In Turkish, they're known as "bottom tulips"; in Dutch they're called "anus berries." But to many who have hemorrhoids, they are simply -- well, a pain in the you-know-what.
Hemorrhoids are swollen veins either inside the anus or rectum or around the outside of the anus. Women often develop them during pregnancy or while in labor. Anyone can get them, in fact, but hemorrhoids are more common as people age. By age 50, about half of men and women have them. Although they're sometimes painful, they're rarely dangerous.
What causes hemorrhoids?
Constipation, which is increasingly common as people age, is the primary cause of hemorrhoids. Difficulty in evacuating stool leads to straining, which in turn puts pressure on the veins in the rectal area, causing the veins to enlarge. Heredity may also play a role in developing hemorrhoids, as can obesity and diseases of the liver.
How do you know if you have them?
Internal and external hemorrhoids show up in different guises. Internal hemorrhoids are often painless unless they protrude outside the anus. If they do, they can develop blood clots, which are painful but not dangerous. Look out for the following signs and symptoms:
A purplish lump around the anus
A reddish mass of tissue around rectum
Bright red blood on toilet tissue, in the stool, in the toilet bowl, or on undergarments
Mucous on undergarments
Feces on undergarments
Symptoms of hemorrhoids resemble those of certain other disorders, such as anal fissures (small skin tears around the anus) or even diseases like colorectal cancer. The best way to check for more serious conditions is to ask your doctor for an exam.
How does my doctor test for hemorrhoids?
The doctor will begin by examining you for external hemorrhoids and inserting a lubricated finger into the anus to check for internal hemorrhoids or other growths or abscesses. If there's pain or sensitivity, the physician uses a numbing agent in order to give a proper examination without pain. Sometimes internal hemorrhoids are not detected by the initial digital exam, and your doctor may use an anoscope, a proctoscope, or a sigmoidoscope. These are flexible lighted tubes that allow your doctor to see the inside of your anus and rectum. If there is bleeding, your doctor may also want you to have other tests.
How are they treated?
If you have pain from hemorrhoids, your doctor may recommend a combination of treatments. This could include warm baths (not hot ones), followed by an ice pack three to four times a day. Hemorrhoid creams or hydrocortisone suppositories often provide relief, and very gentle cleansing of the area can help relieve irritation as well.
For more persistent or painful hemorrhoids, your doctor may suggest rubber band ligation, a procedure that uses rubber bands to cut off the circulation of the hemorrhoid until it withers away and falls off. Other minimally invasive treatments include sclerotherapy, a chemical injection that shrinks the hemorrhoid, and laser or heat therapy, a treatment that causes internal hemorrhoids to harden and shrink.
In the rare event that your hemorrhoids are severe and don't respond well to any of these treatments, your doctor may suggest surgery, which can be performed either in the doctor's office or in the hospital. Swollen veins can also be removed by stapling, which blocks blood flow to them. This procedure has a greater risk of complications, so be sure to discuss with your doctor what the best option is for you. These procedures are usually done by a specialist called a proctologist, or colorectal surgeon.
How can I keep from getting hemorrhoids?
You can avoid developing hemorrhoids by eating healthy food and getting plenty of exercise. But if you already have them, you can keep them from becoming bothersome by making some changes in your lifestyle.
Because constipation is one of the major culprits, you will likely want to talk to your doctor about any medications you take that may cause it. Your physician may be able to give you other drugs that don't have that side effect.
Usually, constipation can be alleviated by eating a diet rich in fiber (found in whole grain foods, fresh fruits, and vegetables) and drinking at least six glasses of fluids a day (not counting alcohol and caffeine, which can dehydrate you). This sort of diet softens and adds bulk to stool to help push it through the intestine. In addition, cut down on your intake of refined or processed foods like cakes, chips, and candy. They may taste good, but they can create a traffic jam in your digestive tract, adding to the strain on those veins.
Constipation may also be caused by a lack of exercise -- that is, too much sitting! If you don't have any physical limitations, try walking more or finding another physical activity that you enjoy. Even if you do have some medical problems, there are undoubtedly at least a few appropriate exercises for you. Chances are, you'll not only feel better and stronger, you'll suffer less from those annoying hemorrhoids. (Just remember to consult with your doctor before starting a new exercise regimen or overhauling your diet.)
Good bowel habits are also important in preventing hemorrhoids or keeping them from becoming a complete nuisance. Heed the urge to defecate, but don't read the whole newspaper while you're on the toilet. Remember, sitting on the toilet for long periods of time can also put pressure or strain on the veins around the anus or rectum. Gently cleansing the anus after a bowel movement often helps keep the area from becoming irritated.
Hemorrhoids may actually be a sort of wake-up call, urging you to eat better, drink more fluids, and get some regular exercise. And if you're able to respond to that call, your body will have done its duty.
Mayo Clinic. Hemorrhoids. December 2008. http://www.mayoclinic.com/health/hemorrhoids/ds00096