Hemorrhoids aroused enough dread in the Middle Ages to be assigned a patron saint. And the condition — also known as St. Fiacre’s curse — has been among the top health concerns trending on Google. Here’s what the latest research says about preventing and treating hemorrhoids.
What are they?
Hemorrhoids are clumps of swollen veins in the anal canal or just outside the anus. The cause is unknown, but the problem starts with compromised blood flow, inflammation and tissue breakdown in the anal cushions, the pads of thickened tissue that surround and support the anal canal. Straining during bowel movements can worsen symptoms. Pregnancy, childbirth and being middle-aged increase the risk of getting hemorrhoids.
Internal hemorrhoids are usually painless but can cause bleeding during bowel movements. They can balloon so much that they prolapse — or protrude — out of the anus and can weaken the seal of the sphincter muscle, allowing mucus and feces to leak onto the surrounding skin and cause itching and burning. External hemorrhoids, located outside the sphincter, near sensitive nerve endings, sometimes develop a clot. Those thrombosed hemorrhoids can be felt as a round mass just outside the opening of the anus.
For relief, try fiber supplements containing psyllium, sterculia or unprocessed bran, which can be effective in reducing bleeding, itching, pain and prolapse. Warm water, in a tub or a sitz bath, may help reduce itching or pain.
The best long-term fix is to avoid constipation and the need to strain during bowel movements. You can do that by exercising regularly and eating more fiber, preferably from vegetables, fruit, legumes and whole grains. Spending less time sitting on the toilet may also limit pressure on the anal cushions.
None of the over-the-counter ointments or creams for hemorrhoids have proved to be very effective in clinical trials. They might relieve superficial itching and irritation, but they don’t shrink hemorrhoids or stop them from bleeding or prolapsing. Don’t use topical numbing agents or steroid creams for more than a week, since longer use can sensitize skin and worsen irritation.
When to call a doctor
If self-help measures don’t bring relief within two weeks, you should consult a doctor. Beyond hemorrhoids, the problem could be an abscess, fissure, viral infection or something even more serious. Explain your symptoms and health history to the doctor, who might do a digital rectal examination and use a scope to see inside the anus. If there’s bleeding, you’re age 50 or older and you’ve never been screened for colorectal cancer, ask the doctor about having a colonoscopy to rule out cancer or inflammatory bowel disease.
Pain from a thrombosed hemorrhoid can seem unbearable, but it might lessen within a week or so. A doctor can relieve severe pain by releasing the clot during an in-office procedure using local anesthesia.
Another safe and effective treatment for prolapsed hemorrhoids uses rubber bands to cut off circulation, causing swollen tissue to shrivel and fall off. Banding, an in-office treatment, succeeds in 80 percent of cases, and people who have the procedure frequently recover with less pain and fewer complications than those who have surgery.
“Surgery is best reserved for patients with long-standing, severe disease that’s not getting better,” says Daniel O. Herzig, a colon and rectal surgeon and an associate professor at Oregon Health & Science University in Portland. Here are some options:
●Traditional hemorrhoidectomy is the most effective choice with the lowest rate of recurrence. It can be safely done as an ambulatory procedure, but recovery can be painful. People usually need two to three weeks of rest before resuming activities.
●Stapling is a less painful procedure with a faster recovery, but it has lost favor with some surgeons because of the greater risk of severe complications, such as rectal perforation, peritonitis (a serious infection of the abdominal lining) and even death.
●Doppler-guided hemorrhoidal artery ligation, a new technique, finds arteries that are feeding the hemorrhoids and stitches them closed, cutting off blood flow to those distended veins. It’s a less invasive procedure but might not work for severe prolapsed hemorrhoids. Its long-term efficacy isn’t clear, and it’s not yet widely available in the United States.