Hemorrhoids: Painless Rectal Bleeding
Hemorrhoids are varicose kind veins of the anal area. They are very similar to a surgical glove squeezed in the fingers to create a large spare tyre. These bulges filled with blood coagulate and form clots. This particular stretching of the blood vessel causes pain, and the clot maintains stretching of the vein leading to continued soreness. Fresh straining after unique formation of the clot, i.e. from constipation, bowel movements, labor or some other type of constriction of the stomach can further stretch this already broadened blood vessel and forms a new thin layer around the clot increasing the clot dimension causing more and more continued pain.
This thin stretched vessel has pressure receptors in it that are perceived as pressure pain and can be swollen by sitting, direct trauma, toilet paper or restraining. If you've ever had them, you know how uncomfortable they could be. Also called "piles", they occur for a number of reasons. One cause is gravity. The veins from higher up on the anus start to decrease down due to the laxity of the tissue as we grow older. Another cause is the pelvic congestion brought on by prolonged sitting, straining with hard work or trying to have a bowel movement, or perhaps by the pelvic congestion of pregnancy. Initial symptoms can be a tad alarming. Maybe it's a small amount of fresh blood on the tissue paper after a bowel movement. Then there is the hazy itching, generalized discomfort and downright pain that can accompany hemorrhoids. Add to that the discovery of "lumps" in the area by the patient, and you have the makings of a panic.
Imagine for a Moment that You are Looking Into the Anal Area Through an Anoscope
There is a circular line around the mucosa wherever muscle tissue attach to the outer anal sphincter called the "dentate" (or "pectinate") line. If hemorrhoids tend to be above the dentate line, they are called "external," and if they are below the dentate line they are classified as "internal." The external ones are more easily seen and felt, while a person may be unaware that they have internal hemorrhoids.
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We Do Not Know for Sure What Percentage of the Population Receives Hemorrhoids
In the usa the number who found for medical care of hemorrhoids tend to be about 4%. In Great Britain, where they have Socialized Medicine, about 30% of patients present for treatment of this condition. Could in the usa that the sale of over-the-counter products for them goes into the billions of dollars.
People who have occupations that require prolonged sitting, for example like truck drivers, get hemorrhoids, as do people who do a lot of heavy lifting. Fighter aircraft pilots get hemorrhoids from gravity and fighting towards G-forces. Pregnant females get hemorrhoids, as mentioned, from pelvic congestion, but later from moving the infant out during the latter part of labor. Probably the most common cause is straining at bowel movement secondary to chronic constipation.
What are the treatments for hemorrhoids? Well, believe it or not, increasing fiber in the diet is a superb treatment for all signs and symptoms.. Stool softeners have not been found to help that much. Dietary fiber decreases bleeding and irritative symptoms. Witch Hazel and glycerin astringent wipes can be very calming to swollen hemorrhoids as well as can often relieve irritation. Sometimes, warm sitz baths several times a day can help, as well as sitting on an inflatable "doughnut" cushion (decreases direct pressure and pinching). If there is an acute clot in a hemorrhoidal vein, it may respond to intermittent ice packs. Occasionally, the E.R. or physician can make a tiny cut in the hemorrhoid and let the clot out, resulting in great relief as well as last healing.
What are the physician remedies of hemorrhoids? Certainly one of the most effective is the outpatient application of specific rubber bands to the hemorrhoids. A patient can have up to three bands a week. Several physicians sclerose (inject that with irritant substance to be able to make it shrink) the hemorrhoids by injecting them with 5% oily phenol, but the results are not as good as with banding.. Some clinics make use of infrared coagulation, cryotherapy (freezing), or various forms of cautery with mixed results. Any time hemorrhoids are too severe, either open or closed, hemorrhoidectomy is actually done in the operating room. The results are generally good, but the time to recovery may be lengthy. There have been some good operative results with simply tying from the hemorrhoidal artery.
So, what's the take-home message? Hemorrhoids are the most common cause of bright red anal bleeding, itching and pain, but this simply can't be assumed in every case. The doctor is going to have to examine your anus. There are plenty of other things which can cause these symptoms. Please leave your embarrassment in the waiting room and tell the doctor what's been going on. The one thing to remember when sitting in the waiting room is you're not alone, and the more open you are with your doctor the better help he/she can provide for you to getting better. If you are over 50 or have risk factors for colon cancer, you probably need anoscopy and colonoscopy. These are very benign tests in this day and age. Once all the more serious possibilities have been ruled out, then you can start a comprehensive program to treat and manage hemorrhoids, and you will "live happily ever after."
John Came Laurusonis M.D.
Doctors Medical Center.