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Medicare / Health Articles / Articles
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Piles and Hemorrhoids
What are hemorrhoids?
Hemorrhoids, often called piles, are swollen and inflamed veins in the anus and rectum.
A possibly embarrassing topic of discussion for some, hemorrhoids are common. More than half of our population will develop hemorrhoids, usually after age 30.
If left untreated, hemorrhoidal tissue can bleed, itch, become inflamed and swell. These symptoms can be extremely uncomfortable and interfere with our normal activities.
Fortunately, effective medications and procedures are readily available to treat piles. In numerous cases, this condition may require only self-care and lifestyle changes.
What’s the difference between external and internal hemorrhoids?
There are 2 types of hemorrhoids: external and internal, which refer to their locations. External hemorrhoids develop at the anal opening and tend to be painful. Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. Because of the lack of pain-sensitive nerve fibers within the internal anal membranes, internal hemorrhoids usually don’t cause discomfort. However, if they protrude from the anal opening (prolapsed), they can cause pain and irritation. Persistently prolapsed hemorrhoids can develop blood clots (thrombosis), leading to ulcerations and gangrene.
What cause hemorrhoids?
Hemorrhoids can develop from any increase in pressure on the veins of our lower rectum.
Common causes of pressure include:
- chronic constipation
- chronic diarrhea
- straining during bowel movements
- prolonged sitting or standing
- heavy-lifting
- pregnancy and childbirth
- obesity
- heredity
- aging
How can hemorrhoids be prevented?
The most important aspect of hemorrhoid management is prevention. Some tips to prevent hemorrhoids include:
- Eat high fiber foods.
- Eating more fruits, vegetables and grains can soften the stools and increase its bulk, which will help lessen straining that can cause hemorrhoids
- Drink more fluids.
- Take fiber supplements. Over-the-counter (OTC) products like Fybogel and Fibrosine can help keep stools soft and regular. However, do drink at least 8-10 glasses of water while on fiber supplements or it can cause constipation.
- Stay Active! Exercising can help reduce the pressure on our veins which occur with long periods of standing or sitting. Exercises can help reduce body weight too.
- Go as soon as you feel the urge. Holding back bowel movements results in stools that become drier and harder to pass
- Do not sit on the toilet for too prolonged a period of time.
What are the treatments available for hemorrhoids?
Mild hemorrhoids can be relieved sufficiently by self-care and adherence to above-mentioned preventive tips.
Here are some self-care tips you can consider:
- If hemorrhoids extend outside the anal canal, ice compresses may ease the swelling.
- Sitting in warm water (sitz baths) for approximately 15min at a time can ease the symptoms. Adding Epsom Salt to the water helps relieve the inflammation.
- Avoid foods and drinks that may make hemorrhoids worse, including spicy foods, nuts, coffee and alcohol.
- Do not use dry toilet paper. Use moist towelettes or wet toilet paper after a bowel movement instead.
- Keep the anal area clean by gently cleansing with warm water. Soap is not necessary and may aggravate the problem.
- Push back a prolapse hemorrhoid. If a hemorrhoid has prolapsed, try pushing it back gently into the anal canal.
- Use OTC hemorrhoidal products. There are a variety of OTC preparations that can help to relief hemorrhoids (See table 1). In general, they contain protectants (protect skin membranes), vasoconstrictors (constrict blood vessels), astringents (decrease secretions that cause irritations), or local anesthetics (reduce pain). Oral medications are also available eg venotonics (strengthen veins).
| Product Names | Contents | Functions |
| Preparation-H ointment | - mineral oil
- petrolatum
- phenylephrine
- shark liver oil | - protectant
- protectant
- vasoconstrictor
- protectant
|
| Anusol ointment/ suppositories | - zinc oxide
- balsam peru
- benzyl benzoate | - astringent
- antiseptic
- antiseptic |
| Preparation-H suppositories | - cocoa butter
- phenylephrine
- shark liver oil | - protectant
- vasoconstrictor
- protectant |
| Xylocaine ointment | - xylocaine | - local anesthetics |
| Daflon / Cyclo-3 Fort oral tablets | - antioxidants | - venotonic |
Table 1. OTC products for hemorrhoids
However, be careful with OTC products that contain vasoconstrictors if you have the following: heart diseases, high blood pressure, diabetes, thyroid problem, difficulty in urination or if on anti-depressant medications. Seek advice from your heath professional first.
See your doctor if the symptoms do not improve after seven days of self-treatment. Also notify your doctor promptly if excessive bleeding, seepage or severe pain occurs.
Sometimes, surgical treatments may be necessary to treat hemorrhoids. These surgical treatments are:
- Hemorrhiodectomies. These are the more common operations done nowadays. There are 2 types of hemorrhiodectomies: open and stapler. Open hemorrhiodectomy is the traditional method for surgical removal of piles. It involves the cutting of piles by diathermy (electrical pencil). Stapler hemorrhiodectomy is a newer and improved method, where the piles are reduced into the anal canal and are then pulled into a special instrument called the PPH-stapler. The stapler cuts off the bulk of the hemorrhiods and some remnants are fixed back into their normal positions within the anal canal. Stapler haemorrhiodectomies give less and shorter periods of pain and quicker return to normal activities.
- Ligation and Scerotherapy. These surgical procedures are less commonly applied. In ligation, a small rubber band is placed over the hemorrhoid to cut off its blood supply. The hemorrhoid and band will fall off a few days later and the wound usually heals in 1-2 weeks. Scerotherapy involves the injection of a chemical solution around the blood vessel to shrink the hemorrhoid.
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