Hemorrhoids, or piles, are one of mankind's most common and nagging disorders. By themselves, hemorrhoids are rarely serious, but they can be extremely troublesome. They may mask a more serious disorder, such as colon or rectal cancer. They therefore require the proper diagnosis and treatment by a physician. Hemorrhoids are dilated (enlarged) veins which occur in and around the anus and rectum. They may be external (outside the anus) or internal and slip to the outside. In both these instances, the hemorrhoids can be felt and seen as lumps or knots. Hemorrhoids also may remain inside the rectum and so cannot be felt or seen.

What Causes Hemorrhoids?

A common cause of hemorrhoids is simply the standing position in which all the blood above the rectum exerts pressure on the rectal and anal areas. Other conditions which contribute to hemorrhoids are poor bowel habits, constipation, diarrhea, pregnancy, obesity, and especially frequent straining when having a bowel movement. However, some patients will have none of these conditions and still develop hemorrhoids.

What Are The Complications?

Hemorrhoids can produce several uncomfortable but non-serious problems.

1. Thrombosis and Pain - An acute, hard blood clot in the hemorrhoid causes severe pain and usually demands immediate medical attention.
   
   
2. Bleeding - Hemorrhoids can ooze fresh red blood, whether located externally or internally. This bleeding often occurs as dripping from the anus while sitting on the toilet or as soiling of the underwear (external hemorrhoids). Internal hemorrhoids that bleed may produce fresh bood in the stool.
   
   
3. Itching and Irritation - External hemorrhoids can be itchy, especially if they are moist and irritated.
   

Do Hemorrhoids Cause Cancer?

Hemorrhoids do not develop into cancer. However, both hemorrhoids and cancer can cause rectal bleeding. In fact, many disorders can be the cause of rectal bleeding. When rectal bleeding occurs in persons over age 40, and especially in those over age 60, it should be considered a serious problem until an exact diagnosis is made. The physician who directly examines the rectal area can make the specific diagnosis.

Treatment

Treatment of hemorrhoids varies depending on where they are, what problems they are causing, and how serious they are. Often, time and the normal process of healing clear hemorrhoids with little or no specific treatment. When hemorrhoids require treatment, the following general measures are recommended:

Conservative Treatment

1. Keep the anal area clean, using a mild soap and gentle dabbing after a bowel movement. Avoid vigorous rubbing of the area.
   
   
2. Keep the anus and hemorrhoids as dry as possible, using talcum powder and a pad of soft tissue to absorb moisture.
   
   
3. Eat a diet high in fiber (bran) and roughage. Fiber and bran retain water in the stool, producing soft, bulky stools which are easier to pass and reduce the tendency to develop hemorrhoids. Bulking agents, such as Metamucil, Effersyllium, Konsyl, Citrucel, and Per Diem Fiber, are available in drug stores. These all come in generic versions, too.
   
   
4. Avoid straining when having a bowel movement.
   
   
5. When thrombosis, pain, and tenderness occur, a 10 to 20 minute hot tub bath two to four times daily brings heat to the area, provides relief from the pain, and promotes healing. These are also called hot sitz baths.
   
   

Ligation

A common method of treating internal hemorrhoids is to use a small rubber hand to tie off the base of the swollen vein. The blood circulation stops and the hemorrhoid then falls off. Repeat treatments are sometimes necessary.

Infrared Photocoagulation

An infrared light source can be used to coagulate the internal hemorrhoidal vein. It usually produces less discomfort than ligation. Often, more than one treatment is necessary.

Lasers

A laser directs a high-intensity light beam at tissue and so produces great heat, thereby coagulating the hemorrhoid. This technique is still in the research phase, but may have application in the future.

Surgery

Surgery is sometimes recommended in treating hemorrhoids. It usually is reserved for:

• Acute, painful clot (thrombosis) of hemorrhoids
  
  
• Profusely or continuously bleeding hemorrhoids
  
  
• Longstanding, irreversible, and large hemorrhoids
  
  
• When other treatment is unsuccessful
  
  

The physician evaluates each patient's case to determine the appropriate treatment.

Preventing Hemorrhoids

• Eat plenty of fiber, bran, or roughage, or use a bulking agent to maintain regular, soft bowel movements.
  
  
• Do not delay or try to prevent a bowel movement when the urge is present.
  
  
• Exercise, especially aerobic, may help produce regular bowel movements.
  
  
• Drink plenty of liquids and eat regularly scheduled meals.
  
  
• Keep the area around the anus clean and dry.

Summary

Hemorrhoids are an especially common disorder and often reduce by themselves or with minimal treatment. Treatment typically is simple and effective, although surgery occasionally is necessary. Hemorrhoids can mask a more serious disorder and, therefore, must be evaluated and diagnosed properly by a physician. People with hemorrhoids who work closely with their physician are usually assured a good resolution to the disorder.