Treating Hemorrhoids

by Food and Drug Administration (FDA)

Say the word hemorrhoids to just about anyone and they will either roll their eyes, moan or both. Invariably they will want to change the subject.

According to the National Institutes of Health, about half the U.S. population over 50 have hemorrhoids.

"Hemorrhoids are one of the most common complaints a physician must evaluate," agrees Lee E. Smith, M.D., director of the division of colon and rectal surgery at the George Washington University Medical Center, Washington, D.C.

Common, but rarely a serious risk to health, hemorrhoids are the result of too much pressure on the hemorrhoidal veins in the rectum. The strain of constipation, diarrhea and pregnancy can cause the veins to swell. Other factors such as obesity and liver disease can also increase pressure and cause hemorrhoids.

There are two kinds of hemorrhoids — internal and external. Frequently, the only sign that internal hemorrhoids exist is bright red blood that appears on the surface of the stool, in the toilet bowl, or on the toilet paper. But, if the pressure and swelling continue, the hemorrhoidal veins may stretch out of shape, sometimes so much that they bulge through the anus to the outside of the body.

The veins around the anus can also become swollen, causing external hemorrhoids. These swollen veins bleed easily, either from straining or rubbing, and irritation from draining mucus may cause itching in the anal area. If blood clots form in these hemorrhoids, the pain can be severe.

"If you see blood, it's probably hemorrhoids," says Smith. Hemorrhoids are the most common source of bleeding from the rectum and the anus. However, if the bleeding lasts for more than a couple of days, it's important to see a doctor for an exam. Smith stresses that a "thorough physical exam, not just talking about the symptoms" is essential.

"The unfortunate thing is every year I see somebody who has been seeing blood and they were treated as having hemorrhoids without really being examined, and they had a cancer," he says.

Treatment for hemorrhoids depends not only on the severity of the symptoms, but also on the patient's reaction to those symptoms.

"Hemorrhoids don't cause cancer; they're a nuisance," says Smith. "Rarely do they cause severe anemia and rarely do they cause something that is hazardous to health. If the patient doesn't mind, then let them live with the hemorrhoids."

Even though he's a surgeon, Smith considers surgery an option only after everything else has failed.

Relieving the Pressure

The first step in treating hemorrhoids is to relieve the pressure and straining. This can often be done by controlling constipation with a high-fiber diet, according to Barbara Frank, M.D., director of the division of gastroenterology at the Crozer-Chester Medical Center, Chester, Pa.

Eating the right amounts of bran (the outer coating of grains, available mainly as cereals), as well as fruits, vegetables, and whole grains results in a soft, bulky stool that is easily eliminated without strain or pressure on the hemorrhoidal veins. (See box for list of good fiber sources.)

"Bran is the cheapest way to go," says Smith, who also recommends bulk stool softeners (brand-name products include FiberCon, Metamucil, Citracil, and Serutan) as a way to relieve pressure and straining.

Lots to drink, as long as it isn't alcohol, which can actually cause dehydration, is also important for the regularity that can relieve hemorrhoids you already have and prevent new ones.

People should drink "several glasses [of liquid] a day, and it doesn't have to be just water," says Marilyn Stephenson, a registered dietitian with FDA's Center for Food Safety and Applied Nutrition. "Fruits and vegetables are high in fluids, too."

"Several" may seem a little too fluid an amount, but people's needs vary, sometimes daily, depending on things like the weather or exercise.

"Especially in hot weather, a glass [of water] every couple of hours is very reasonable," says Smith.

One thing to avoid when trying to relieve constipation is any laxative other than a stool softener, says Smith. Other laxatives frequently cause diarrhea, which can be just as rough on the hemorrhoidal veins as straining due to constipation, he explains.

Besides an improved diet, other simple steps to relieve the irritation some hemorrhoids cause include:

• warm soaks (sitz baths) three or four times a day
• cold packs
• good hygiene. (Be gentle about cleaning, though. Frank recommends using a soft, moist pad or even rinsing in the shower as an alternative to wiping.)

About the Author

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