If there’s one topic that never comes up in conversation, but afflicts a large portion of Americans, it’s hemorrhoids. At least half of American adults over the age of 50 have experienced unpleasant symptoms of hemorrhoids, which are clumped and swollen blood vessels in the lower rectum. But even colorectal surgeons were shocked when I asked them to speak to me about it.
“I laughed when I got this request,” said Robert Cima, a colorectal surgeon at the Mayo Clinic in Rochester, Minnesota. “I thought, ‘Is this a punk call? Does the New York Times want to know about hemorrhoids?'”
Here’s what I learned about hemorrhoid prevention and treatment after talking to four doctors.
Know the symptoms
Everyone is born with hemorrhoidal tissue. In fact, these blood vessels that line the anus have a useful function: they help us feel what’s in the rectum, said Cima. They’re why you can (usually) tell if the pressure you’re feeling down there is gas or diarrhea, or a normal bowel movement.
Hemorrhoids also help form a seal inside the anus that keeps it closed, like caulking on a door, explained Cima.
It is only when hemorrhoids become swollen and inflamed that they cause unpleasant symptoms. These symptoms can include itching, burning, bleeding, and sometimes the hemorrhoid protruding outside the body.
Hemorrhoids typically become inflamed from straining during bowel movements, said Rahul Narang, a colorectal surgeon at Langone Health at New York University.
Most hemorrhoids are called internal hemorrhoids, which means they develop inside the anus, even though they sometimes bulge. People may, more rarely, have external hemorrhoids, which affect the blood vessels outside the anus. These tend to come on suddenly and are extremely painful, said Cima, but usually go away on their own within a week.
Even if you have hemorrhoid symptoms, you shouldn’t assume you have hemorrhoids, said Karen Zaghiyan, a colorectal surgeon at Cedars-Sinai Medical Center in Los Angeles. Symptoms such as rectal bleeding and pain can also be caused by other problems, including anal fissures (sores in the anus), anal fistulas (infected tunnels between the anus and the skin), and rectal cancer.
A doctor should perform a rectal exam with a finger to rule out other problems, she said. If not, consider seeing a specialist, such as a gastroenterologist or colorectal surgeon, who may also order an endoscopic exam, such as a colonoscopy, to properly diagnose the problem, Cima said.
how to prevent
When it comes to preventing hemorrhoids, eating a high-fiber diet almost certainly helps, said Neha Mathur, a gastroenterologist at Houston Methodist Hospital. She recommended consuming 20 to 30 grams of fiber a day.
Staying hydrated can also make a big difference, Narang said. Fiber and water make bowel movements easier, which reduces the chances of hemorrhoids becoming inflamed, he explained.
How you sit on the toilet also matters: Products like the Squatty Potty — a stool placed under your feet while you’re sitting on the toilet — change the angle at which you sit in a way that can reduce strain, Mathur added.
Sitting for long periods of time in general can also make hemorrhoid symptoms worse, Cima said, as can lifting heavy weights with your upper body, which strains blood vessels around the anus. He said that men often come to him with painful hemorrhoids after becoming dehydrated during strenuous physical activity.
Women also often develop symptoms of hemorrhoids during pregnancy, in part because as the uterus grows, pressure in the anal area increases, Mathur said. Hormonal changes and prenatal vitamins also increase the chance that pregnant women will experience constipation, which makes the problem worse by making them strain to have a bowel movement, she said.
Fiber, hydration and less time spent in the bathroom can help, as can a stool softener. Mathur recommended that pregnant women with hemorrhoids talk to their doctors about safe treatment options.
Simple treatments can help
Doctors categorize internal hemorrhoids into stages 1 to 4, depending on their physical characteristics and severity. For minor hemorrhoids — grade 1, which do not protrude outside the anus, and grade 2, which may protrude but then come back on their own — people can usually get relief by following the recommendations mentioned above.
They may also feel better after sitting in a sitz bath or Epsom salt (magnesium sulfate) bath for 15 minutes, Narang said. These baths soothe the tissue and reduce inflammation.
I was surprised to learn from Cima that over-the-counter hemorrhoid lotions and gels often don’t help as much as people expect. They may briefly relieve symptoms, he said, but they don’t address the underlying problem.
If hemorrhoid symptoms don’t improve, an in-office procedure can help, Narang said. A popular treatment is rubber band ligation, in which the doctor uses an instrument to place a rubber band around the base of the hemorrhoid, which stops blood flow to the inflamed tissue and causes the hemorrhoid to die and fall off within one to four days. .
It’s quick, relatively painless and requires very little downtime for the patient, Mathur said. Some people can return to work after the procedure. But others may need multiple treatments.
Severe hemorrhoids can be treated with surgery
Grade 3 and 4 internal hemorrhoids – grade 3 means the hemorrhoid protrudes out of the anus but can be manually pushed back in, and grade 4 is when it is constantly outside the anus – sometimes they require surgery.
There are surgical options available. One is excisional hemorrhoidectomy, which is the surgical removal of the hemorrhoid, Narang said.
Another option is stapled anopexy (also called stapled hemorrhoidopexy), in which a doctor removes part of the hemorrhoid and then staples it back together, reducing it to a normal size, Cima said.
Some doctors instead use Doppler-guided hemorrhoidal artery ligation, which is a good option for hemorrhoids that bleed a lot, Narang said. In this procedure, the doctor ties off the main arteries that feed the hemorrhoid, causing it to wither and fall off.
While surgical procedures often work, they’re not without potential downsides, Mathur said. They can have painful and longer recoveries than in-office procedures and can cause fecal incontinence.
What’s more, even after surgery, hemorrhoids can return — some surgeries, such as ligation of the artery, are associated with up to a 30% chance of recurrence, Narang said. This is in part because these treatments remove or kill some of the body’s hemorrhoidal tissue but leave the rest behind, which can become engorged and inflamed, Cima said.
If people don’t address the lifestyle factors that cause hemorrhoids, the problem is more likely to return.
Chad-98Weaver, a distinguished author at NewsBulletin247, excels in the craft of article writing. With a keen eye for detail and a penchant for storytelling, Chad delivers informative and engaging content that resonates with readers across various subjects. His contributions are a testament to his dedication and expertise in the field of journalism.
