Hemorrhoids can be truly painful, but not always. Hemorrhoids are caused generally by the frequent straining (bearing down) to produce a bowel movement. Constipation is frequently associated with hemorrhoid occurrence due to lack of fiber intake on a daily basis. Dehydration, not taking in adequate fluid intake, can cause stool to be dry, enlarged, and more difficult in having a bowel movement or increase the need for straining.

Excessive amount of straining to produce a bowel movement causes increased pressure on the tissue surrounding the anus. This tissue is lined with blood vessels that swell, become inflamed, and at times, form clots within the vessel lining (called thrombosis). Hemorrhoids can be either internal (on the inside of the anal opening) or externally where small rounded skin protrusions can be seen or palpated manually.

Both types of hemorrhoids can cause discomfort, irritation and itching, and bleeding when producing the next bowel movement. Often, patients present in the Emergency Room or physicians office with complaints of bleeding rectally and seeing blood in the toilet bowl after a bowel movement. Other complaints related to hemorrhoids are: blood on the toilet paper, increased discomfort in sitting, and noticing a round lump on the outside of the anal opening.

 Diagnosis can be done by visualization of the anal opening. Your physician has several options to accurate diagnose hemorrhoids. Direct visualization of the external tissue surrounding the anal opening can be done for hemorrhoids located or protruding from the anus. An internal procedure using a Anoscope can be done in most physician offices. This procedure requires inserting a lubricated round scope to visualize internal tissue. Discomfort with this procedure is similar to producing a bowel movement. Your physician might opt for manual internal exam using a lubricated gloved finger to palpate the internal tissue. Discomfort of this procedure is again similar to the use of the Anoscope. To lessen any discomfort of both procedures, the patient may be asked to "bear down" as if having a bowel movement which relaxes the anal muscle.

There are surgical procedures for severe cases of hemorrhoids through the use of Sclerotherapy to decrease scar tissue, Laser therapy to remove involved tissue, and more frequently the use of an electrical cautery to remove tissue and seal the vessels involved. These options should be discussed with your physician.

Most hemorrhoids can be treated at home very effectively by maintaining adequate fluid and fiber intake. Hydration is best by avoiding large amounts of caffeine and consuming at least eight glasses of water on a daily basis. Good fiber intake increases your ability of having softer bowels movements that can be passed without the need to strain. You should always ask your physician if you can add a stool softener before using any over the counter medications. All of the above can be utilized for internal hemorrhoids.

External hemorrhoids are treatable using the same method as internal hemorrhoids with a few added adjustments. Pain is usually more prominent with external hemorrhoids. The pain is largely due to the swelling of the hemorrhoidal tissue. You can effectively decrease both swelling and pain by adding the following care:

• Avoid long periods of sitting in an erect position on hard surfaces. Take time to position yourself in a lateral side lying position or on your back several times a day. This reduces pressure on the anal tissues.
• Use hemorrhoidal creams that provide an anesthetic effect on the swollen tissue several times as directed. Usually, the reduction of pain reduces straining and relieves pain.
• The use of warm sitz baths several times per day reduced swelling, irritation, and discomfort. You should be able to sit in the tub with several inches of warm water for 15-20 minute intervals and relax.
• Avoid excessive wiping motions to external hemorrhoids which can only increase irritation. Simple moistened hygiene wipes may provide more comfort.
• Avoid the use of circular inflated rings to sit on. They may reduce discomfort but not necessary reduce increased anal pressure.

Remember: If you do have an external hemorrhoid, if you utilize the above treatments, a large thrombosed hemorrhoid can take up to several weeks for full absortion of the clot. As the swelling decreases, comfort increases.