We are often so hesitant to discuss certain topics that we avoid learning some important things. Take hemorrhoids, for instance — go ahead, have a chuckle now but rest assured that the comedy routines about donut pillows do not apply here.
Hemorrhoids, while not a serious health issue, can still cause significant pain. And as you might expect, they are not new: we have been complaining for ages — records exist from ancient Egypt and even the Old Testament.
Hemorrhoids are swollen blood vessels in the rectum. The hemorrhoidal veins are located in the lowest area of the rectum and the anus and they can swell so that the vein walls become stretched, thin, and irritated when you have bowel movements.
Though hemorrhoids can occur at any age, they typically develop in middle age around age 45 to 65. Hemorrhoids come in two varieties: internal and external, and you can have both at the same time. Internal hemorrhoids lie far enough inside the rectum that you cannot see or feel them. Better yet, they don’t usually hurt because there are few pain-sensing nerves in the rectum. Bleeding may be the only sign they are present. They may be accompanied by itching and irritation if they prolapse (protrude to the outside).
Internal hemorrhoids are more common than the external variety, but it is the latter that causes the most pain. External hemorrhoids, which form on the edge of or just outside the anus, can be especially painful if they thrombose, that is, form a blood clot.
The primary way hemorrhoids make their presence known is with bright red blood. There will frequently be signs of bleeding showing up on the toilet paper, in the stool or the toilet bowl; there might also be some anal leakage including blood.
Now we know what hemorrhoids are, but what causes them and how do we prevent it? Though often debated, there is little agreement on what causes hemorrhoids. Most likely there are multiple factors involved and no one cause.
Various links have been suggested including having ‘weak’ veins; prolonged straining when defecating; aging; and even genetics. Hemorrhoids have also been associated with irregular bowel habits such as chronic constipation or diarrhea. Other factors identified as possibly related include pregnancy, childbirth, obesity, and prolonged sitting.
In most instances, treatment comes from self-care. Hemorrhoids may be painful and irritating, but they are unlikely to pose a threat to health. That is, unless bleeding is a sign of something else such as an anal fissure or colorectal cancer. Seeing your physician may be a good idea.
Most hemorrhoid treatments aim to minimize pain and itching. For temporary relief over-the-counter creams, ointments and suppositories can help. You might apply witch hazel, a soothing anti-inflammatory agent, or petroleum jelly or zinc oxide to reduce irritation during bowel movements.
Treatment is fine, but avoidance is always better. There is some agreement that getting enough fibre and staying hydrated help prevent hemorrhoids by helping to prevent constipation. If you are often constipated, consider a fibre supplement.
Anyone who has experienced hemorrhoids can tell you it is not a walk in the park. The itch and pain can be both frustrating and painful. Think of that as you choose fibre for your diet.
Written by Dr. Paul Martiquet, Medical Health Officer for the Sunshine Coast and Powell River.