Pain in the  butt! (well they are) If you suffer from hemorrhoids then that is what
you are going through often. And the people who are referred to my practice come
through the door often walking slowly and sitting gingerly are tired of dealing with
the constant pain in the patootie.

Hemorrhoids: Treatment
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What are hemorrhoids?
A precise definition of hemorrhoids does not exist, but they can be described as
masses or clumps (“cushions”) of tissue within the anal canal that contain blood
vessels and their surrounding, supporting tissue made up of muscle and elastic
fibers. The
anal canal is the last four centimeters through which stool passes as it
goes from the rectum to the outside world. The anus is the opening of the anal canal
to the outside world.

Although most people think hemorrhoids are abnormal, they are present in
everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can
cause problems and be considered abnormal or a disease.
Prevalence of hemorrhoids

Although hemorrhoids occur in everyone, they become large and cause problems in
4 percent of the general population. Hemorrhoids that cause problems are
found equally in men and women, and their prevalence peaks between 45 and 65
years of age.

What causes hemorrhoids?
It is not known why hemorrhoids enlarge. There are several theories about the
cause, including inadequate intake of fiber, prolonged sitting on the toilet, and
chronic straining to have a bowel movement (constipation). None of these theories
has strong experimental support.
Pregnancy is a clear cause of enlarged
hemorrhoids though, again, the reason is not clear. Tumors in the pelvis also cause
enlargement of hemorrhoids by pressing on veins draining upwards from the anal

What are the symptoms of hemorrhoids?
For convenience in describing the severity of internal hemorrhoids, many physicians
use a grading system:

  • First-degree hemorrhoids: Hemorrhoids that bleed but do not prolapse.
  • Second-degree hemorrhoids: Hemorrhoids that prolapse and retract on their
    own (with or without bleeding).
  • Third-degree hemorrhoids: Hemorrhoids that prolapse but must be pushed
    back in by a finger.
  • Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be
    pushed back in. Fourth-degree hemorrhoids also include hemorrhoids that are
    thrombosed (containing blood clots) or that pull much of the lining of the
    rectum through the anus.

How are hemorrhoids diagnosed?
Most individuals who have hemorrhoids discover them in one of several ways. They
either feel the lump of an external hemorrhoid when they wipe themselves after a
bowel movement, note drops of blood in the toilet bowl or on the toilet paper, or
feel a prolapsing hemorrhoid (protruding from the anus) after bowel movements.

Severe anal pain may occur when an external hemorrhoid thromboses or a
prolapsing internal hemorrhoid becomes gangrenous. Symptoms of anal discomfort
and itching may occur, but anal conditions other than hemorrhoids are more likely to
cause these symptoms than hemorrhoids. (Hemorrhoids often get a “bum rap” for
such symptoms since both hemorrhoids and other anal conditions are common and
may occur together. For example, up to 20% of individuals with hemorrhoids also
have anal fissures.)

By the history of symptoms, the physician can suspect that hemorrhoids are present.
Although the physician should try his or her best to identify the hemorrhoids, it is
perhaps more important to exclude other causes of hemorrhoid-like symptoms that
require different treatment. These other causes—anal fissures, fistulae, perianal
(around the anus) skin diseases, infections, and tumors—can be diagnosed on the
basis of a
careful examination of the anus and anal canal. If necessary, scrapings of
the anus to diagnose infections and biopsies of the perianal skin to diagnose skin
diseases can be done.

External hemorrhoids appear as a bump and/or dark area surrounding the anus. If
the lump is tender, it suggests that the hemorrhoid is thrombosed. Any lump needs
to be carefully followed, however, and should not be assumed to be a hemorrhoid
since there are rare cancers of the perianal area that may masquerade as external

The diagnosis of an internal hemorrhoid is easy if the hemorrhoid protrudes from the
anus. Although a rectal examination with a gloved finger may uncover an internal
hemorrhoid high in the anal canal, the rectal examination is more helpful in excluding
rare cancers that begin in the anal canal and adjacent rectum. A more thorough
examination for internal hemorrhoids is done visually using an anoscope.

How are hemorrhoids treated?
Over-the-counter medications for hemorrhoids
Many over-the-counter products are sold for the treatment of hemorrhoids. These
often contain the same drugs that are used for treating anal symptoms such as
itching or discomfort. There are few studies showing that they do anything for
hemorrhoids. They probably only reduce the symptoms of hemorrhoids. It is
possible, however, that their effectiveness relates to their treatment of anal
conditions other than hemorrhoids, for example, idiopathic anal itching, that often
accompany hemorrhoids.
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