- Chronic constipation or diarrhea, excess straining to have bowel movements is a common cause of hemorrhoids
- Pregnancy, due to pressure in the pelvis from the baby in the uterus
- Prolonged sitting for most of the day (for example truck drivers or other professions that require sitting for most of the day)
- Painless rectal bleeding, usually is a small amount
- Anal itching or pain, due to irritation of the skin surrounding the anus
- Tissue bulging around the anus, some people can see or feel hemorrhoids on the outside of the anus
- Leakage of feces or difficulty cleaning after a bowel movement
While hemorrhoids are one of the most common reasons for rectal bleeding, there are other, more serious causes. It is not possible to know what is causing rectal bleeding unless you are examined.
You should seek medical attention if you see bleeding after a bowel movement
In many cases, your doctor can determine if you have hemorrhoids by asking you about your symptoms and doing a physical examination. Some hemorrhoids are visible on the outside (called External Hemorrhoids) and others are deeper inside (called Internal Hemorrhoids), and these are generally not visible on the outside.
The doctor will likely do a digitial rectal examination (using a gloved finger inside your rectum) or may need to do an Anoscopy (by placing a short, lighted, scope into your anus and examining the inside of the anal canal).
If you have rectal bleeding, the doctor will need to determine where the bleeding is coming from. Many times the bleeding can be from hemorrhoids, but it can also be from other medical conditions such as colon or rectal cancer. You may need to have a Colonoscopy or sigmoidoscopy for further testing.
- Grade 1(minor): present but only visualized by a doctor with anoscopy or colonoscopy, and do not extend out the anus
- Grade 2: can extend out of the anus with a bowel movement or with straining, but will go back inside spontaneously
- Grade 3: extend out of the anus with a bowel movement or with straining, but will not go back inside spontaneously, and requires the patient to manually push it back inside. If you have this, you should seek medical attention, but it is not urgent.
- Grade 4 (severe): extend outside the anus and are not able to be pushed manually back inside.
Fiber supplements-Increasing fiber in your diet is one of the best ways to soften your stools. Fiber is found in fruits and vegetables. The recommended amount of dietary fiber is 20 to 35 grams per day
Several fiber supplements are available, including psyllium (Konsyl; Metamucil; Perdiem), methylcellulose (Citrucel), calcium polycarbophil (FiberCon; Fiber-Lax; Mitrolan), and wheat dextrin (Benefiber). Start with a small amount and increase slowly to avoid side effects.
Laxatives – If increasing fiber does not relieve your constipation, or if side effects of fiber are intolerable, you can try a laxative.
Many people worry about taking laxatives regularly, fearing that they will not be able to have a bowel movement if the laxative is stopped. Laxatives are not “addictive” and using laxatives does not increase your risk of constipation in the future. Instead, using a laxative may actually prevent long-term problems with constipation.
Topical treatments – Various creams and suppositories are available to treat hemorrhoids, and many are available without a prescription. Pain-relieving creams and hydrocortisone rectal suppositories may help relieve pain, inflammation, and itching, at least temporarily.
You should not use hemorrhoid creams and suppositories, particularly hydrocortisone, for longer than one week, unless your healthcare provider approves.
Sclerotherapy – During sclerotherapy, a chemical solution is injected into hemorrhoidal tissue, causing the tissue to break down and form a scar. Sclerotherapy may be less effective than rubber band ligation
If you continue to have hemorrhoids despite conservative or minimally invasive therapies, you may require surgical removal of hemorrhoids (hemorrhoidectomy). Surgery is the treatment of choice for patients with large internal hemorrhoids.
Hemorrhoidectomy involves surgically removing excess hemorrhoidal tissue. This can be done in various ways, but it is generally done under general anesthesia with the patient asleep. It is successful in 95 percent of patients.
- Bleeding, may be immediate or delayed several days after the surgery
- Constipation, due to pain in rectal area and due to narcotic pain medication
- Injury to the anal sphincter, which could result in anal incontinence
- Anal stricture (narrowing of the anus due to scar tissue)
This is generally a same-day surgery. Most people are able to return to work and other activities in about 1-2 weeks. You may have a small amount of bleeding on the dressing or after having a bowel movement; this can last for a couple weeks. You should contact your doctor if the bleeding is more than a few Tablespoons per day.
You may resume your usual diet immediately after surgery.
- To avoid constipation or stool impaction, we recommend starting a high fiber diet the morning after surgery (Bran cereal, wheat or rye bread, fresh fruits, and vegetables) and also one tablespoon of Metamucil (or other fiber supplement powder) mixed with 8 ounces of water each morning and evening starting the day after surgery.
- You should take Dulcolax stool softener (Docusate is the generic name) 100mg tablet twice daily starting on the day before your surgery, and until you are no longer taking pain medication.
- If you go 48 hours without a bowel movement (BM), you should take 2 tablespoons of Milk of Magnesia every 6 hours until your first BM, and then stop.
- Call the office if you go more than 2 days without a BM or if you are having abdominal pain or abdominal distension.
- Drink plenty of water and juice and eat fresh fruits and vegetables.