Treating

Hemorrhoids
Using Non-Surgical Methods
A Common When Hemorrhoids Swell
Hemorrhoid tissues are a network of blood vessels located in and
Problem around the anal canal (the last few inches of the rectum). When
these veins swell, you can have symptoms such as:
If you have hemorrhoids, Pain or a burning sensation
youre not alone. Theyre a Bleeding during bowel movements
very common problem. In Protrusion of tissue from the anus
fact, hemorrhoid tissues
Itching around the anus
are a natural part of the body.
Most of the time you dont
notice them as they help What Causes Hemorrhoids?
during bowel movements. Theres no single cause of hemorrhoids. Most often, though, they are
But if these tissues become caused by too much pressure on the anal canal. This can be due to:
swollen or inflamed, they Chronic (ongoing) constipation
can cause uncomfortable Straining during bowel movements
symptoms. The good news
Diarrhea
is that hemorrhoids can be
treated so you feel better. Pregnancy and childbirth
Sitting too long on the toilet
Strenuous exercise or heavy lifting
Aging

Constipation caused by
a low-fiber diet can
lead to hemorrhoids.

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What You Can Do
Hemorrhoids arent life-threatening. But the symptoms they cause are
hard to ignore. Fortunately, there are many treatments that can provide
relief right away. Most of these treatments do not involve surgery. You
can also learn simple ways to help keep hemorrhoids from returning.

Evaluation Treatment Prevention

The first step to feeling better is Your treatment will depend on Treatment and prevention go hand
seeing your healthcare provider the severity of your symptoms. For in hand. Thats because measures
for an evaluation. Youll be asked many people, a change in diet and such as eating a high-fiber diet do
questions about your symptoms bowel habits are enough to relieve more than just ease constipation.
and health. Youll also be exam- the problem. In other cases, the They also help prevent hemorrhoids
ined. You may have some tests to hemorrhoids may need to be from coming back. Having good
make sure your symptoms arent removed. Your healthcare provider bowel habits and getting more
caused by other problems. can explain these options. exercise will also help.

Table of Contents
Understanding Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Your Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Self-Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Removing Hemorrhoids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
After Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Preventing Future Problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

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Understanding Normal Hemorrhoid
Tissue
Hemorrhoids Hemorrhoid tissues play an
important role in helping your
Hemorrhoid tissues are body eliminate waste. Food
cushions of blood vessels passes from the stomach through
that swell slightly during bowel the intestines.The waste (stool)
movements. Too much pressure then travels through the colon Colon

on the anal canal can make to the rectum. It is stored in the

rectum until its ready to be Small
these tissues remain enlarged passed from the anus. During intestine
and cause symptoms. This can bowel movements, hemorrhoids Rectum
happen to hemorrhoids both swell with blood and become
inside and outside the anal slightly larger. This swelling
canal. To diagnose hemorrhoids, helps protect and cushion the
your doctor will rule out other anal canal as stool passes from
Anus
problems that can cause symp- the body. Once the stool has
passed, the tissues stop swelling
toms similar to hemorrhoids. and return to normal.

Parts of the Anal Canal

The rectum is the

last several inches
of the colon. This is
where stool is stored
prior to bowel
movements.
Internal
hemorrhoid
tissue is in the
Anal sphincters upper area of
are ring-shaped the anal canal.
muscles that expand
and contract to
control the anal
opening.

The anus is the

passage between External hemorrhoid
the rectum and the tissue lies under the
outside of the body. anal skin

4
Problem Hemorrhoids
Pressure due to straining or other factors can cause hemorrhoid tissues to
remain swollen. When this happens to the hemorrhoid tissues in the anal
canal theyre called internal hemorrhoids. Swollen tissues around the
anal opening are called external hemorrhoids. Depending on the location,
your symptoms can differ.

Internal Hemorrhoids
Internal hemorrhoids often occur in clusters
Internal hemorrhoids
around the wall of the anal canal. They are
usually painless. But they may prolapse
(protrude out of the anus) due to straining
or pressure from hard stool. After the bowel
movement is over, they may then reduce
(return inside the body). Internal hemorrhoids
often bleed. They can also discharge mucus.

External Hemorrhoids
External hemorrhoids are located at the anal
opening, just beneath the skin. These tissues
Prolapsed internal
rarely cause problems unless they thrombose hemorrhoid Skin tag External hemorrhoid
(form a blood clot). When this occurs, a hard,
bluish lump may appear. A thrombosed hemor-
rhoid also causes sudden, severe pain. In time,
the clot may go away on its own. This sometimes
leaves a skin tag of tissue stretched by the clot.

Other Anal Problems

Below are common problems that can cause
symptoms similar to hemorrhoids. Your doctor
can explain your treatment options.
A fissure is a small tear or crack in the
lining of the anus. It can be caused by hard
bowel movements, diarrhea, or inflammation
in the rectal area. Fissures can bleed and
cause painful bowel movements.
An abscess is an infected gland in the anal
canal. The infected area swells and often
causes pain.
Fistula (after an
A fistula is a pathway that may form when Abscess Fissure abscess has drained)
an anal abscess drains. The pathway may
remain after the abscess is gone. Fistulas
are not usually painful. But they can cause
drainage where the pathway meets the skin.
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Your Medical History
A medical history helps your doctor learn more about your symptoms
Evaluation and overall health. This often includes questions about your bowel
habits and diet. You may also be asked how often you exercise, and
whether you take any medications. Be sure to mention if any members
To learn more about your of your family have had cancer or polyps of the colon.
symptoms, youll have an
evaluation. This includes a
medical history and exam.
You may also have tests to
help rule out other health
problems. After the evaluation,
your doctor will discuss the
results with you. Together,
you can decide on a treatment
plan thats best for you.

Physical Exam
During a physical exam, youll be asked to lie on an exam table. Youll
then be examined for signs of swollen hemorrhoids and other problems.
The exam takes just a few minutes. It is usually not painful.
A visual exam is used to view the outer anal skin.
A digital rectal exam is used to check for hemorrhoids or other
problems in the anal canal. It is done using a lubricated gloved finger.
Pregnancy and An anoscopic exam is done using a special viewing tube called an
Hemorrhoids anoscope. The scope helps your doctor view the anal canal.
Many women develop
hemorrhoids during
pregnancy and childbirth. Grading Hemorrhoids
This is likely caused by Based on the physical exam, your doctor may assign a grade to internal
pressure on the pelvis and hemorrhoids. The grades are based on the severity of your symptoms.
by hormonal changes. In Grade I hemorrhoids do not protrude from the anus. They may
most cases, the hemor- bleed, but otherwise cause few symptoms.
rhoids will eventually go
away on their own. In the Grade II hemorrhoids protrude from the anus during bowel
meantime, talk with your movements. They reduce back into the anal canal when straining stops.
doctor about ways to help Grade III hemorrhoids protrude on their own or with straining.
relieve your symptoms. They do not reduce by themselves, but can be pushed back into place.
Grade IV hemorrhoids protrude and cannot be reduced at all.
They can also be painful and may require prompt treatment.
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Diagnostic Tests
Diagnostic tests help make sure
your symptoms arent caused by
other problems, such as polyps
or colorectal cancer. These tests
include a fecal occult blood test,
which checks for hidden blood in
the stool. You may also have tests
to take a closer look at your
colon. Some tests are done in
your doctors office. Others are
done in a hospital or radiology
(x-ray) center. After any of these
tests, youll be able to go home
the same day.

Sigmoidoscopy Colonoscopy Barium Enema

Your doctor uses a thin, lighted Your doctor uses a long, thin, A radiologist injects a liquid
tube called a sigmoidoscope to lighted, flexible tube called a barium solution into the colon.
view the rectum and lower colon. colonoscope to view the entire The barium acts as a dye that
This test is done in your doctors colon. This procedure is usually makes the colon easier to see
office. It takes just a few minutes. done in a hospital. Medications on x-rays. This test is done at
help you relax during the test. a hospital or radiology center.

Sigmoidoscope Colonoscope

A sigmoidoscope is used to view A colonoscope is used to view Barium is used to make the colon
the lower colon. the entire colon. appear white on x-rays.

Your Treatment Plan

After your exam and any tests, your doctor will discuss treatment options with you.
In many cases, just making simple changes in your diet and bowel habits are enough
to relieve your hemorrhoids. But if your symptoms are severe, your doctor may
recommend removing a hemorrhoid. Keep in mind, there are many things you can do on
your own to relieve symptoms. Read on to learn more about how self-care can help you.

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Self-Care Relieving Symptoms
When hemorrhoids are swollen and painful, its hard to think about
When it comes to treating anything else. But you dont have to suffer for long. Your doctor may
hemorrhoids, nonsurgical prescribe anti-inflammatory medication to help ease your symptoms.
The following tips will also help relieve pain and swelling.
treatments are often used
first. Follow your doctors Take Sitz Baths
advice about caring for your Taking a sitz bath means sitting in a few inches of warm bath water.
hemorrhoids at home. Some It may sound simple. But soaking for 15 to 20 minutes twice a day can
treatments help relieve provide welcome relief from painful hemorrhoids. It can also help the
symptoms right away. area stay clean.
Others involve making
changes in your diet and
exercise habits. These can
help ease constipation and
prevent hemorrhoids from
coming back.

Develop Good Bowel Habits

Each persons bowel habits are different. So follow your own rhythm.
Use the bathroom when you need to. Dont ignore the urge to go. This
can lead to constipation, hard stools, and straining. Also, dont read
while on the toilet. Sit only as long as needed. Wipe gently with soft,
unscented toilet tissue or baby wipes.

Use Ice Packs

Placing an ice pack on a thrombosed external hemorrhoid can help
relieve pain right away. It will also help reduce the blood clot. Use the
ice for 15 to 20 minutes at a time. Keep a cloth between the ice and
your skin to prevent skin damage.

Use Other Measures

Laxatives and enemas can help ease constipation. But use them
only on your doctors advice. For symptom relief, try using cotton
pads soaked in witch hazel. These are available at most drugstores.
Over-the-counter hemorrhoid ointments and petroleum jelly can
also provide relief.

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Add Fiber to Your Diet
Adding fiber to your diet can help relieve constipation by
making stools softer and easier to pass. To increase your
High-Fiber Foods
High-fiber foods offer many benefits.
fiber intake, your doctor may recommend a bulking By making your stools softer, they
agent, such as psyllium. This is a high-fiber supplement help heal and prevent swollen hem-
available at most grocery and drugstores. Eating more orrhoids. They may also help reduce
fiber-rich foods will also help. There are two types of fiber. the risk of colon and rectal cancer.
Both help keep your bowels healthy: Best of all, theyre usually low in
Insoluble fiber is the main ingredient in bulking calories and taste great. Here are
agents. Its also found in foods such as wheat bran, some examples of fiber-rich foods.
whole-grain breads, fresh fruits, and vegetables. Whole grains, such as wheat
Soluble fiber is found in foods such as oat bran. bran, corn bran, and brown rice.
Although soluble fiber is good for you, it may not ease Vegetables, especially carrots,
constipation as much as foods high in insoluble fiber. broccoli, cabbage, and peas.
Fruits, such as apples, bananas,
raisins, peaches, and pears.
Nuts and legumes, especially
peanuts, lentils, and kidney beans.

Easy Ways to Add Fiber

Its not always easy to change your
diet. But the tips below offer some
simple ways to add more high-fiber
foods to your meals.
Start your day with a high-fiber
breakfast. Eat a wheat bran
Drink More Water cereal along with a sliced banana.
Or, try peanut butter on whole-
Along with a high-fiber diet, drinking more water can
help ease constipation. This is because insoluble fiber wheat toast.
absorbs water, making stools soft and bulky. Be sure to Eat carrot sticks for snacks.
drink plenty of water throughout the day. Drinking fruit Theyre easy to prepare, taste
juices, such as prune juice or apple juice, can also help great, and are low in calories.
prevent constipation. Use whole-grain breads instead
of white bread for sandwiches.
Get More Exercise Eat fruits for treats. Try an apple
Regular exercise aids digestion and helps prevent consti- and some raisins instead of a
pation. Its also great for your health. So talk with your candy bar.
doctor about starting an exercise program. Low-impact
activities, such as swimming or walking, are good places
to start. Take it easy at first. And remember to drink
plenty of water when you exercise.

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Removing Thrombosed External Hemorrhoids
External hemorrhoids are often very painful. Thats because the swol-
Hemorrhoids len hemorrhoid stretches the sensitive skin around it. To relieve the
pain, your doctor may remove the blood clot. This takes just a few min-
utes. You may need to rest for a few days before returning to work.
If your symptoms persist,
your doctor may recommend Numbing the Hemorrhoid
removing the hemorrhoid. Youll be asked to lie or kneel on a table. The hemorrhoid is then
This can be done in your injected with a local anesthetic. This may cause some discomfort
doctors office or at a surgical for a moment. But within a short time your doctor will be able to
center. In most cases, no remove the hemorrhoid without causing pain.
special preparation is needed.
Keep in mind that your treat- Removing the Hemorrhoid
ment may differ depending A small incision is made to remove the blood clot. The hemorrhoid
on your symptoms and the may also be removed. The skin is then either closed with sutures or left
open to heal on its own. The area around the incision will likely be sore
location of the hemorrhoid. for a few days. But your pain should improve soon after the procedure.

Thrombosed Incision
hemorrhoid

Before treatment, a thrombosed external Removing the blood clot helps ease
hemorrhoid causes painful swelling pain. The incision may be closed with
around the anal opening. stitches or left open to heal.

Risks and Complications

The possible risks and complications of the
treatments described on these pages include:
Infection
Bleeding
Trouble urinating
Narrowing of the anal canal (very rare)

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Internal Hemorrhoids
Youll be asked to lie or kneel on a table. Your doctor then inserts an ano-
scope to view the anal canal. To treat the hemorrhoid, your doctor will
use one of the methods listed below. Because internal hemorrhoids do not
have nerves that sense pain, you wont have too much discomfort. You can
often return to your normal routine the same day. If you have many hem-
orrhoids, you may need repeated treatments.

Bands

Banding Infrared Coagulation Sclerotherapy

The banding method is done This procedure is done using Sclerotherapy is done by
by placing tight elastic bands a small probe that exposes the injecting a chemical into the
around the base of the hemor- hemorrhoid to short bursts of tissue around the hemorrhoid.
rhoid. This cuts off blood supply infrared light. This seals off the The chemical causes the
to the hemorrhoid, causing it to blood vessel, causing it to shrink. hemorrhoid to shrink within
fall off. This usually takes about Slight bleeding may occur for a a few days. Bleeding usually
a week. The area then heals few days. The area usually heals stops in about 24 hours.
within a few days. within a week or two.

When to Call Your Doctor

After any of the treatments described on these
pages, call your doctor if you have:
Increasing pain
Fever or chills
Persistent bleeding
Trouble urinating

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After
Treatment
Once youre back at home,
youll need to take it easy for
a few days. To help speed
your recovery, follow all your
doctors advice. This means
taking care of the treated
site and maintaining good
bowel habits. As you feel
better, you can begin return-
ing to your normal routine.
Just keep in mind it may
take a month or two for
complete healing.

Reclining on a soft chair or sofa can help you

feel better after treatment.

Manage Pain
Its normal to have some pain after treatment. To help you feel better,
your doctor may prescribe pain medication. Dont wait for your pain to
get bad. Take the medication on time as directed. Be aware that some pain
medications can cause constipation. So your doctor may also prescribe a
laxative or stool softener. If you have pain or burning after bowel move-
ments, sitz baths can help provide relief.

Avoid Straining on the Toilet

You may be nervous about having a bowel movement after treatment.
But dont ignore the urge to go. This can lead to constipation and
straining on the toilet. For the first few days, you may have minor
bleeding or muscle spasms during bowel movements. You can also
have swelling that feels like unpassed stool or a hemorrhoid. Call
your doctor if youre unable to have a bowel movement within the
first few days after your procedure.

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Preventing
Future
Problems
Once youve been treated for
hemorrhoids, you dont want
them to come back. So take
steps now to prevent future
problems. Keep drinking
plenty of fluids and eating
high-fiber foods. Maintain
good bowel habits. And
exercise as often as you can.
If needed, be sure to see your
doctor for any follow-up visits.

Stay Active
Regular exercise can help prevent con-
stipation. Its also great for your overall
health. So try to be active at least a few
times a week. It doesnt really mat-
ter what you do. Walking, swimming,
tennisthe choice is up to you. For best
results, choose an activity you enjoy. This
makes you more likely to stick with it.
Your doctor can also advise you about an
exercise program to suit your needs.

See Your Doctor

If needed, be sure to see your doctor
for follow-up appointments. These help
ensure youre healing well. You should
also contact your doctor if you have any
new or unusual symptoms. During office
visits, ask your doctor about regular
screening for colon and rectal cancer.
These problems are best treated when
detected early.

13
Feeling
Good Again
Anyone can have trouble
with hemorrhoids. But you
dont have to live with them.
By working with your doctor,
your hemorrhoids can be
treated so you feel good
again. You can also take steps
to prevent symptoms from
coming back. Then it will be
easier to enjoy the little things
in life without worrying about
your hemorrhoids.

This product is not intended as a substitute for professional medical care.

Only your doctor can diagnose and treat a medical problem.
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