Crohn's Disease

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What are hemorrhoids?

Hemorrhoids are a normal part of human anatomy. They are enlarged, bulging blood vessels in and about the anus and lower rectum. There are two types of hemorrhoids based on their location: external and internal.

External (outside) hemorrhoids are under very sensitive skin around the anal opening. A blood clot (thrombosis) that might arise in the hemorrhoid can cause severe pain. Patients usually complain about a painful, hard lump. Rupture of a thrombosed hemorrhoid may bleed.

Internal (inside) hemorrhoids are located inside the anal canal. Most commonly they bleed and protrude during bowel movements but are usually painless. An internal hemorrhoid "prolapse" can be painful due to the fact that the hemorrhoid slides out through the anal opening and cannot be pushed back inside.

What are the symptoms people with hemorrhoids complain about the most?

Most complaints deal with the bleeding, protrusion and itching caused by hemorrhoids.

What causes hemorrhoids to become symptomatic?

The answer to this question involves a multitude of factors. As with many other tissue related maladies aging is one factor. Other factors are chronic constipation or diarrhea, pregnancy, straining during bowel movements, overuse of laxatives or enemas, as well as prolonged sitting on the toilet due to combined reading and other related activities while using the toilet. All of these factors contribute to weakness of supporting tissues resulting in distention, dilatation and increased fragility of the vascular wall.

What treatments are available for symptomatic internal hemorrhoids?

Dietary adjustments (e.g. adding fruits, vegetables, breads and cereals with increased intake of fluids) and improved bowel regimen with the elimination of straining is an important initial step in the management of symptomatic internal hemorrhoids. Using these measures in most cases will cause the symptoms to subside in a matter of days. The use of sitz baths will also help to relieve pain. In the case of more persistent problems not resolved by dietary and bowel regimen management, the following methods are available:

Ligation: A procedure in which a small rubber band is placed over the hemorrhoid causing the blood supply to the hemorrhoid to be cut off. After a few days, the hemorrhoid and the band fall off; during this time a small amount of bleeding may be experienced. Eventually, a firm scar will form which helps to support the tissues. For a full effect the procedure must be repeated. Success rate for this procedure is about 60-70% in properly selected patients. It is relatively painless and can be performed on an outpatient basis.

Infrared coagulation: Similar to ligation, in this procedure blood supply is cut off to the hemorrhoid, but instead of using a rubber band, a specialized infrared instrument is used to produce thermal coagulation at the base of the internal hemorrhoid ultimately resulting in scarring that helps to support the tissues. As with ligation, this procedure is relatively painless and can be done on an outpatient basis.

Hemorrhoid stapling: This procedure is performed if ligation fails. It involves the stapling and excision of internal hemorrhoids to produce the same effect as ligation. It is, however, a more painful procedure than ligation but less painful than surgery to remove the hemorrhoids (see hemorrhoidectomy below).

Hemorrhoidectomy: This is a surgical procedure to remove the hemorrhoids. It results in the most complete removal of internal and external hemorrhoids but must be done under anesthesia and requires sutures upon completion. Significant pain can be expected after the procedure whether a standard scalpel is used or more expensive techniques involving the use of a laser or harmonic scalpel.

What treatments are available for external thrombosed hemorrhoids?

The pain and swelling of a thrombosed hemorrhoid will usually decrease in two to seven days. However, when patients present with severe pain within 24-48 hours after initial pain it might be beneficial to surgically remove the thrombosed hemorrhoid which will generally provide relief. Removal of the hemorrhoids usually involves a small incision while under local anesthesia.

Is there a link between hemorrhoids and cancer?

No, there is no definitive link. However, hemorrhoids and cancer (and other diseases of the digestive system) can have similar symptoms particularly bleeding. Therefore, it is important that all symptoms are investigated and not merely assumed to be hemorrhoids. Symptoms should first be properly assessed by a colorectal surgeon so that treatment can be accurately prescribed.