Hemorrhoids More than half of the population of the United States suffers from hemorrhoids.

There is essentially two types of hemorrhoids: internal and external. The internal type tends to bleed and in advanced cases protrude outside of the anus. The external ones develop on the outside of the anus, produce pain and itching. There is also a grey zone between internal and external of hemorrhoids that give a combination of symptoms. Hemorrhoids are blood vessels which are part of the normal anatomy. They line up around the anal canal to make a soft cushion and facilitate defecation. Straining makes these vessels (veins) enlarge very much like varicose veins in the legs. Once veins are enlarge they lose the ability to make blood return to the heart. In the worse cases this results in clotting of the blood or thrombosis, a very painful condition. Hemorrhoidal veins cannot be eliminated from the body (unless the rectum and anus are eliminated). Therefore, successful treatment of hemorrhoids does not preclude from new hemorrhoids developing. The main predisposing factor is straining on defecation or physical activity that involves intense use of the abdominal musculature. The most common cause of straining on defecation is constipation and this could be due to a diet poor in fiber, pregnancy or other conditions slowing down the bowels, although sometimes diarrhea can precipitate hemorrhoids. Physical activity with intense use of the abdominal musculature can be in the form of weight lifting, playing wind musical instruments, or just coughing excessively. Occasionally hemorrhoids can be the red herring masking another process such as a tumor of the colon that is producing constipation by blockage or that is bleeding. This is why colonoscopy is recommended for most patients along with the various treatments. Unfortunately, colonoscopy sometimes aggravates the symptoms but it is really important to make sure that something more important is not being missed. In all patients is essential to correct the main predisposing factor: straining from constipation. This is done by increasing fluid and fiber in the diet (vegetables, fruits, legumes and cereals), bulking agents (psyllium seeds), and stool softeners (docusate). Spending time sitting in the toilette is counterproductive and worsens hemorrhoids. A sitz bath - sitting in plain warm water for about 10 minutes - can also provide some relief . With these measures, the pain and swelling of most symptomatic hemorrhoids will decrease in two to seven days, and the firm lump should recede within four to six weeks. In cases of severe or persistent pain from a thrombosed hemorrhoid, your physician may elect to remove the hemorrhoid containing the clot with a small incision. Performed under local anesthesia as an outpatient, this procedure generally provides relief. Severe hemorrhoids may require special treatment, much of which can be performed on an outpatient basis.

 Injection screotherapy works well on bleeding hemorrhoids that do not protrude. It is relatively painless and cause the hemorrhoid to shrivel up. Ligation the rubber band treatment - works effectively on internal hemorrhoids that protrude with bowel movements. A small rubber band is placed over the hemorrhoid, cutting off its blood supply. The hemorrhoid and the band fall off in a few days and the wound usually heals in a week or two. This procedure sometimes produces mild discomfort and bleeding and may need to be repeated for a full effect. Hemorrhoidectomy surgery to remove the hemorrhoids - is the most complete method for removal of internal and external hemorrhoids. It is necessary when (1) clots repeatedly form in external hemorrhoids; (2) ligation fails to treat internal hemorrhoids; (3) the protruding hemorrhoid cannot be reduced; or (4) there is persistent bleeding. A hemorrhoidectomy removes excessive tissue that causes the bleeding and protrusion. It is done under anesthesia using either sutures or staplers, and may, depending upon circumstances, require hospitalization and a period of inactivity. Laser hemorrhoidectomies do not offer any advantage over standard operative techniques. They are also quite expensive, and contrary to popular belief, are no less painful. In our practice we perform surgery (hemorrhoidectomy) in less than 10% of patients and our preferred treatment for bleeding internal hemorrhoids is injection sclerotherapy.