Hemorrhoids have plagued mankind’s derrieres for centuries.
It’s said that French leader Napoleon Bonaparte’s rectal protrusion caused him such pain during the Battle of Waterloo that it affected his ability to lead, ultimately costing him victory.
Hippocrates pioneered many of the surgical techniques used today to address hemorrhoids, or more accurately “piles,” which is the name for a swollen, inflamed hemorrhoid. The word hemorrhoid actually refers to cushions of tissue that line the anal canal. We all have them, as they are responsible for bolstering and tightening the anal canal and sphincter muscle that keep us from leaking unmentionables when we cough or sneeze.
But those tissues break down, and by the time we are 50, over half of us will have suffered at least one episode of this itchy, burning, often excruciating life event. Despite that, the subject of hemorrhoids is not one that we often speak about, even away from the dinner table.
Just what causes these pains in our buttocks? Are they dangerous? What treatments are available? And if you’ve ever had one, you’ll quickly agree this is the most important question: How do you prevent hemorrhoids from happening?
Causes of hemorrhoids
Think of hemorrhoids like your booty’s version of varicose veins. Most of the time, they are just there, doing their job. But add some pressure — such as obesity, straining during a bowel movement, the extra weight of pregnancy, prolonged sitting during a long car or airplane ride or while on the toilet, and chronic diarrhea or constipation — and the tissue swells, knots and often becomes painful.
There are other reasons for this unfortunate experience. As we age, our connective tissues weaken and stretch out of shape, which can lead to a prolapse, or falling, of a part of the anal wall, which can then protrude from the anus. Repeated anal intercourse can produce the same effect or irritate existing hemorrhoids and make them bleed.
There is some indication that hemorrhoids run in families, too. And those with ulcerative colitis, Crohn’s and inflammatory bowel disease can add a higher risk for hemorrhoids to their long list of ailments.
Types of hemorrhoids
There are two types of hemorrhoids: internal and external. If you had to choose, pick internal.
Internal “piles” occur in the lower rectum, where there are no pain centers, so they don’t hurt. But it’s scary when they bleed, normally a bright red color due to high oxygen content in the area. Sometimes, internal hemorrhoids can prolapse outside the anus, collecting minute particles of feces or other materials and leading to intense itching known as pruritus ani.
External hemorrhoids develop in the skin around the anus and can be extremely painful as we sit, wipe and go about our daily lives, especially if a blood clot or thrombosis develops inside the hemorrhoid sac. Even if the clot resolves on its own, which can happen in one or two weeks, the shrunken hemorrhoid can leave a skin tag that can cause hygiene problems.
Are hemorrhoids dangerous?
Rarely. If blood loss from hemorrhoids is severe, there is a chance of anemia, with which you don’t have enough red blood cells to carry needed oxygen throughout the body.
Internal hemorrhoids can collapse and be “strangulated” when their blood supply is cut off by anal muscles. This can lead to blood clots, infections and, in extreme cases, gangrene or sepsis.
Immunocompromised patients may heal slowly and be more at risk for infection after surgical interventions, so doctors recommend surgery as a last resort.
What can be really dangerous is assuming that your symptoms are just hemorrhoids without getting a colorectal specialist to have a look-see. Though not the most pleasant experience, it beats many of the other diseases that mimic the symptoms of a hemorrhoid.
Bleeding, for example, is the most common symptom of hemorrhoids, but it is also a sign of colorectal or anal cancer. Pain can indicate an external hemorrhoid, but it can also signify an anal fissure, or a tear in the skin at the opening of the anus. Anal pain can also point to an abscess or to fistula disease, an abnormal tunnel between two organs.
Treatments for hemorrhoids
Most hemorrhoids, both internal and external, can be managed at home with care not to exacerbate the problem. Try not to strain during bowel movements or sit too long. Stool softeners and extra hydration and fiber can help with constipation.
For external hemorrhoids, studies show that swelling and pain peak about 48 hours after onset of symptoms and tend to go away within four days. In the meantime, warm soaks in the tub or sitz baths can reduce swelling and itching. Some topical ointments, like steroids and analgesics, may help with pain during that period, but studies show that they do little for long-term management.
In severe cases, your doctor may recommend excision of the entire hemorrhoid, possibly within 48 to 72 hours after your symptoms begin.
Internal hemorrhoids with significant symptoms, such as bleeding, can be addressed in a variety of ways.
One of the most popular treatments is rubber band ligation, which can be done in a doctor’s office with no bowel prep or anesthesia. Tissue is gathered around the area and banded tightly. Because of the location in the anal canal, there should be little pain other than a dull ache for a day or so. Over the next week, the tissue dies, and the resulting scar helps shore up the wall of the anus.
Another treatment, sclerotherapy, involves injecting the irritated vein with a caustic agent, as is often done for spider veins on legs and ankles. Infrared photo rays that blast the hemorrhoid with heat is a third option. Studies show that it may have less pain than ligation, but the possibility of a recurrence of the hemorrhoid was higher.
A fourth method uses staples to fix the hemorrhoids in place on the tissue wall, keeping them from collapsing and exiting the anus. This method too has less pain but a greater incidence of recurring hemorrhoids.
Preventing hemorrhoids
So, ready for some wise words on how to avoid all those procedures?
Drink a ton of water and eat a lot more dietary fiber, both of which will dissolve hard stools and keep your digestive tract moving smoothly. To avoid excess gas, increase the fiber slowly over a week or so until your system adjusts.
The Institute of Medicine recommends 25 grams of fiber each day for women and 38 grams for men. Since most Americans eat only about 15 grams a day, here are some tips to punch up your fiber intake:
Eat a lot of fresh fruits and vegetables. According to the US Department of Agriculture, good veggie choices include lentils, which have 8 grams of fiber per half-cup; navy or kidney beans, with 6 grams per half-cup; and Brussels sprouts, green peas, winter squash, spinach and carrots, which have 2 to 4 grams per half-cup.
Good choices in the fruit family include fresh pears and apples, ranging from 4 to 5 grams per fruit. Blueberries and strawberries can quickly add fiber, with 4 grams per cup.
Finally, add whole grain breads and grains to your diet. Oat and wheat bran cereals are good choices; one quarter-cup serving adds 6 whopping grams to your daily total. Multigrain bread adds 2 grams.
If you can’t manage to eat that much fiber, consider a fiber supplement. Several popular choices come in powder form that you add to 8 ounces of water — but be sure to drink another eight glasses of water or other fluids each day. Sorry, alcohol doesn’t count!
Other than water and fiber, what else can you do? Avoid sitting too long; studies show that it can be as bad for you as cigarettes, as well as bad for your bowels. Go to the bathroom as soon as you feel the urge. And while doing your business, never strain or push!
Finally, exercise. It’s key to keeping your digestive system flowing and helps to lose weight that might be putting pressure on your veins.
