Hemorrhoids

Hemorrhoids are swollen venous tissues in the anorectal region. Common causes of hemorrhoids are chronic constipation or diarrhea, straining during defecation, pregnancy, heavy lifting and prolong periods of sitting on the toilet. Hemorrhoids are differentiated between internal hemorrhoids and external hemorrhoids based on their location. Internal hemorrhoids are proximal to the dentate line and are typically painless; external hemorrhoids are distal to the dentate line and are often painful.

The most common symptom of internal hemorrhoids is rectal bleeding. The blood is typically bright red and is often present towards the end of the bowel movement and in the toilet water. Patient’s may also complain of irritation or sense of fullness in the anorectal region. Common symptoms associated with external hemorrhoids include perianal itching, swelling and pain.

Conservative therapies for hemorrhoids includes increasing fiber intake and hydrating appropriately. Patients with chronic constipation may find relief in adding miralax or a stool softner as well to help with defecation. Limiting time on the toilet to 2-3 minutes is also recommended. Sitz baths can help relieve perianal irritation.

Topical analgesics, such as lidocaine ointments, are often used for quick symptomatic relief.  Topical steroids, such as hydrocortisone, may relieve irritation and shrink internal hemorrhoids. When used, topical steroids should be used no more than 7 days as long-term use could result in thinning of perianal and anal mucosa.

Rubber band ligation is the most common technique for eradication of symptomatic internal hemorrhoids. Bands cannot be placed over external hemorrhoids as it would cause significant pain. A bowel prep is not needed for hemorrhoid banding. During the banding procedure, a band is placed over the internal hemorrhoid tissue. After the band is placed the patient would be asked if there is a pressure-like sensation (similar to having the urge to have a bowel movement) or pinching sensation. If there is a pressure-like sensation, it suggests the hemorrhoid band is placed correctly with the appropriate amount of tissue inside the band. If the sensation is a pinching sensation the physician, will adjust the band to release excess tissue. One hemorrhoid band is banded at a time as complication rates with one hemorrhoid being banded per session is significantly lower than the complication rate with banding of multiple hemorrhoids at the same time. If one hemorrhoid is banded at a time, there is a 1% chance of pain or bleeding.