARTS INVOLVED--Veins under the rectal or anal membrane.

SEX OR AGE MOST AFFECTED--Adults of both sexes.

SIGNS & SYMPTOMS

• Rectal bleeding. Bright-red blood may appear as streaks on toilet paper adhering to fecal residue, or it may be a slow trickle for a short while following bowel movements. It almost always colors the toilet water.
• Pain, itching or mucus discharge after bowel movements. Straining during bowel movements increases pain.
• A lump that can be felt in the anus.
• A sensation that the rectum has not emptied completely after a bowel movement (large hemorrhoids only).

CAUSES--Repeated pressure in the anal or rectal veins.

RISK INCREASES WITH

• Diet that lacks fiber; constipation.
• Prolonged sitting (especially truck drivers and pilots) or prolonged standing.
• Obesity.
• Pregnancy.
• Constipation.
• Loss of muscle tone due to older age, rectal surgery or episiotomy.
• Liver disease.
• Anal intercourse.
• Colon malignancy.
• Portal hypertension.

HOW TO PREVENT

• Don't try to hurry bowel movements, but avoid straining and prolonged sitting on the toilet.
• Lose weight if you are overweight.
• Include plenty of fiber in your diet.
• Drink 8-10 glasses of water a day.
• Exercise regularly.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Anoscopy or proctoscopy (See Glossary).

APPROPRIATE HEALTH CARE

• Self-care.
• Doctor's treatment.
• Surgery may be required in stubborn cases. Procedures include ligation (tying off hemorrhoid with a rubber band to strangulate it); sclerotherapy (injection of chemical to induce scarring); cryosurgery (freezing the hemorrhoid with liquid nitrogen); coagulation (by infrared light or laser) or hemorrhoidectomy (surgical removal). (See Hemorrhoid Banding and Hemorrhoid Removal in Surgery section.)

POSSIBLE COMPLICATIONS

• Iron-deficiency anemia if blood loss is significant.
• Severe pain caused by a blood clot in a hemorrhoid.
• Infection or ulceration of a hemorrhoid.

PROBABLE OUTCOME--Hemorrhoids usually clear up with proper care, but symptoms may flare up after a bout of constipation. Stubborn cases may require surgery.

How To Treat

GENERAL MEASURES--

• Never strain to push stool out.
• Lift feet on a low footstool to aid bowel movement.
• Clean the anal area gently with soft, moist paper after each bowel movement.
• To relieve pain, sit in 8 to 10 inches of hot water for 10 to 20 minutes several times a day.
• To reduce pain and swelling of a blood clot or protruding hemorrhoid, stay in bed for 1 day and apply ice packs to the anal area.

MEDICATION--

• For minor pain, itching or to reduce swelling, you may use non-prescription drugs that are formulated to relieve symptoms of hemorrhoids.
• Your doctor may prescribe a stool softener or bulk laxative, such as psyllium seed.

ACTIVITY--No restrictions. Bowel function improves with good physical conditioning.

DIET--

• To prevent constipation, eat a well-balanced diet that contains many high-fiber foods such as fresh fruit, bran muffins, beans, vegetables and whole-grain cereals.
• Drink 8-10 glasses of fluid daily.

Call Your Doctor If

• A hard lump develops where a hemorrhoid has been.
• Hemorrhoids cause severe pain that isn't relieved by treatment above.
• Rectal bleeding is excessive (more than a trace or streak on toilet paper or stool).