Hemorrhoids

Hemorrhoids

Soothing a Sore Situation

The trouble started when we stood up, got a good look around and discovered things like steak au poivre and crème brûlée.

If we were still walking on all fours and eating roots and berries the way our forerunners did, we'd probably never have problems with hemorrhoids. But we'd also never enjoy the view from more than three feet off the ground or celebrate special occasions with anything more festive than tubers.

According to the National Institutes of Health in Bethesda, Maryland, 10.4 million Americans a year suffer from hemorrhoids--but fewer than one-third of these people seek professional treatment. They either ignore them or try treating the problem at home.

Nearly 60 percent of those with hemorrhoids are women, many of whom develop them during pregnancy. Both men and women can inherit a predisposition for hemorrhoids, says Sidney Wanderman, M.D., a retired New York City proctologist and author of two books about hemorrhoids.

What's in a Vein?

Despite all the bad jokes, hemorrhoids are nothing to blush about. One theory is that they're simply swollen blood vessels, like varicose veins. Instead of being in your legs, these vessels are in your rectum and anus, the last two stops in your digestive tract.

Called hemorrhoidal blood vessels, these veins are particularly prone to swelling with blood because they lack the tiny valves found in most veins that help channel blood back toward the heart.

Researchers speculate that we didn't need valves in our hemorrhoidal blood vessels when we were down on all fours. In that position, blood traveling through the vessels didn't have to fight gravity to get back to the heart.

Standing upright changed all that. Now any additional pressure on these vessels can make them swell and turn into hemorrhoids.

Another theory speculates that hemorrhoids aren't swelling veins but actually sagging, blood-filled cushions. These cushions have two major functions. First, when engorged they help with continence, and second, they support the anal lining during a bowel movement. Elastic tissue holds the cushions in place. But due to aging, the constant downward pressure from chronic straining and the passage of hard stools, the tissue loses its elasticity, allowing the cushions to sag. Then you have hemorrhoids.

Whether they're swelled veins, sagging cushions or a combination, there's plenty we can do about hemorrhoids, short of returning to our old quadruped ways. Although they can be distressing and sometimes very painful, hemorrhoids are relatively easy to treat and largely avoidable.

What's behind Them

Though some hemorrhoids can be excruciating, many who have them are oblivious--at first, says Steven Wexner, M.D., chairman of the Department of Colorectal Surgery at the Cleveland Clinic-Florida in Fort Lauderdale. But pain and bleeding can crop up if people persist in the habits that started the hemorrhoids in the first place.

If you carry extra weight--because you're overweight or pregnant--you'll increase the pressure on your hemorrhoidal vessels. If you're constipated and strain to defecate, you'll do the same. The result? Hemorrhoids.

Since we left our original high-fiber, roots-and-berries diet behind for a more refined, low-fiber menu, constipation has become uncomfortably widespread. In fact, most people who have hemorrhoids are simply eating too little fiber, which we need to make stools easy to pass.

There are two kinds of hemorrhoids, internal, which appear inside the rectum, and external, which are visible at the end of the anus. Both types can bleed, but internal hemorrhoids tend to bleed without the associated pain or discomfort. This can happen when you pass hard feces that irritate the swollen blood vessels, explains Philip E. Jaffe, M.D., assistant professor of medicine in the gastroenterology section at the University of Arizona College of Medicine in Tucson.

When internal hemorrhoids bleed, you may notice blots of bright red blood on toilet tissue or in the toilet. Internal hemorrhoids usually don't hurt, since your rectum is free of pain-sensing nerves. But they will hurt, keenly, if continued straining pushes them through the anal opening.

External hemorrhoids bleed if you scratch them or wipe too hard with toilet tissue. They can be excruciatingly painful if the blood inside them forms clots. This happens when pressure builds up to the point where blood can barely move through the hemorrhoid and the blood congeals. The pain usually subsides after a week or so, after the body absorbs the clot, says John J. O'Connor, M.D., chairman of the colon and rectal surgery section at Suburban Hospital in Rockville, Maryland. But the pain may be so intense that it sends you to the doctor, who can drain the clot in the office.

When It's Something Serious

Hemorrhoids are rarely life-threatening. But some people have so much bleeding that they become anemic. In rare instances infection may set in, and hemorrhoids may become gangrenous, Dr. Wexner says.

It's worth seeing a doctor, because you may have an infection and because anal discomfort can be a sign of all sorts of things--some more serious than hemorrhoids. A persistent itch may mean the skin around your anus is allergic to something you're eating--caffeine and citrus fruits are prime culprits--or to the dye in your toilet tissue. Pain may signal a tear in the anus.

Bleeding can be a warning sign of colon or rectal cancer, as well as inflammatory bowel disease, such as ulcerative colitis or Crohn's disease. Though they're relatively uncommon in women in their thirties and forties, colon and rectal cancer are possibilities nonetheless. That's why it's important to see a doctor to be evaluated if you have any bleeding, Dr. Jaffe says.

How to Get Rid of Them

Treat your hemorrhoids right and, after a week or two, the swelling usually subsides and the discomfort passes, says J. Byron Gathright, Jr., M.D., professor of surgery at Tulane University in New Orleans and past president of the American Society of Colon and Rectal Surgeons. The hemorrhoids are still there--and they'll remain unless a doctor removes them surgically--but they're no longer causing you trouble. The same things that soothe hemorrhoids also help prevent new ones from forming. Here's how to take care of them.

Eat like a Neanderthal. High-fiber foods, like the tubers our prehistoric predecessors subsisted on, are kind to sensitive hemorrhoidal blood vessels. They make for bulky and soft stools, which move quickly through your digestive tract and keep you from straining. You don't have to get by on raw roots and berries, but you do need to add high-fiber foods--fresh fruits and vegetables, cereals and other whole grains--to your diet. Dr. Wexner recommends 25 grams of fiber a day, minimum.

Add fiber and you may also lower your risk of colon and rectal cancer, both far more prevalent in countries with low-fiber, high-fat diets, like ours.

Drink up. Remember to drink a lot, too. You need both fiber and fluid for bulk. But avoid alcohol and beverages that contain caffeine, since they have a diuretic effect. Eight to ten eight-ounce glasses of nonalcoholic, caffeine-free fluids a day are essential, Dr. Wexner says. Water is best.

Add bulk. Over-the-counter products, such as Metamucil, that contain an insoluble fiber called psyllium will also make your stool bulkier and easier to pass. Try those, but pass on the laxatives, Dr. Gathright advises. They're too harsh for your digestive tract. "There's no particular reason for America's fascination with laxatives," he says. "Eating a diet with sufficient bulk, most people should have normal bowel function. Normal is anywhere from three bowel movements a day to one every third day."

Go immediately. Take a lesson from Holly Golightly, who was always excusing herself to use the powder room in Breakfast at Tiffany's. It was perfectly polite, and very healthy. When you feel the urge, you must go. If you don't, the feeling of urgency will fade and so will your ability to defecate with ease. Then, when you do make time to use the bathroom, you may find yourself straining on the toilet, putting excess pressure on your sensitive hemorrhoidal blood vessels, says Dr. Wanderman.

Don't linger. Don't read or ponder the meaning of life on the toilet. "Maintaining a sitting position is thought to increase the risk of hemorrhoids because of the effect it has on blood flow in the pelvis," Dr. Jaffe explains. It's believed to cause pooling and congestion of blood in the hemorrhoidal blood vessels.

Work out. Regular exercise helps to move feces through your body, Dr. Wanderman says. Walking, running, doing yardwork or playing sports are all good things to try. Do whatever it takes to get in at least 30 minutes of continuous exercise three times a week. If you sit or stand all day on the job, remember to take a break every hour or so and walk around a bit. And take the stairs.

Soak in a sitz. A 20- to 30-minute soak in a very warm bath two to three times a day may help ease the pain of hemorrhoids while you're waiting for the swelling to subside, Dr. Jaffe says. There is no need to add anything to the bathwater. If a bath is inconvenient, or if you're pregnant, use a hand-held shower, Dr. Gathright suggests. Hot soaks are out during pregnancy because the heat can harm a fetus.

Soothe with mild lotions. Emollient lotions like over-the-counter Balneol will also temper the pain, Dr. Wexner says. But avoid products that contain witch hazel and alcohol, since they're too harsh for the skin around your anus. He suggests you also steer clear of petroleum jelly and other oil-based lotions, which will trap irritating sweat and mucus near your skin, and cortisone creams, which will thin the skin.

Commercial hemorrhoid preparations like Preparation H are no better than cheaper all-purpose emollient lotions, Dr. Gathright says. According to Dr. Wanderman, suppositories aren't particularly useful either, since they often slide too high up in your rectum to help hemorrhoids that are lower.