If there is one topic that is never touched upon in conversation, but which afflicts a large portion of Americans, it is the topic of hemorrhoids. At least half of American adults over the age of 50 have unpleasant symptoms of hemorrhoids, which are lumpy, swollen blood vessels at the bottom of the rectum. But even colorectal surgeons were shocked when I asked them to talk to me about it.
“I laughed when I got this order,” said Robert Sima, a colorectal surgeon at Mayo Clinic in Rochester, Minnesota. “I thought, ‘Is this a slut call?'” Does the New York Times want to know about hemorrhoids? “
Here’s what I learned about hemorrhoid prevention and treatment after talking to four doctors.
Know the symptoms
Everyone is born with hemorrhoidal tissue. In fact, these blood vessels that line the anus have a useful function: They help us feel what’s in the rectum, Sima said. They are why you can (usually) tell if the pressure you’re feeling is gas or diarrhea, or a normal bowel movement.
Sima explained that hemorrhoids also help create a barrier inside the anus that keeps it closed, like blocking a door.
Only when hemorrhoids become swollen and inflamed do they cause unpleasant symptoms. These symptoms can include itching, burning, bleeding, and sometimes hemorrhoids protruding from the body.
Hemorrhoids usually become inflamed from straining during bowel movements, said Rahul Narang, a colorectal surgeon at NYU Langone Health.
Most hemorrhoids are called internal hemorrhoids, which means that they develop inside the anus, although they sometimes swell. Rarely, people develop external hemorrhoids, which affect the blood vessels outside the anus. These tend to come on suddenly and be very painful, Sima said, but they usually go away on their own within a week.
Even if you have hemorrhoid symptoms, you shouldn’t assume you have hemorrhoids, said Karen Zagian, MD, a colorectal surgeon at Cedars-Sinai Medical Center in Los Angeles. Symptoms such as rectal bleeding and pain can also be caused by other problems, including anal fissures (sores in the anus), anal fistulas (infected tunnels between the anus and the skin), and rectal cancer.
She said the doctor should perform a rectal examination with his finger to rule out other problems. If not, consider seeing a specialist, such as a gastroenterologist or colorectal surgeon, who may also order an endoscopic examination, such as a colonoscopy, to properly diagnose the problem, Sima said.
how to prevent
When it comes to preventing hemorrhoids, eating a high-fiber diet definitely helps, said Neha Mathur, MD, a gastroenterologist at Houston Methodist Hospital. She recommended 20 to 30 grams of fiber per day.
Narang said staying hydrated can make all the difference. He explained that fiber and water make bowel movements easier, reducing the chances of hemorrhoids becoming inflamed.
The way you sit on the toilet matters, too: Mathur added that products like the Squatty Potty — a chair that sits under your feet while you’re sitting on the toilet — change your angle in a way that can reduce stress.
Sitting for long periods in general can also exacerbate hemorrhoid symptoms, Sima said, as well as lifting heavy weights in your upper body, which strains the blood vessels around your anus. He said that men often came to him with painful hemorrhoids after they became dehydrated during strenuous physical activity.
Mathur said women often develop symptoms of hemorrhoids during pregnancy, in part because pressure in the anal area increases as the uterus grows. She said hormonal changes and prenatal vitamins also increase the chance of pregnant women developing constipation, making the problem worse by straining them to have a bowel movement.
Fiber, water, and less time in the bathroom can help, as can a stool softener. Mathur recommended that pregnant women with hemorrhoids talk to their doctors about safe treatment options.
Simple treatments can help
Doctors classify internal hemorrhoids into stages 1 through 4, depending on their physical characteristics and severity. For minor hemorrhoids — grade 1, which doesn’t protrude outside the anus, and grade 2, which may protrude and then come back on its own — people can usually get relief by following the recommendations above.
They may also feel better after sitting in a sitz bath or an Epsom salt (magnesium sulfate) bath for 15 minutes, Narang said. These baths soothe tissues and reduce inflammation.
I was surprised to learn from Sima that over-the-counter lotions and gels don’t help as much as people expect. He said they may relieve symptoms for a while, but they don’t cure the underlying problem.
Narang said that if hemorrhoid symptoms don’t improve, an in-clinic procedure can help. A common treatment is rubber band ligation, in which the doctor uses an instrument to place a rubber band around the base of the hemorrhoid, which stops blood flow to the inflamed tissue and causes the hemorrhoid to die and fall off within one to four days. .
It’s quick, relatively painless, and requires very little patient recovery time, Mathur said. Some people can return to work after the operation. But others may need multiple treatments.
Severe hemorrhoids can be treated with surgery
Grade 3 and 4 Internal Hemorrhoids – Grade 3 means the hemorrhoids protrude from the anus but can be manually pushed inwards, Grade 4 is when they are constantly outside the anus – sometimes requiring surgery.
There are surgical options available. One of them, Narang said, is excisional hemorrhoidectomy, which is the surgical removal of hemorrhoids.
Another option, Sima said, is stapling anorexia (also called stapling of hemorrhoids), in which a doctor removes a portion of the hemorrhoids and then reattaches it together, reducing it to a normal size.
Some doctors instead use Doppler-guided hemorrhoidal artery ligation, Narang says, which is a good option for hemorrhoids that bleed a lot. In this procedure, the doctor ties the main arteries that supply the hemorrhoids, causing them to wilt and fall off.
Mathur said that while surgical procedures are often successful, they are not without potential downsides. They can have a painful and longer recovery from in-clinic procedures and can cause fecal incontinence.
What’s more, even after surgery, hemorrhoids can return — some surgeries, such as arterial ligation, are associated with up to a 30% chance of recurrence, Narang said. This is partly because these treatments remove or kill some of the hemorrhoid tissue in the body, Sima said, but leave the rest behind, which can become engorged and inflamed.
If people do not treat the lifestyle factors that cause hemorrhoids, the problem is likely to return.
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