Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

The Anus as a Whole

Ah! The season of yard work is once again upon us. It’s time to push lawnmowers,and carry large bags of topsoil, fertilizer,and mulch. Although there is no official season for hemorrhoids, heavy lifting, prolonged standing and straining are all factors associated with their development. Many people do not realize that hemorrhoids are varicose veins of the anorectal region. Healthy veins are a part of the normal anatomy in this area, but with repeated straining, pressure, and/or irritation, these veins can become swollen and tender. . .creating the symptomatic nuisance many of us know so well.

Both men and women experience hemorrhoids; it is estimated that at least half of Americans have hemorrhoids by age 50. In addition to lifting, chronic constipation or chronic diarrhea, pregnancy and delivery, obesity, rectal intercourse, and routines involving prolonged standing can promote hemorrhoids. There are two types: internal hemorrhoids (varicose veins inside the anus) or external hemorrhoids (varicose veins that develop around the anal opening). The most common symptom of internal hemorrhoids is painless, bright red bleeding at the time of bowel movements. When internal hemorrhoids are severe enough to protrude through the anal opening, they can cause considerable pain. External hemorrhoids are generally painful and can be felt as tender or itchy, swollen lumps around the anus. Hemorrhoids may be red, blue, or black in appearance depending on the degree of swelling, clotting, and disruption of blood supply to the veins. (Fortunately, for most of us, the visual inspection of such is relegated to health care providers and/or very very good friends!)

Generally, hemorrhoidal symptoms will resolve within a few days. Measures to reduce symptoms include: warm tub or sitz baths several times/day in plain, lukewarm water for about 10 minutes/session; ice packs when swelling and pain are severe; and application of hemorrhoid creams or suppositories to aid in reducing discomfort and inflammation. “Regularizing” bowel movements to soften constipated stools or firm up diarrhea will also help in conservative treatment. Remember that hemorrhoids are SWOLLEN,INFLAMED veins. Measures to reduce swelling can always be helpful. Do not use scalding hot water for sitz baths or hot packs–for these will only intensify the swelling. Additionally, lying down whenever possible during the acute phase of hemorrhoids will reduce the effect of gravity on the varicose veins by decreasing the pooling of blood in them.

When conservative measures are not successful, several surgical procedures are available to shrink and destroy hemorrhoidal tissue. For internal hemorrhoids, these methods include: 1) sclerotherapy–a chemical solution is injected around the blood vessel to shrink the varicose veins, and 2) Rubber band ligation–rubber bands are placed around the base of hemorrhoids, and they wither from lack of circulation within days. Treatments that are used to treat both internal and external hemorrhoids include: 1) Electrical or laser or infrared light coagulation to burn/cauterize the hemorrhoidal tissue and 2) Hemorrhoidectomy–full surgical excision of the hemorrhoids. Several of the above procedures can be performed in a doctor’s office with minimal anesthesia. Obviously, most people prefer to give personal conservative measures a rigorous trial before proceeding to these next steps.

Good health habits are useful in preventing hemorrhoids. Keep stools soft and easy to pass with a diet high in fiber and water consumption (especially when travel disrupts one’s eating and activity routines). Exercise regularly; try to maintain a healthy body weight; try not to strain with bowel movements, and learn to lift and carry objects properly without holding your breath and creating undue pressure on your body. And, by all means, if you’re a “toilet reader“–stop this habit immediately! Consider the effect of gravity on all those unsupported anorectal veins sagging through an opening as you peruse the New York Times, People Magazine, or War and Peace. Toilet-sitting should be a brief ritual intended for one purpose alone. People who perform this task correctly certainly have more than mere potluck to explain their decreased incidence of hemorrhoids.

There are other reasons for painless rectal bleeding and painful swelling or itching in the anorectal area. Though you are now better educated about the cause and treatment of hemorrhoids, please do not assume that you can correctly diagnose yourself in all instances. Certain infections, allergies, and even colorectal cancer can create many of these same symptoms. So, use your common sense to treat your symptoms but confer with your physician about diagnosis and further therapy. Happy Gardening. . . Happy Endings.

Stephen L. Hines, M.D.
May 2000

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