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 is painful, and the clot maintains stretching of the vein producing continued soreness. Fresh straining right after initial creation of the clot, i.e. from constipation, bowel movements, work or some other form of constriction of the belly can further stretch this already broadened blood vessel and forms a new thin layer around the clot increasing the clot size causing more and more continued pain.
This thin stretched vessel has pressure receptors in it that are perceived as pressure pain and can be painful by sitting, direct trauma, toilet paper or restraining. When you've ever had these, you know how uncomfortable they may be. Also known as "piles", they occur for a number of reasons. One cause is actually gravity. The blood vessels from higher up on the anus start to drop down due to the laxity of the tissue as we grow older. Another cause is the pelvic congestion due to 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 little bit alarming. Maybe it's a small amount of fresh blood on the tissue paper after a bowel movement. Then there is the vague itching, generalized discomfort and downright pain that can accompany hemorrhoids. Add to that the discovery of "lumps" in the area by the sufferer, 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 are usually above the dentate line, they are called "external," and if they are below the dentate line they are known as "internal." The external ones are more easily seen and felt, while a person may be unaware that they have internal hemorrhoids.
We Don't Know for Sure What Percentage of the Population Receives Hemorrhoids
In the usa the number who found for medical care of hemorrhoids are about 4%. In Great Britain, where they have Socialized Medicine, about 30% of patients present for treatment of this condition. Could in the us 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 pilots get hemorrhoids from gravity and fighting against G-forces. Pregnant females get hemorrhoids, as mentioned, from pelvic congestion, but later from moving the baby out during the latter part of labor. Probably the most common cause is straining at bowel movement secondary to chronic constipation.
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Hemorrhoid Removal (Hemorrhoidectomy)
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What are the treatment options for hemorrhoids? Well, believe it or not, increasing fiber in the diet is an excellent treatment for all symptoms.. Stool softeners haven't been found to help that much. Dietary fiber decreases bleeding and irritative symptoms. Witch Hazel and glycerin astringent wipes can be very comforting to painful 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" cushioning (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 family doctor can make a tiny cut in the hemorrhoid and let the clot away, resulting in great relief as well as last healing.
What are the physician remedies of hemorrhoids? One of the most effective is the outpatient application of special rubber bands to the hemorrhoids. A patient can have up to three bands a week. A few medical doctors sclerose (inject this with irritant substance 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 use infrared coagulation, cryotherapy (freezing), or various forms of cautery with mixed results. Whenever hemorrhoids are too severe, either open or closed, hemorrhoidectomy will be done in the operating room. The results are generally good, but the time in order to recovery may be extended. 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 not be assumed in every case. The doctor is going to have to examine your own 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 keep in mind 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 obtaining 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 significant options have been ruled out, then you can start a comprehensive program to treat and manage hemorrhoids, and you will "live happily ever after."
John Drew Laurusonis M.D.
Doctors Medical Center.