Hemorrhoids - Management and Treatment of Hemorrhoids

 Primus General Surgery and Minimal Access Surgery Department

Hemorrhoids are  vascular structures  in  the anal  canal which  help  with  stool  control and  act  as  a  cushion  composed  of arterio-venous channels and  connective  tissue.  They become pathological or piles when swollen or inflamed.

The  exact  cause  of  symptomatic  hemorrhoids  is  unknown. A  number  of  factors  are believed  to  play  a  role  including:  constipation or diarrhea,  a  lack  of  exercise,  nutritional factors,  increased  intra-abdominal  pressure,  genetics,  an  absence  of  valves  within  the hemorrhoid veins, and aging.Internal  hemorrhoids  usually  present  with  painless rectal  bleeding while  external hemorrhoids may produce few symptoms or if thrombosed significant pain and swelling in the area of the anus. Hemorrhoids are typically diagnosed by physical rectal examination or through anoscopy.Management  depends  upon  the  stage/grade  of  hemorrhois.  Increasing fiber   intake,  oral fluids to maintain hydration or  fiber supplements, avoiding constipation, not straining  for stools, regular exercises are few preventive measures

Early stage is treated with medical management & lifestyle modifications. Later stage needs a surgical intervention.
If your hemorrhoids produce only mild discomfort, the doctor may suggest over-the-counter creams, ointments, suppositories or pads. These products contain ingredients, such as witch hazel or hydrocortisone that can relieve pain and itching, at least temporarily.It is not recommended to use over-the-counter cream or other product for more than a week unless directed by your doctor. These products can cause side effects, such as skin rash, inflammation and skin thinning.

Minimally invasive procedures

If a blood clot has formed within an external hemorrhoid, your doctor can remove the clot with a simple incision, which may provide prompt relief.For persistent bleeding or painful hemorrhoids, the may recommend another minimally invasive procedure.

Lifestyle modification to prevent hemorrhoids

The best way to prevent hemorrhoids is to keep your stools soft. To prevent hemorrhoids and reduce

symptoms of hemorrhoids, follow these tips:

 Eat high-fiber foods- Eat more fruits, vegetables and whole grains. Doing sosoftens the stool and increases its bulk, which will help you avoid the straining that can cause hemorrhoids or worsen symptoms from existing hemorrhoids. Add fiber to your diet slowly to avoid problems with gas.

 Drink plenty of fluids- Drink six to eight glasses of water and other liquids (not alcohol) each day to help keep stools soft.

Consider fiber supplements-Most people don't get enough of the recommended amount of fiber -25 grams a day for women and 38 grams a day for men -in their diet. If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause constipation or make constipation worse.

Don't strain-Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.

Go as soon as you feel the urge- If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.

Exercise-Stay active to help prevent constipation and to reduce pressure on veins, which can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that may be contributing to your hemorrhoids.

Avoid long periods of sitting-Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.

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