Hemorrhoids: How to prevent and treat them

Timothy Maly, MD, practices family medicine at Berthoud Family Physicians.

Question: What are hemorrhoids?

Answer: Hemorrhoids are dilated veins in the anal and rectal region. They arise from a structure called an anal cushion, which serves to protect the sensitive tissues of the region from the abrasive effects of bowel movements. When these cushions become a problem and display certain symptoms, they earn the title of hemorrhoids.

Question: What are the symptoms?

Answer: The most common symptoms are pain, bleeding, itching and burning. Often a bump or lump of skin can be felt, and it can be hard to keep the area clean after bowel movements. Other symptoms can include leakage, mucous discharge, constipation and incomplete emptying of the bowels. Different individuals have varying degrees of symptoms.

Question: What causes them and how did I get them?

Answer: Many factors may cause hemorrhoids. Genetics play an important role. There are many ways to prevent and treat hemorrhoids:

• Have a fiber-rich diet, (25-30 grams per day), and drink six-eight glasses of water each day. Consider using fiber supplements. 
• Try not to sit on the toilet longer than five-10 minutes at a time. This will help to prevent flare-ups. Don’t read while sitting there! Use the toilet only for the intended purpose.
• Some evidence shows that certain nutritional supplements such bio-flavonoids and fish oil capsules (both taken orally) can help.
• When the problem is acutely painful, sitting in a warm tub of water will often help to soothe the area. Ice to the area may also give relief.
• Avoid dry toilet paper and instead use wet wipes. Witch hazel, is helpful in keeping the area clean. Just moisten wipes or cotton balls and apply after bowel movements.
• Creams and other over-the-counter hemorrhoid preparations are OK to use, but are a “crutch” or “band-aid” approach that does not address the root of the problem.

Question: What are the medically prescribed treatment options? 

Answer: There are surgical and non-surgical treatments, as well as rubber-banding and infrared coagulation. Non-surgical treatments include prescription creams and ointments, which may contain stronger forms of anesthetics and hydrocortisone, an anti-inflammatory medicine.

Hemorrhoid surgery usually strikes fear in most people and for good reason. The traditional form of surgery usually sets a patient up for a prolonged, painful recovery. Still, the hemorrhoids can recur. There are newer techniques that are less severe, but as with all surgeries there are risks. Specifically, those are bleeding, infection, pain and the risks associated with general anesthesia. 

Rubber banding is a technique which involves placing a very tight rubber band around the hemorrhoid. The hemorrhoid will die and eventually fall off. This technique has risks as well which include pain, bleeding and the potential for life-threatening infections. 

Another technique called injection sclerotherapy involves injecting a type of medication into the hemorrhoid that will cause the veins to scar shut.

IRC or infrared coagulation is a relatively new procedure which has the advantage of being the only treatment in which there is no injection or disruption of the skin. Therefore, it carries the lowest risk and causes the least amount of pain of all of the above treatments. It may not be available in all areas and it does not effectively eliminate the most advanced forms of hemorrhoids.