Hemorrhoids

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Hemorrhoids are a nuisance. While they are occasionally alarming, they'll never kill us. In fact, the greatest risk of hemorrhoids is the possibility of attributing symptoms of serious conditions like colorectal cancer to them.
What they are

"Hemorrhoids" is a term describing enlarged veins in the rectum and anus. The majority of hemorrhoids, and those responsible for the most frequent symptoms, are internal, that is, they are inside the anus. The remainder, external hemorrhoids, are under the skin around the anus.

Hemorrhoids were once thought to be a natural consequence of walking upright, which makes these vessels vulnerable to gravitational pressure. Recently, however, many gastroenterologists have come to view them as vascular cushions that help plug the anus and keep stools inside. They present problems only when the fibrous attachments that hold them in place are weakened by pressure inside the rectum. Then hemorrhoids slide out of place, fill with blood, and eventually prolapse, or protrude through the anus.
Symptoms

External hemorrhoids usually do not come to our attention until they fill with a blood clot, or thrombosis. These clots, which may vary from pea-size to walnut-size, form bluish lumps around the anus. They can cause pain that can increase for a day or two but usually dissipates within a week as the clot dissolves. After the clot disappears, skin tags--small, empty pouches--often remain.

Bright red blood on the stool or toilet paper is often the first clue of internal hemorrhoids, which are usually painless. Prolapse is unmistakable; one can sense a mass protruding from the anus. Prolapsed hemorrhoids may regress spontaneously, or in response to gentle pressure from the finger tips. When internal hemorrhoids are permanently prolapsed, they can become inflamed and may issue a watery discharge.
Diagnosis

Whenever you experience rectal bleeding it's a good idea to see your clinician. He or she should perform a rectal exam, using a gloved, lubricated finger to feel for abnormalities, and may look for internal hemorrhoids through a lighted tube called an anoscope. To rule out ulcers, colon cancer, and other sources of bleeding, a sigmoidoscopy, in which the lower colon is viewed through a flexible lighted tube, or colonoscopy, a similar procedure in which the entire colon can be seen, may be necessary.
Treatment

To relieve the symptoms of most hemorrhoids, clinicians usually recommend the following:

* Home remedies. Sitting in plain, warm water for l 0-15 minutes several times a day can soothe irritated tissues. Applying cold packs while resting in bed with the buttocks on a pillow can reduce swelling.
* Over-the-counter aids. Petroleum jelly can provide limited relief by reducing friction. Many hemorrhoid creams do the same, but some also contain topical anesthetics such as lidocaine, and others, like Anusol HC, have hydrocortisone to reduce inflammation. Dabbing (not wiping) with Tucks or cotton pads soaked in witch hazel can relieve itching.
* Surgery. The simplest surgical approach is lancing a thrombosed hemorrhoid to remove the clot to provide immediate pain relief. Other procedures, intended to reduce the chance of recurrence, employ lasers, electricity, or infrared energy to seal off affected vessels. Rubber band ligation, in which an elastic is placed around the base of the hemorrhoid to cut off circulation, and sclerotherapy, chemical injections to shrink the blood vessels, are reserved for internal hemorrhoids. Hemorrhoidectomy, in which hemorrhoids are cut away, is a last resort.

Prevention

The most effective approaches are:

* Diet. Consuming 25-30 grams of fiber in fruits, vegetables, and whole grains along with at least 8 cups of water a day is usually sufficient to produce soft, bulky stools that can be passed without straining. Bulk-forming agents like Metamucil and Fiber-con are also helpful.
* Changes in bowel habits. Respond to the urge to defecate promptly; stay relaxed to avoid straining.
* Exercise. Exercises that entail rhythmically contracting and relaxing the buttocks can strengthen muscles and improve the tone of the anus.

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