DR. ISLAM: What are Hemorrhoids and how are they treated?

By Dr. Rafiul Sameer Islam

Hemorrhoids are unpleasant gastrointestinal symptoms that affect people of all ages.

Without intervention, hemorrhoids can keep recurring. But there are many treatments that can relieve symptoms of hemorrhoids long-term.

Keep reading to learn more about hemorrhoids and their treatment options.

What Are Hemorrhoids?

Hemorrhoids are natural “cushions” of veins inside the anus and rectum that swell with blood during bowel movements. This swelling protects the anal canal from the stool as it exits the body. After a bowel movement, hemorrhoids usually return to their standard size.

However, factors that increase pressure within the anal canal, such as straining, can cause hemorrhoids to remain swollen. Swollen hemorrhoids can become inflamed and lead to the following symptoms:

  • Rectal pain.
  • Itching.
  • Stool leakage.
  • Bright red rectal bleeding.

Hemorrhoids may appear like rubbery lumps protruding from the anus. But some types of hemorrhoids are so far up the anal canal that you can’t see them.

Types of Hemorrhoids

There are two types of hemorrhoids: internal and external hemorrhoids.

Internal hemorrhoids sit in the upper portion of the anal canal above the dentate line. The dentate line is an anatomical junction that divides the anal canal into upper and lower portions. The upper portion of the anal canal doesn’t contain pain receptors, so internal hemorrhoids are usually not painful.

Internal hemorrhoids include the following grades:

  • Grade 1: Hemorrhoids that don’t prolapsed.
  • Grade 2: Hemorrhoids that prolapse outside the anus during straining but spontaneously reduce.
  • Grade 3: Hemorrhoids that prolapse outside the anus during straining and need manual reduction.
  • Grade 4: Prolapsed, non-reducible hemorrhoids.

External hemorrhoids sit below the dentate line in the lower portion of the anal canal. External hemorrhoids are sensitive to pain, touch, and temperature. These types of hemorrhoids are always visible.

What Happens if Hemorrhoids Are Left Untreated?

If hemorrhoids are left untreated, they can become larger and more symptomatic over time. This can make everyday activities like walking, sitting, and using the bathroom uncomfortable.

Lifestyle factors play a vital role in the development of hemorrhoids. If you don’t make any changes to your daily routines, hemorrhoids can keep coming back.

In rare cases, untreated hemorrhoids can cause complications such as:

  • Strangulation: Prolapsed hemorrhoids can become trapped between the anal muscles, cutting off their blood supply. This can be extremely painful.
  • Blood clots: Strangulation can cause painful blood clots to form within the swollen vein. This is known as a thrombosed hemorrhoid.
  • Anemia: Excessive bleeding from hemorrhoids can lead to a reduction in healthy red blood cells. Symptoms of anemia may include weakness and fatigue.
  • Infection: Bleeding hemorrhoids are more susceptible to bacterial infections. Signs of infection may include fever and redness around hemorrhoids.

Hemorrhoid Treatment Options

Many hemorrhoid treatment options differ depending on the types of hemorrhoids.

Home remedies can treat both internal and external hemorrhoids. Treatment focuses on diet and lifestyle modifications that can prevent hemorrhoids from recurring.

Diet modifications include eating a high-fiber diet and drinking plenty of water to soften stools and prevent constipation. In some cases, laxatives may also help change stool consistency in individuals with organic bowel problems.

Lifestyle modifications can correct bad bowel movement behaviors that contribute to hemorrhoid development. For example, limiting bathroom time can prevent straining and avoid increased pressure in the anal canal.

Some home remedies can also relieve symptoms of hemorrhoids such as pain and itching. These treatments include the use of topical creams, sitz baths, and medication.

Non-invasive procedures can safely treat internal hemorrhoids with minimal risk of side effects.

Rubber band ligation, also known as hemorrhoid banding, is an office-based procedure that can permanently remove internal hemorrhoids in grades 1, 2, and 3. This procedure is quick, painless, and effective. What’s more, hemorrhoid banding involves no recovery time.

During the procedure, the doctor gently places a rubber band around the base of hemorrhoid. This cuts off blood flow to the area, which causes hemorrhoids to fall off naturally. Scar tissue remains in place of hemorrhoid and prevents the vein from bulging again.

Hemorrhoid banding has the lowest recurrence of symptoms, which makes it the best hemorrhoid treatment.

Sclerotherapy can treat internal hemorrhoids in grades 1, 2, and 3. However, success rates are higher for grade 1 hemorrhoids. Sclerotherapy provides an injection in a hemorrhoid that forms scar tissue and stops blood flow to the hemorrhoid.

Infrared coagulation can treat internal hemorrhoids in grades 1, 2, 3, and 4. This procedure applies infrared waves (heat) to stop blood flow, form scar tissue, and kill the hemorrhoid tissue.

Surgery is only necessary when hemorrhoids don’t respond to other treatments or become more significant in size. The surgical treatment of hemorrhoids comes with greater risks than non-invasive procedures. Risks may include pain, bleeding, infection, and urinary retention.

A hemorrhoidectomy is a surgery that can remove internal hemorrhoids grades 2 to 4. This procedure can also remove acute strangulated or thrombosed external hemorrhoids. During the procedure, the doctor cuts out the hemorrhoid and ties off the swollen vein inside the hemorrhoid to stop the bleeding. The doctor may leave the surgical area open or closed for healing.

Laser removal can treat internal hemorrhoids grades 1 to 3. This procedure uses a laser beam that generates heat to cauterize the vein inside the hemorrhoid, which causes the hemorrhoid to fall off.

Hemorrhoid stapling, also known as stapled hemorrhoidectomy, can treat internal hemorrhoids in grades 2, 3, and 4. This procedure staples the prolapsed hemorrhoid higher up the rectum to prevent prolapse. It also removes the tissue above the hemorrhoid that allowed it to move downward in the first place. Removing this tissue partially disrupts blood flow to hemorrhoid and causes it to shrink.

A harmonic scalpel removal procedure uses a specialized scalpel known as the ultrasonic scalpel to remove internal hemorrhoids in grades 3 and 4. The ultrasonic scalpel uses high-frequency mechanical vibration to cut tissue and seal blood vessels at the same time. This procedure reduces postoperative blood loss and pain.

Hemorrhoid Treatment Recommendations

Hemorrhoids are easier to treat in their earlier stages of development. If you notice hemorrhoids, don’t wait to seek treatment.

You can reduce your risk of hemorrhoids by:

  • Eating a high-fiber diet.
  • Drinking water.
  • Staying active.
  • Avoiding straining during bowel movements.

If you suffer from internal hemorrhoids, you should consult your healthcare provider about hemorrhoid banding. This procedure can provide permanent relief from hemorrhoids quickly and painlessly.

Sameer Islam, MD is a board-certified Gastroenterologist and Hepatologist practicing at Southwest Gastroenterology in Lubbock, Texas. For an appointment feel free to contact his office at (806)-696-4440. You can get more information from his webpage (www.sameerislam.com) where you can also subscribe to his monthly newsletter. He also has a weekly Facebook Live show on Tuesday, 8:00PM CST.