Hemorrhoids: Painless Rectal Bleeding
Hemorrhoids are varicose kind veins of the anal area. They are very similar to a surgical glove squeezed in the fingers to create a large spare tyre. These bulges filled with blood coagulate and form clots. This particular stretching of the blood vessel is painful, and the clot maintains stretching of the vein producing continued soreness. New straining right after initial creation of the clot, i.e. from constipation, bowel movements, labour or some other form of constriction of the abdomen can further stretch this already broadened blood vessel and forms a new thin layer round the clot increasing the clot size causing more and more ongoing pain.
This thin stretched vessel has pressure receptors in it that are perceived as pressure pain and can be painful by sitting, direct trauma, toilet paper or restraining. When you've ever had them, you know how uncomfortable they can be. Also called "piles", they occur for a number of reasons. One cause is actually gravity. The veins from higher up on the anus start to decrease down due to the laxity of the tissue as we grow older. Another cause is the pelvic congestion brought on by prolonged sitting, straining with heavylifting or trying to have a bowel movement, or perhaps by the pelvic congestion of pregnancy. Initial symptoms can be a tad alarming. Maybe it's a small amount of fresh blood on the tissue paper after a bowel movement. Then there is the obscure itching, generalized discomfort and downright pain that can accompany hemorrhoids. Add to that the discovery of "lumps" in the area by the sufferer, and you have the makings of a panic.
Imagine for a Moment that You are Looking Into the Anal Area Through an Anoscope
There is a circular line around the mucosa exactly where muscles attach to the outer anus called the "dentate" (or "pectinate") line. If hemorrhoids tend to be above the dentate line, they are called "external," and if they are below the dentate line they are called "internal." The external ones are more easily seen and felt, while a person may be unaware that they have internal hemorrhoids.
We Do Not Know for Sure What Percentage of the Population Will Get Hemorrhoids
In america the number who existing for medical care of hemorrhoids are about 4%. In Great Britain, where they have Socialized Medicine, about 30% of patients present for treatment of this condition. We know in the usa that the sale of over-the-counter products for them goes into the billions of dollars.
People who have occupations that require prolonged sitting, for example like truck drivers, get hemorrhoids, as do people who do a lot of heavy lifting. Fighter aircraft pilots get hemorrhoids from gravity as well as fighting towards G-forces. Pregnant girls get hemorrhoids, mentioned above previously, from pelvic congestion, but later from pushing the child out during the latter part of labor. Probably the most common cause is straining at bowel movement secondary to chronic constipation.
What are the treatments for hemorrhoids? Well, believe it or not, increasing fiber in the diet is a wonderful treatment for all symptoms.. Stool softeners have not been found to help that much. Dietary fiber decreases bleeding and irritative signs and symptoms. Witch Hazel and glycerin astringent wipes can be very soothing in order to painful hemorrhoids and also can often relieve itching. Sometimes, warm sitz baths several times a day can help, as well as sitting on an inflatable "doughnut" cushion (decreases direct pressure and pinching). If there is an acute clot in a hemorrhoidal vein, it may respond to intermittent ice packs. Occasionally, the E.R. or family doctor can make a tiny cut in the hemorrhoid and let the clot away, resulting in great relief and also ultimate healing.
What are the physician treatments of hemorrhoids? Among the most effective is the outpatient application of specific rubber bands to the hemorrhoids. A patient can have as much as three bands a week. Some medical doctors sclerose (inject this with irritant substance to cause it to shrink) the hemorrhoids by injecting them with 5% greasy phenol, but the results are not as good as with banding.. Some clinics utilize infrared coagulation, cryotherapy (freezing), or various forms of cautery with mixed results. Whenever hemorrhoids are too severe, either open or closed, hemorrhoidectomy will be done in the operating room. The results are generally good, but the time in order to recovery can be lengthy. There have been some good operative results with simply tying from the hemorrhoidal artery.
So, what's the take-home message? Hemorrhoids are probably the most common cause of bright red anal bleeding, itching and pain, but this simply can't be assumed in every circumstance. The doctor is going to have to examine your anus. There are plenty of other things which can cause these symptoms. Please leave your distress in the waiting room and tell the doctor what's been going on. The one thing to remember when sitting in the waiting room is you're not alone, and the more open you are with your doctor the better help he/she can provide for you to getting better. If you are over 50 or have risk factors for colon cancer, you probably need anoscopy and colonoscopy. These are very benign tests in this day and age. Once all the more severe possibilities have been ruled out, then you can start a comprehensive program to treat and handle hemorrhoids, and you will "live happily ever after."
John Drew Laurusonis M.D.
Doctors Medical Center.
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