When you even hear the word “hemorrhoids” you probably wince with discomfort. With treatment, however, you can be comfortable and prevent complications. Hemorrhoids or piles are very common, with about 75 per cent of the population being affected, most notably adults between 45 and 65 years old.
Hemorrhoids are inflamed and swollen veins in the anal and rectal area. The veins are actually part of the vascular cushioning structures which control the passage of stools. The most common cause is constipation and the straining needed to pass a dehydrated hard stool. Pregnancy can cause constipation and may also result in hemorrhoids. Chronic or acute diarrhea can mean straining with resulting hemorrhoids.
Sitting on the toilet, physical exertion caused by lifting heavy weights, and sitting for long periods of time (for example, at a desk job) can also cause stress on the vascular cushions and veins, resulting in hemorrhoids.
Hemorrhoids seem to affect women and men equally, with the exception of the pregnancy risk, but men more often require medical intervention. With age, the connective tissues that are part of the vascular cushions weaken, thus the risk for hemorrhoids increases for older individuals. Children are not as often affected by hemorrhoids, although they can be. However, their symptoms should be checked to ensure that hemorrhoids are the cause.
Internal hemorrhoids, just as the term suggests, lie inside the rectal area and do not usually cause symptoms. External hemorrhoids protrude outside the anal opening, and because this area has a rich supply of nerves, can be painful, itchy, and swollen. Hemorrhoids are described by the degree to which they lie outside or inside the anus. First degree ones remain internal; second degree may protrude but return after a bowel movement without any intervention; third degree remain externally after a bowel movement but you are able to manually replace them; and fourth degree cannot be replaced, remaining externally.
Ideally, you want to prevent hemorrhoids, so preventing constipation is key. A diet high in fibre and fluids as well as exercise is an easy and effective help in preventing constipation. Regular bowel habits are important, as is not delaying or “holding it.” The colon is the most active in the morning, making it an ideal time for bowel movements.
Some drugs, most commonly narcotic pain relievers, cause constipation and often a laxative is recommended to be taken at the same time. Being overweight is associated with constipation and hemorrhoids, thus weight loss may be a good idea.
Obviously, you want a healthy diet and exercise, but if you do experience hemorrhoids, there are non-drug approaches. A sitz bath, that is a warm, shallow bath, will relieve symptoms, but you may need to use it up to four times daily. If the hemorrhoids are external, they should be replaced with a soft moist tissue followed by a gentle soap and water wash to keep the area clean.
Hemorrhoid creams and suppositories contain a variety of ingredients to reduce the symptoms, for example local anesthetics, anti-inflammatory agents like hydrocortisone, astringents like zinc oxide and witch hazel, protectants like glycerine, and vasoconstrictors like phenylephrine. Suppositories are best used at bedtime because they slip into the rectum and during the day will “melt out.” Creams and ointments are easy to apply and can be used both externally and internally.
If the symptoms persist or get worse, then they need to be checked. Bleeding occurs because hard stools pass over the swollen blood vessels and in fact your noticing blood on toilet tissue may be your first indication of hemorrhoids. However, this bleeding may be a sign of more serious hemorrhoids and if the blood is dark in colour or if there are large quantities of blood, you certainly do want your condition evaluated.
Hemorrhoids may be uncomfortable and embarrassing, but they can be treated and prevented. Who can argue with a high-fibre diet, exercise, weight loss, and plenty of liquids?
Marie Berry is a lawyer/pharmacist interested in health and education.