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Hemorrhoids - What they are, how you get them, and what to do about them.

Updated on September 17, 2016

Knowledge Is Power.

Oh that feeling when you have to sit down very carefully or have to use a pillow in order to sit comfortably. That horrible feeling when you know you have to go to the loo but try to put it off as long as possible because it will HURT. Never mind the feeling that you don’t want to have intimate contact with someone and have them see those unsightly lumps.

Nobody LIKES to talk about hemorrhoids (which are also called piles). Few people want to admit they have them except to their doctors. However, hemorrhoids are a common condition. They are lumps of tissue that contain enlarged blood vessels and occur in the anal/rectal area. They can be internal, external, or both.

What Causes Hemorrhoids?

The most common causes of hemorrhoids include straining during a bowel movement, diarrhea, constipation, and the pressure of the uterus on the anal/rectal area during pregnancy. Not eating sufficient fiber and not getting sufficient exercise can lead to constipation, and the resulting straining during a bowel movement can cause hemorrhoids. Even sitting on the toilet too long can exacerbate existing hemorrhoids.

Hemorrhoids Can Be Internal or External


Two Types of Hemorrhoids - Internal and External

Internal hemorrhoids can cause bleeding during a bowel movement. Internal hemorrhoids usually are not painful. When they become external (when they prolapse), they can sometimes be pushed back inside.

External hemorrhoids can be painful and itchy and can make good hygiene difficult.

Symptoms and Diagnosis

The symptoms of hemorrhoids include "lumps" protruding from the anus, bright red blood on toilet tissue after a bowel movement, a feeling of pressure, and itching and pain during or after a bowel movement. There may also be a sense of urgency when you need to have a bowel movement. A small lump may appear suddenly if a hemorrhoid becomes trapped (strangulated) and becomes thrombosed (develops a blood clot).

Help Yourself By Developing Good Habits

  • Wear cotton underwear to maximize ventilation of the anal area and prevent moisture buildup.
  • Exercise in order to prevent constipation.
  • Sit on a pillow to relieve pressure on your anal area.

  • Eat fiber and drink a lot of water in order to bulk up your stool and prevent constipation.

  • Refrain from sitting on the toilet when you are through. The longer you sit, the more pressure you put on your anal area and thus on your hemorrhoids.

A Sitz Bath

Anal Hygiene When You Have Hemorrhoids

Hemorrhoids can cause problems with hygiene. Sitz baths are available at specialty drugstores. You can place a Sitz bath on your toilet, fill it with warm water, and sit and soak for half an hour after a bowel movement.

You can use a soft pad with aloe gel to very gently clean your anal area. A topical ointment such as Anusol or Proctosedyl can numb the anal area and reduce the pain and itching that make proper hygiene difficult.. A pantiliner will protect your underwear. Medicated wipes are also available.

Medical Intervention in the Treatment of Hemorrhoids

When home treatment does not relieve the pain, itching, and bleeding of hemorrhoids, medical intervention may be necessary.

When you require medical intervention, your doctor will do a manual test for hemorrhoids as well as use a device called an anoscope to examine your anal canal. Your might also require further rule-out tests to ensure that bleeding is not coming from another source.

Internal Hemorrhoids

Doctors have a number of options for treating internal hemorrhoids depending upon their size, location, and how long they have been present Other factors include the medicines the patient is taking (for example, anticoagulants) and the presence of an anal fissure. Any medical procedure has associated risk factors, and the patient must discuss these with the doctor.

Internal hemorrhoids are rated according to the Banov classification system and are graded as follows:

  • I – Nonprolapsing internal hemorrhoids.
  • II – Internal hemorrhoids prolapse during defecation but spontaneously reduce.
  • Internal hemorrhoids prolapse during defecation, must be manually reduced.
  • IV - Internal hemorrhoids prolapsed and incarcerated.

Medical Treatment Options for Internal Hemorrhoids Include:

  • band ligation
  • sclerotherapy
  • LASER hemorroidectomy
  • harmonic ultrasound scalpel hemorrhoidectomy
  • Doppler-guided hemorrhoidal artery ligation

Medical Treatment Options for External Hemorrhoids Include:

  • open hemorrhoidectomy
  • closed hemorrhoidectomy
  • stapled hemorrhoidectomy

Overview of Treatment Options for Internal and External Hemorrhoids

The following are just a few examples of treatments that are available for internal and external hemorrhoids.

Band Ligation

The doctor puts a rubber band over the base of the hemorrhoid to impede the blood supply so that the hemorrhoid will shrink and fall off.


The doctor injects a solution called a sclerosant. This irritates the lining of the vein and causes it to deteriorate and block the blood supply. The hemorrhoid shrinks and may disappear

LASER Hemorrhoidectomy

The doctor uses a LASER beam to divide, cut, and seal the tissue.

Harmonic Ultrasound Scalpel Hemorrhoidectomy

The harmonic scalpel uses a lower temperature than a laser and causes less thermal damage to the tissues around the target area. The harmonic scalpel cuts and coagulates hemorrhoidal tissue.

Doppler-guided Hemorrhoidal Artery Ligation

The doctor uses a proctoscope to ligate hemorrhoids by putting sutures around them to cut off their blood supply.

Open Hemorrhoidectomy

The doctor incises the skin around the hemorrhoid and then removes the hemorrhoid with surgical scissors. The wound is left open because it is difficult to close.

Closed Hemorrhoidectomy

The doctor removes the hemorrhoids with a scalpel, scissors, or electrocautery and then sutures the wound closed.

Stapled Hemorrhoidectomy

The doctor uses a stapling device to remove large hemorrhoids and then staples the smaller hemorrhoids back into their normal position inside the anal canal

Other Treatment Options

Although there are other treatment options, some of them are rarely used now. This article has presented the most common methods of treating internal and external hemorrhoids. YouTube videos will allow you to explore these procedures.

Ignoring the Symptoms of Hemorrhoids

What happens if you simply ignore your hemorrhoids? You will continue to suffer the symptoms of pain and itching.

What is more important than the discomfort of hemorrhoids is the possibility that you might miss the symptoms of something far worse because you attribute any bleeding to your hemorrhoids. There are a few conditions that can present with the some of the same symptoms as hemorrhoids. These conditions include an anal fissure, colon/anal/rectal cancer, polyps, and rectal prolapse.

© 2016 Moon Langley


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