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Types and symptoms of hemorrhoids
Two of the most common types of hemorrhoids are external and internal hemorrhoids. External hemorrhoids are those that occur outside of the anal verge (the distal end of the anal canal). They are usually painful, and are often accompanied by pruritus ani or an itching, swelling, and burning sensation. If the vein ruptures and a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.
Internal hemorrhoids are those that occur inside the rectum. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated.
Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids. Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside of the anus. If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside of the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.
Hemorrhoids are very common. It is estimated that approximately half of all Americans have this condition by the age of 50. However, only a small number seek medical treatment. Annually, only about 500,000 people are medically treated for hemorrhoids, with 10 to 20% of them requiring surgeries.
The causes of hemorrhoids include genetic predisposition (weak rectal vein walls and/or valves), straining during bowel movements, and too much pressure on the rectal veins due to poor posture or muscle tone. Constipation, chronic diarrhea, poor bathroom habits (reading on the toilet or excessive cleaning attempts), pregnancy, postponing bowel movements, and fiber-deprived Western diet can also contribute.
Prevention of hemorrhoids includes drinking more fluids, eating more dietary fiber, exercising, practicing better posture, and reducing bowel movement strain and time. Hemorrhoid sufferers should avoid using laxatives and should strictly limit time straining during bowel movement.
Treatments for hemorrhoids vary in their cost, risk, and effectiveness. Different cultures and individuals approach treatment differently. Some of the treatments used are listed here in increasing order of intrusiveness and cost.
For many people, hemorrhoids are mild and temporary conditions that heal spontaneously or by the same measures recommended for prevention. In these cases, warm sitz bath using a bidet, cold compress, or topical analgesic (such as Preparation H), is sufficient to provide temporary relief.
Some people successfully apply natural procedures for treatment or reversal of chronic conditions. These procedures largely echo the prevention measures. They include:
- Reducing regional pressure in such ways as improving posture and muscle tone
- Taking herbs and dietary supplements that strengthen vein walls, such as butcher's broom, horse chestnut, bromelein , and Japanese pagoda tree extracts
- Topical application of natural astringents and soothing agents, such as witch hazel, cranesbill and aloe vera
- Eating fiber-rich bulking agents such as plantain and psyllium to help create soft stool that is easy to pass to lessen the irritation of existing hemorrhoids.
Some people require the following medical treatments for chronic or severe hemorrhoids:
- Dilation: stretching of the anal sphincter muscle. Although no longer popular, this treatment can be successfully applied to select cases of strangulated hemorrhoids.
- Rubber band ligation: elastic bands are applied onto an internal hemorrhoid to cut off its blood supply. Within several weeks, the withered hemorrhoid is sloughed off during normal bowel movement.
- Sclerotherapy (injection therapy): sclerosant or hardening agent is injected into hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up.
- Cryosurgery: a frozen tip of a cryoprobe is used to destroy hemorrhoidal tissues.
- Laser, infared or BICAP coagulation: laser, infrared beam, or electricity is used to cauterize the affected tissues.
- Hemorrhoidectomy : a true surgical procedure to excise and remove hemorrhoids.
For some people, surgery may be the only treatment option for severe cases of hemorrhoids, such as prolapsed, thrombosed, or strangulated hemorrhoids.
- NIDDK-NIH Hemorrhoid
- eMedicine Hemorrhoids
- MEDLINEplus Hemorrhoids
- Hemorrhoids In Plain English
- American Society of Colon & Rectal Surgeons
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