source;oids, the natural way.

How I cured Hemorrhoids, the natural way.



I prepared this page because I just went through this ordeal and could not find any helpful information on the internet explaining how to deal with it.
I’m a sporty guy and only 37, so I thought it a bit strange for me to have hemorrhoids at all. But then it occurred to me that it could be due to the fact that, after a long break, I started riding a bicycle again. I was borrowing a cheap bike with a very hard seat, and after riding 30 km or more for many days near to each other, I noticed tons of blood mingling in my stool. So many days in fact that I was seriously thinking of going to the hospital, which I almost never do.

Anyway, after much research and experimentation, I managed to find a solution to my predicament. Therefore, feel free to embark on this journey with me. As everything I do in my life, I prefer to lace it with a sense of humour (almost necessary in hard times like these). However, this could foreseeably lead to rather graphic and gruesome descriptions, so I hope you enjoy, or can stomach it..

So, after noticing a deeply red toilet bowl for more than a week, a pain started developing and I eventually realised I had what I thought I would never have: Hemorrhoids.

True, my translating agency job requires that I sit in front of the computer more than eight hours a day, most of the time of which I am sprawled out on the couch or in some other comfortable position, but I never thought this would happen to me.

Here is how I believe one gets hemorrhoids:

after sitting on your butt for an excessively long period (it is even worse apparently if you sit on hard and cold surfaces), the blood veins in your intestines get constricted and damaged. When you incur any damage to your body, your body naturally sends a lot of blood and healing juices to that area, which results in swelling. However, ironically, this is often the worst thing that can happen because this very swelling ends up constricting the blood vessels in the area, slowing down the healing process. I once took a first aid course and the standard procedure to deal with such cases is to put an icepack on the wound – to reduce the swelling.
In your butt, the situation is aggravated further by the fact that the swelling has nowhere to expand. Therefore, the damaged area results in a sweltering furnace of pain. Because it is difficult to reduce the swelling in such an awkward and confined space, the healing process for this type of damage can be rather lengthy (months?).
There is apparently an inner and an outer type of hemorrhoids. It seemed to me that the swelling led the inner sleeve of the intestine to eventually slip out a bit, sort of hanging out a little and what a friend of mine referred to as “his little cauliflower”.

There are two solutions that I know of how to solve this problem:

1) the standard western medicine approach: a large cone shaped device is placed carefully up your rear end, after which you hear a quick zip sound, like the sound of one of those powerdrills for tightening bolts on car tires, and a chunk of your inner intestines are miraculously sliced out.
Make sure you have a full bag of amphetamines on your way home from the doctor.

2) the old wives tale approach.
Go to a pharmacy, or maybe a forest, and get a bunch of oak bark. Cut into small shavings. Bring to boil about one litre of water per 50 g of shavings. Let your concoction boil for about 3 minutes, then seep for about 30. When your concoction is not so hot anymore, pour it into some plastic or other basin and let cool down until you can bear it (supposed to be applied lukewarm) and

START SOAKING THAT CAULIFLOWER BABY!

The reason this works is because it causes the flesh in the burning inferno compression chamber to compress and become smaller, allowing the blood to flow through it easier and hence help the healing process. I usually soak it for about 25 minutes. I think the best time to do this is sometime shortly before noon, by which time you should have fully released your previous day’s meal. Otherwise, the compressed nature of your inner tubes might compress against any remaining processed food, making matters potentially worse.
To aid in the excrement releasing process, you should eat foods which, when “processed”, remain nice and soft to avoid any sort of constipation or strained release efforts. I was recommended long grain, natural and unpealed rice with lightly cooked vegetables. I also generally like to drink a lot of juice – my favourite being pineapple juice with fibre in it. Fibre in general is good to attain soft stool. Or just eat a lot of green salad.
Now that you have attained the soft stool you are seeking, you can further alleviate the discharge process by your position while doing it. Yes, for millions of years mankind has squatted while relieving themselves, but somehow over the past century or something we have invented, as usual, something not reflecting our evolution. What I do (and what I adopt consistently when using public facilities, as well as all the time now that I have discovered it) is to squat on the toilet, my bare feet positioned on each side of the seat and my arms resting on my knees. A comfortable enough position but even more comfortable with regards to the effortless and smooth release. (However, in this position and because of the gaping open basin, a few courtesy flushes may be in order!)

This seems to work the best of all approaches I've tried, although it may take a few hours to make noticeable effect, and until the next day when it will make a great difference.
You can combine this with various creams if you like. Save a trip to the doctor and just go to a good pharmacy and tell them your problem. I'm sure they will prescribe the same thing your doctor will. And you can include some good anti-inflammatory with that, which you should take in the morning and evening after a hearty meal, to avoid a stomach ulcer. Wheat germ oil (helps with digestion - consume) is supposed to help, but I haven't tried that. I also found oak bark oil with chamomile (apply to area - external use), which seemed to help.

At night you should lie on your stomach. If after all your efforts you still feel pain and have difficulty falling asleep, I found that assuming the ostrich position, with my head buried in my pillow and butt in the cold air, had the most immediate effect. Try putting an icecube there or cooling it down in some way, such as with a cold shower on the spot, as the cold is the quickest way to reduce the swelling, avoid the pain, and start a proper healing process. Spread your butt cheeks to help the inner part cool down too, and I found twisting around the waste and other similar movements helped shift the intestines inside to help them get in a better position.

If you are having constipation problems and can't get rid of your stool so well (holding onto handlebars and squeezing until your eyes almost pop out is not good because you are only increasing pressure in the area), you can try an intestinal flush with sea or ocean water. Between one and three pints can do the trick well. If you are not near the ocean, make your own but make sure to use sea salt and not regular iodized table salt, otherwise it wont work. Bring to taste like the ocean. That shoots right through your whole system and will nicely clean out your guts. Try to drink within 5 minutes and then hang around the toilet for about half an hour or more, because you might not get much warning. You can lie on your back and move your legs a bit to help get it through your system.


This all is the quickest fix. You want to do something like this as soon as possible, because if you let the swelling stay there too long, you could create an extra permanent piece of flesh which will only hassle you for the years to come. I've held out for 5 years and decided I've had enough, so will finally go for option 1 above. It took me a while to find some natural means, so perhaps I let the inflammation stay too long and now it is too late.
If you have developed a permanent internal inflammation and you find you are now having problems releasing your stool (it doesn't come out so easy, and is followed by an extended trickle of see-through liquid - your body's solution to continued swelling), it is better to remove it, because it is more important you properly release any waste from your body. Your body constantly processes toxins and gets rid of them in various ways, but if your intestines are clogged in some way, the toxins will seep back into your bloodstream and you are only damaging yourself. Avoiding a lot of pork and beef is advisable for this, as pork tends to line your intestinal walls and beef block it. Your body is like a machine, and you want to help it remove stuff that doesn't belong there.











During your period of pain, there are things we might want to avoid. One of my friends’ doctor referred to it as the four Cs:

* Coffee (I guess it is an abrasive substance and scratches the sensitive and damaged areas)
* Ketchup (sounds like C but anything with tomatoes in it is supposed to be bad)
* Cheese (probably promotes constipation)
* Chili (anything which contributes to the burning rim of fire – something we might be able to handle better under normal circumstances)


And, while we’re at it, Couch! Yes, get OFF yer butts (that's something I almost always do as part of the translating agency agency I run)! I put my computer on a chair on my table and basically stood while working for a month. Or sit on your side somehow. Or get a little rubber dingy thing (like an inner tube for a car tire) for children to sit on to help you spread you butt cheeks and not apply pressure to the area.

Speaking of spreading your butt cheeks, it is generally good to keep the area cool, so if you don’t mind sitting naked on the rubber dingy while at work…

Also, after you’ve relieved yourself, you may find that you have inadvertently pushed out the inner lining of your swollen intestines, hence producing the unwanted cauliflower. Such a situation could prove painful when, for example, walking, seeing that the poor little cauliflower is sandwiched between your moving butt cheeks. So I found it a good idea to pull my protruding intestine back where it belongs. After you finish your big duty, you can achieve this by spreading your butt cheeks with your hands while in a semi squat standing position, move your hips from side to side, or up and down, and contract your pooppush muscles to pull that baby back in there.
My friend also said that squats in the weight room are generally good for strengthening those muscles.
So, your cauliflower reducing routine may look as follows:
sit if your little tub of warm to hot oak bark mixture. It should be a fresh batch every time and freshly heated, but not boiled or overheated. Sit in that for the full 25 minutes, if possible. Get up a bit and let your bum drip dry a bit (the mixture apparently makes a stain which could be quite difficult to remove), run to the shower, shower off, blast your butt hole with freezing cold water for as long as you can endure it, perhaps do squats at the same time, but make veeeeery sure none of your friends are catching any of this on film.

source:pws.prserv.net

Hemorrhoids Symptoms, Hemorrhoids Signs, and Hemorrhoids Diagnosis

Hemorrhoids can present no symptoms of disease but may cause bleeding, protrusion, and pain. Rectal bleeding should be attributed to hemorrhoids only after more serious conditions are excluded. Hemorrhoidal bleeding, which typically follows defecation and is noted on toilet tissue, rarely leads to anemia or severe hemorrhage. External and internal hemorrhoids can protrude; they may regress spontaneously or be reduced manually. Only the formation or presence of a blood clot within a blood vessel or ulcerated hemorrhoids are painful.

The formation or presence of a blood clot within a blood vessel appears as protruding tissues surrounding the anus. These protrusions can vary with pain from nonexistent to severe.

Hemorrhoids which are ulcerated, and swollen with edema, or strangulated hemorrhoids, “acute attack of piles” can cause severe pain. Less commonly, internal hemorrhoids cause mucus discharge and a sensation of incomplete evacuation, and external hemorrhoids cause difficulty in cleansing the anal region.

localized or generalized itching due to irritation of sensory nerve endings from organic or originating in the mind or in mental or emotional conflict causes is usually not a symptom of hemorrhoids.

Blood clots within an anal blood vessel and ulcerated swollen strangulated hemorrhoids can be readily diagnosed on inspection of the rectum. Examination after straining at stool or a phosphate enema often reveals the extent of a person’s hemorrhoidal condition. Anoscopy is essential in evaluating painless hemorrhoids.
Hemorrhoid Treatment

Stool softeners or bulking agents (eg, psyllium) may correct constipation and straining, thus allowing hemorrhoids to resolve. Pain caused by a thrombosed hemorrhoid can be treated with reassurance, warm sitz baths, anesthetic ointments, or witch hazel compresses.

Bleeding hemorrhoids can be treated by injection sclerotherapy (the injection of a sclerosing (condition in which a tissue has become hard also called also hardening) agent into a vericose vein or spider veins to create fibrosis which closes the lumen) with 5% phenol in vegetable oil. Bleeding should cease at least temporarily.

source:www.edris.com

A Comprehensive Guide to Hemorrhoids

Hemorrhoids is a common rectal/bowel disorder that as many as half of the people in the United States and other industrialized nations may suffer from. The itching or painful mass of dilated veins in swollen anal tissue is a hemorrhoid. When bulging hemorrhoidal veins are irritated, they often cause surrounding membranes to swell. The swelling may lead to pain, burn, and itchiness of the area.

Did you know? (some quick statistics and facts)

* Hemorrhoids was the most commonly reported digestive disorder in 2003.
* About 23 million adults in America had hemorrhoids (12.8 percent of the noninstitutionalized population).
* Of those who ever report having hemorrhoids, only 21 percent ever had hemorrhoids surgery.

(based off of studies in the 1990s, Advance Data From Vital and Health Statistics; No. 212)

Who is at risk for hemorrhoids?

Hemorrhoids is a common rectal/bowel disorder that as many as half of the people in the United States and other industrialized nations may suffer from at one point in their life.

If any of the following statements are true, you may be at risk of getting hemorrhoids:
· You do not have a balanced diet with sufficient roughage like bran and raw vegetables
· You "eat and run" as your breakfast routine
· You frequently feel constipated
· You postpone going to the bathroom for a more convenient time
· Going "regularly" is a problem
· You need to take laxatives often

source:www.hemorrhoids-advice.com

Hemorrhoid Misery

Whether you're a young mother, a truck driver, or senior citizen you've probably had an experience with hemorrhoids. Hemorrhoids are a very common health problem for millions of Americans. The itching and burning of hemorrhoids have lead to a billion dollar business from salves to various homeopathic treatments.

What are hemorrhoids?

Hemorrhoid, or piles, is a painful mass of swollen veins in the lining of the anus and rectum, resulting from the formation of varicose veins around the anus.

Hemorrhoids can occur at any age, often without apparent cause. Causes may include constipation, pregnancy, liver disorders, rectal tumors, and the repeated use of laxatives. Hemorrhoids can cause itching and burning and may bleed during a bowel movement.

Hemorrhoids do not cause cancer nor do they become cancerous. But any rectal bleeding may be a sign of cancer of the colon or rectum and should be checked by a physician.

What can I do about hemorrhoids?

* Temporary relief
from hemorrhoids may be obtained by applying a cold compress directly to the affected area until the pain subsides. This is most asily done if the patient lies face-down and another person applies the compress.
* Tepid water baths
may also help.
* High-roughage diet
A person should eat a high-roughage diet to ensure regular defecation of large, soft stools.
* Ointments, creams, and suppositories
containing corticosteroids may also ease the symptoms.
* Stress can also make hemorrhoids flare up.
Foods that can cause you trouble include strong spices such as red pepper and mustard, and drinks such as coffee, decaffeinated coffee and alcohol. Tobacco can also cause flare ups.
* You can treat constipation by eating more fiber.
A vegetarian diet will help you here. Or take psyllium seed husks, in any of the forms available in drugstores and health-food stores. Drink lots of water -- 8 glasses of day works well.
* Sitz Bath
A natural, soothing treatment for the hemorrhoids themselves is an old-fashioned sitz bath. Sit in a bathtub filled with enough warm water to cover the anal area for 15 minutes several times a day. Also, apply aloe vera gel to the area frequently. Instead of dry toilet paper, which will irritate the veins, use compresses or cotton balls of witch hazel to clean the anal area after bowel movements. You can buy witch hazel at any drugstore. Just moisten sheets of toilet paper with it. There are also premoistened, prepackaged versions available. You also might find relief by placing a a small folded square of dry toilet paper in the anus area. Change this everytime you go to the bathroom to keep the area dry. It's the moisture that causes the itching.
* Natural Remedies
Finally, here are two Chinese remedies that use foods to correct the imbalances that may cause hemorrhoids: Eat an orange three times a day, or eat two bananas first thing in the morning.

See your doctor
All cases of rectal bleeding should be examined by a physician to rule out cancer of the colon and rectum. If the diagnosis is hemorrhoids, the remedies mentioned above may solve the problem. However, persistent hemorrhoids may need to be removed, using one of several methods. The hemorrhoid may be frozen off during cryosurgery; hardened, using a sclerosing agent; tied off, using a rubber band at the base of the hemorrhoid; or removed surgically (hemorrhoidectomy).

Ovarian Cancer Facts
Signs & Symptoms of Ovarian Cancer
by Sue Spataro, RN, BSN
click here to find out more about Sueosp100logo.jpg (5457 bytes)Ovarian cancer is our most deadliest gynecologic cancer. It ranks number 4 in the cause of cancer deaths in women. Most of us have a less that 2% lifetime chance of developing ovarian cancer. But, every year over 25,000 women are diagnosed with ovarian cancer. But once diagnosed with ovarian cancer 75% of women will die within 5 years of their diagnosis.

source:www.families-first.com

Hemorrhoids are abnormally swollen veins in the rectum and anus

Hemorrhoids are abnormally swollen veins in the rectum and anus. They are much like varicose veins you might see on a person's legs. When bulging hemorrhoidal veins are irritated, they cause surrounding membranes to swell, burn, itch, become very painful, and bleed. Hemorrhoids are caused by too much pressure in the rectum, forcing blood to stretch and bulge the walls of the veins, sometimes rupturing them. Listed below are the most frequent causes of hemorrhoids:

* Constant sitting
* Straining with bowel movements (from constipation or hard stools)
* Diarrhea
* Sitting on the toilet for a long time
* Severe coughing
* Childbirth
* Heavy Lifting

There are two kinds of hemorrhoids: internal and external (see diagram).

* Internal hemorrhoids usually don't hurt or itch; you can't feel them because they are deep inside the rectum. Internal hemorrhoids are pretty harmless. But since their bleeding could mask blood from a dangerous source like colorectal cancer, they should be treated.
* External hemorrhoids cause most of the symptoms we commonly hear about --- pain, burning, and itching. If an external hemorrhoid becomes strangulated (cut off from blood supply), a clot can form in it and become an excruciatingly painful thrombosed hemoroid. Because of these unpleasant symptoms, external hemorrhoids get the most treatment attention.

Once the rectal veins have been stretched out and hemorrhoids created, they are difficult to get rid of completely and tend to recur with less straining than it took to cause them in the first place. Fortunately, good habits and simple medical treatment usually control hemorrhoids well, and surgery is only recommended in unusually severe cases.

Avoiding the causes listed in Basics will prevent most cases of hemorrhoids, but this advice is sometimes hard to follow. For example, how can you avoid sitting all day if you have a seated job? And most of us would like to avoid coughing, diarrhea, and childbirth, but that's pretty much impossible, isn't it? Here are some practical hints to help:

* If your main job activity is seated, always stand or walk during your breaks. Make it a point to stand and walk at least 5 minutes every hour and try to shift frequently in your chair to avoid direct rectal pressure.
* Always exhale as you strain or lift. Don't hold your breath.
* Control coughing, diarrhea and constipation with early treatment since hemorrhoids may soon follow.
* Make a rule: No reading or other relaxing activity while on the toilet. If bowel movements take longer than 3-5 minutes, something is wrong. If you want to keep hemorrhoids away, maintaining good bowel habits and softer stools should be your highest priority (see Treatment section).

If these preventive measures fail, you must take action right away! Hemorrhoids are one condition that can be mild in the morning and become intolerable by nightfall.

You must first find the cause of your hemorrhoids and stop it. Treating the hemorrhoids themselves is pointless if you keep re-creating them. Click here to review the causes listed in Basics. You should also read the Self Care Advisory section on constipation, since it's probably the major cause of hemorrhoids.

Once you have eliminated factors causing your hemorrhoids, it's time to treat them. There are two treatment goals: first, take away the symptoms (burning, pain, itching) and second, shrink the hemorrhoids.

* Sitz baths (soaking the rectal area in hot water, in a shallow bath) for 15-20 minutes, 3-4 times/day are a simple and effective treatment for both goals.
* Pain medicine should be used for aching, but burning and itching respond best to surface-acting creams and suppositories found in the Recommended Products section.
* To shrink your hemorrhoids back down to normal size, topical medications are again useful.
* Cleanse the entire rectal area with warm water after each bowel movement, and use a bulk fiber laxative to soften stools. This helps eliminate straining with bowel movements.
* Many people use bulk fiber supplements daily to prevent recurrences of hemorrhoids. But remember, bulk fiber may take several days to work. If you have existing hemorrhoids and hard stools are already present, you may want to use an immediate-acting stool softener and laxative to encourage elimination without straining and further aggravating your hemorrhoids.

* Venapro is an interesting new product that we have discovered. It is a natural hemorrhoids treatment that can help reduce flareups and alleviate painful symptoms. Other treatments include:

* Aleve (naproxen sodium 220 mg). Use this quick acting anti-inflammatory for the aching discomfort of severe hemorrhoidal flare ups.

* Anusol HC cream (hydrocortisone 1%). For swollen external hemorrhoids, brands containing hydrocortisone such as this one are effective at reducing the swelling, burning, and itching sensations.

* Anusol HC suppositories (hydrocortisone 1%). These hydrocortisone suppositories should be used for internal swelling and discomfort.

* Citrucel (methycellulose 2 grams/tbs.). Softening stools and treating constipation are crucial aspects of treating your hemorrhoids. Many find this brand of bulk fiber laxative to be less gritty than others, and it comes in both sugared and sugar-free versions.

* Senokot, Senokot S (senna concentrate, various concentrations; docusate sodium 50 mg per tablet is the softener in Senokot S). The active ingredient senna is a bowel contraction stimulant. If you desire stool softening or lubrication along with the stimulant effect, Senakot S is the recommended combination.

Aggressive treatment using the above techniques should improve hemorrhoids within days, but they may need 2-4 weeks of treatment to completely calm down. If they have not resolved to your satisfaction in that time, consult a physician. Other medical problems such as inflammatory bowel disease or bowel infection can cause hemorrhoid-like symptoms. So if the problem does not clear up promptly with basic OTC treatment, see your doctor.

None of the OTC treatment methods listed above will be effective for thrombosed hemorrhoids (click here to review thrombosed hemorrhoids). These clotted hemorrhoids are always very hard, have a smooth black or purple surface, and feel like a growth coming from the anus. They are extremely painful, and a tiny incision made by a physician to remove the clot alleviates pain and bulging immediately. Don't delay seeing your doctor for a thrombosed hemorrhoid. Left alone, they take days or even weeks to go away.

source:www.quickcare.org

Articel Hemorrhoid

Hemorrhoids are common. In the USA, the prevalence is about 4.4%.[1][2] It is estimated that approximately one half of all Americans have had this condition by the age of 50, and that 50% to 85% of the worlds population will be affected by hemorrhoids at some time in their life.[citation needed] However, only a small number seek medical treatment. Annually, only about 500,000 people in the U.S. are medically treated for hemorrhoids, with 10 to 20% of them requiring surgeries.[citation needed]

[edit] Causes

The causes of hemorrhoids include genetic predisposition (weak rectal vein walls and/or valves), straining during bowel movements, and too much pressure on the rectal veins due to poor muscle tone or poor posture. Similarly, sitting for prolonged periods of time can cause hemorrhoids. Hypertension, particularly in the portal vein, can also cause hemorrhoids because of the connections between the portal vein and the vena cava which occur in the rectal wall - known as portocaval anastomoses. Anal sex can also stress the anus, particularly if too little lubricant is used, and lead to hemorrhoids.[3]

Additional factors that can influence the course of hemorrhoids (mostly by increasing rectal vein pressure), especially for those with a genetic predisposition, are obesity and a sedentary lifestyle.

Both constipation and chronic diarrhea, which increase straining during bowel movements, may lead to hemorrhoids. Postponing bowel movements, and fiber-deprived diet both lead to constipation and thus may cause hemorrhoids.

Pregnancy causes hypertension and increases strain during bowel movements, and thus hemorrhoids are often associated with pregnancy.

Excessive consumption of alcohol or caffeine can both cause hemorrhoids. Both can cause diarrhea. Alcohol can also cause Alcoholic liver disease leading to portal hypertension. Caffeine on the other hand can cause general hypertension.
Dehydration can cause a hard stool or chronic constipation which can lead to hemorrhoidal irritation. An excess of lactic acid in the stool, a product of excessive consumption of milk products such as cheese, can cause irritation and a reduction of consumption can bring relief. Vitamin E deficiency is also a common cause.

Food considered "probiotic," such as yogurt with active culture, may help keep the gut functioning normally and thus help prevent flare-ups, as will the consumption of fruit.

[edit] Types of hemorrhoids
Direct view of hemorrhoid seen on sigmoidoscopy
Direct view of hemorrhoid seen on sigmoidoscopy

* (I84.3-I84.5) External hemorrhoids are those that occur outside of the anal verge (the distal end of the anal canal). They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom from external hemorrhoids, is more commonly due to skin irritation.
o (I84.3) External hemorrhoids are prone to thrombosis: if the vein ruptures and a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.[4]
* (I84.0-I84.2) Internal hemorrhoids are those that occur inside the rectum. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated.
* (I84.1) Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids:
o Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside the anus.
o If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.


source:en.wikipedia.org

Hemorrhoids

Hemorrhoids are swollen, inflamed veins around the anus or lower rectum. They are either inside the anus or under the skin around the anus. They often result from straining to have a bowel movement. Other factors include pregnancy, aging and chronic constipation or diarrhea.

Hemorrhoids are very common in both men and women. About half of all people have hemorrhoids by age 50. The most common symptom of hemorrhoids inside the anus is bright red blood covering the stool, on toilet paper or in the toilet bowl. Symptoms usually go away within a few days.

If you have rectal bleeding you should see a doctor. You need to make sure bleeding is not from a more serious condition such as colorectal or anal cancer. Treatment may include warm baths and a cream or other medicine. If you have large hemorrhoids, you may need surgery and other treatments.

National Institute of Diabetes and Digestive and Kidney Diseases

Start Here

* HemorrhoidsFrom the National Institutes of Health(National Institute of Diabetes and Digestive and Kidney Diseases)
* Hemorrhoids: Reducing the Pain and Discomfort(American Academy of Family Physicians)

Also available in Spanish

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Research Reference Shelf For You

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* Women

* Overviews
o Hemorrhoids(Mayo Foundation for Medical Education and Research)
* Diagnosis/Symptoms
o Bleeding in the Digestive TractFrom the National Institutes of Health(National Institute of Diabetes and Digestive and Kidney Diseases)
* Treatment
o Hemorrhoid SurgeryInteractive Tutorial(Patient Education Institute) - Requires Flash Player

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* Related Issues
o Fiber: How to Increase the Amount in Your Diet(American Academy of Family Physicians)

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o Hemorrhoid Surgery(Patient Education Institute) - Requires Flash Player

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o ClinicalTrials.gov: HemorrhoidsFrom the National Institutes of Health(National Institutes of Health)
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* Journal Articles

References and abstracts from MEDLINE/PubMed (National Library of Medicine)
o Article: Advanced grades of bleeding hemorrhoids in a young boy.
o Article: Bleeding after stapled haemorrhoidopexy using the PPH 03 stapler device....
o Article: Maimonides: an early but accurate view on the treatment of...
o Hemorrhoids -- see more articles
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* Medical Encyclopedia
o Hemorrhoids
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o Digestive Diseases DictionaryEasy-to-ReadFrom the National Institutes of Health(National Institute of Diabetes and Digestive and Kidney Diseases)
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o American Gastroenterological Association
o American Society of Colon and Rectal Surgeons
o National Digestive Diseases Information ClearinghouseFrom the National Institutes of Health(National Institute of Diabetes and Digestive and Kidney Diseases)
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* Women
o During Your Pregnancy: Hemorrhoids(March of Dimes Birth Defects Foundation)

Also available in Spanish


source:/www.nlm.nih.gov

Surgical treatment of hemorrhoid disease. A comparison between techniques

BACKGROUND: The past years have seen the development of outpatient treatment and surgical procedures for the treatment of hemorrhoid disease in an attempt to reduce postoperative pain on the one hand and execution and hospitalisation times on the other. METHODS: This retrospective study compares the results obtained in the treatment of hemorrhoid disease using three different METHODS. Three groups of 30 patients were selected from those operated during the past 10 years using Milligan-Morgan s technique (Group A), Parks technique (Group B) and radiosurgery (Group C). All patients were matched for sex (50% males and 50% females), age (ranging between 30 and 50 years old), diagnosis (4th degree hemorrhoids not associated with another proctologic pathology such as anal fissures, fistulas, etc.) and referred symptoms. RESULTS: The results obtained allow a positive evaluation to be made of all three surgical techniques, but indicate submucous hemorrhoidectomy using radiosurgery as the method of choice for the treatment of grade III and IV hemorrhoids. CONCLUSIONS: The excellent results achieved using this approach in the authors opinion amply justify the relatively difficult execution and longer operating times.

source:www.ncbi.nlm.nih.gov

Digestive Disease: Hemorrhoids

Hemorrhoids are varicose (swollen or dilated) veins located inside the anus (internal hemorrhoids) or around the exterior of anus (external hemorrhoids).

It is normal for blood vessels to be located in this region. Doctors are not exactly sure why these veins become enlarged and swollen, but several associations have been made. Hemorrhoids are usually not very painful or critical, but they can be bothersome.
Internal Hemorrhoids

The classic symptom of an internal hemorrhoid is the presence of blood when you go to the bathroom. The blood is found on the stool or toilet paper or in the toilet bowl.

Internal hemorrhoids occasionally extend outside of the anus.

Certain conditions may cause internal hemorrhoids to bulge and/or become irritated and bleed, including the following:

* Trauma during childbirth
* The extra weight of pregnancy
* Obesity
* Chronic (long-lasting) constipation with straining
* Diarrhea
* Anal intercourse

Rarely, a bulging internal hemorrhoid may cause a blood clot to occur.

Hemorrhoids
External Hemorrhoids

External hemorrhoids are varicose veins located on the outside of the anus, under the skin. They are more frequently associated with painful irritation, especially when a blood clot forms within the dilated vein.

Patients with external hemorrhoids may have painful swelling or a hard, painful lump (from a blood clot). If the hemorrhoid is irritated from such things as straining on the toilet or from rubbing or cleaning, the area may itch and bleed.

Hemorrhoids caused by a blood clot (thrombosed hemorrhoids) need to be treated right away by a doctor. The doctor usually will remove the blood clot. Otherwise, most cases of hemorrhoids can be treated at home. On rare occasions, surgery is required to remove hemorrhoids.
What Are the Symptoms of Hemorrhoids?

Symptoms of hemorrhoids include:

* Pain and pressure in the anal canal.
* A grapelike lump on the anus.
* Itching and soreness in and around the anus.
* Blood on underwear, toilet paper, the surface of the stool or in the toilet bowl.

Symptoms can be made worse by straining during constipation and overly aggressive wiping of the anus
What Causes Hemorrhoids?

Hemorrhoids can be caused by the following:

* Straining during a bowel movement.
* Frequent constipation (hard or difficult bowel movements).
* Diarrhea (frequent, loose, watery stool).
* Pregnancy (especially in the third trimester).
* Cirrhosis of the liver (can cause pooling of blood in the vessels around the rectum).

How Are Hemorrhoids Diagnosed?

It's important to describe all of your symptoms to your doctor. On examination, your doctor may be able to see external hemorrhoids and bulging internal hemorrhoids.

When hemorrhoids are not visible beyond the anus, your doctor may examine the inside of the anal canal using a lighted instrument called an anoscope.

In some cases, your doctor will recommend a detailed examination of your lower colon (sigmoidoscopy) or entire colon (colonoscopy) using a lighted scope to ensure that there is no inflammatory disease, such as Crohn's disease or ulcerative colitis or colon cancer.

source:www.webmd.com

Disease - Hemorrhoids

Definition:

Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus.

Alternative Names:

Rectal lump; Piles; Lump in the rectum

Causes And Risk:

This condition is very common, especially during pregnancy and after childbirth. Hemorrhoids result from increased pressure in the veins of the anus. The pressure causes the veins to bulge and expand, making them painful, particularly when you are in a sitting position.

The most common cause is straining during bowel movements. Hemorrhoids may result from constipation, sitting for long periods of time, and anal infections. In some cases they may be caused by other diseases, such as liver cirrhosis.

Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. External hemorrhoids occur at the anal opening and may hang outside the anus.

Prevention:

Avoid straining during bowel movements. You can help prevent hemorrhoids by preventing constipation. Drink plenty of fluids (at least eight glasses per day). Eat a high-fiber diet (fruits, vegetables, whole grains). You may want to consider fiber supplements.

Symptoms:

Symptoms of hemorrhoids include:

* Anal itching
* Anal ache or pain, especially while sitting
* Bright red blood on toilet tissue, stool, or in the toilet bowl
* Pain during bowel movements
* One or more hard tender lumps near the anus

Signs And Tests:

A doctor can often diagnose hemorrhoids simply by examining the rectal area. If necessary, tests that may help diagnose the problem include:

* Stool guaiac (shows the presence of blood)
* Sigmoidoscopy
* Anoscopy

Treatment:

Over-the-counter corticosteroid creams can help reduce the pain and swelling. Hemorrhoid creams with lidocaine (also available over-the-counter) can reduce pain. Witch hazel (applied with cotton swabs) can reduce itching. Other measures to take for anal itching include:

* Wear cotton undergarments
* Avoid toilet tissue with perfumes or colors
* Try not to scratch the area

Sitz baths can help you to feel better -- sit in warm water for 10 to 15 minutes. Stool softeners help reduce straining and constipation.

For cases that don´t respond to home treatments, a doctor may recommend surgery, like rubber band ligation or surgical hemorrhoidectomy. These procedures are generally used for patients with severe pain or bleeding who have not responded to other therapy.

Prognosis:

Most treatments are effective, but to prevent the hemorrhoids from coming back, you will need to maintain a high-fiber diet and drink plenty of fluids.

Complications:

The blood in the enlarged veins may form clots, and the tissue surrounding the hemorrhoids can die. Hemorrhoids with clots generally require surgical removal.

Severe bleeding may also occur. Iron deficiency anemia can result from prolonged loss of blood. Significant bleeding from hemorrhoids is unusual, however.

source:www.drgreene.org

Hemorrhoids

Hemorrhoidal disease is a common entity in the general population and in clinical practice. The most common cause of hematochezia in adults, it remains high in the differential diagnosis of almost any anorectal complaint.

Although hemorrhoids are very common, their true prevalence is unknown. Their presence may be underestimated due to the large proportion of relatively asymptomatic patients. Conversely, many nonspecific anorectal symptoms can be reflexively, and falsely, attributed to hemorrhoids without the appropriate workup.

The presentation of symptomatic hemorrhoids may be acute, chronic, or relapsing.

Pathophysiology: Hemorrhoids are a normal part of the human anorectum and arise from subepithelial connective tissue cushions within the anal canal.

Present in utero, these cushions surround and support distal anastomoses between the superior rectal arteries and the superior, middle, and inferior rectal veins. They also contain a subepithelial smooth muscle layer, contributing to the bulk of the cushions. Normal hemorrhoidal tissue accounts for approximately 15-20% of resting anal pressure and provides important sensory information, enabling the differentiation between solid, liquid, and gas.

Most people contain 3 of these cushions. Although classically described as lying in the right posterior (most common), right anterior, and left lateral positions, this combination is found in only 19% of patients. Hemorrhoids can be found at any position within the rectum.

Hemorrhoids are classified by their anatomic origin within the anal canal and by their position relative to the dentate line.

* Internal hemorrhoids develop above the dentate line from embryonic endoderm. They are covered by the simple columnar epithelium of anal mucosa and lack somatic sensory innervation.

* External hemorrhoids develop from ectoderm and arise distal to the dentate line. They are covered by stratified squamous epithelium and receive somatic sensory innervation from the inferior rectal nerve.

* Mixed hemorrhoids are confluent internal and external hemorrhoids.

Venous drainage of hemorrhoidal tissue mirrors embryologic origin:

* Internal hemorrhoids drain through the superior rectal vein into the portal system.

* External hemorrhoids drain through the inferior rectal vein into the inferior vena cava.

* Rich anastomoses exist between these 2 and the middle rectal vein, connecting the portal and systemic circulations.

Most symptoms arise from enlarged internal hemorrhoids. Abnormal swelling of the anal cushions causes dilatation and engorgement of the arteriovenous plexuses. This leads to stretching of the suspensory muscles and eventual prolapse of rectal tissue through the anal canal. The engorged anal mucosa is easily traumatized, leading to rectal bleeding that is typically bright red due to high blood oxygen content within the arteriovenous anastomoses. Prolapse leads to soiling and mucus discharge (triggering pruritus) and predisposes to incarceration and strangulation.

Most clinicians use the grading system proposed by Banov et al in 1985, which classifies internal hemorrhoids by their degree of prolapse into the anal canal. This system both correlates with symptoms and guides therapeutic approaches.

* Grade I hemorrhoids project into the anal canal and often bleed but do not prolapse.

* Grade II hemorrhoids may protrude beyond the anal verge with straining or defecating but reduce spontaneously when straining ceases.

* Grade III hemorrhoids protrude spontaneously or with straining and require manual reduction.

* Grade IV hemorrhoids chronically prolapse and cannot be reduced. They usually contain both internal and external components and may present with acute thrombosis or strangulation.

Frequency:

* In the US: Prevalence is estimated at 4.4% in the general population.

Race: Patients presenting with hemorrhoidal disease are more frequently white, from higher socioeconomic status, and from rural areas.

Sex: No predilection is known, although men are more likely to seek treatment.

Age: External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years. Symptomatic hemorrhoids also increase in pregnancy, possibly due to direct pressure on the rectal veins.
History: The most common presentation of hemorrhoids is rectal bleeding, pain, pruritus, or prolapse. However, these symptoms are extremely nonspecific and may be seen in a number of anorectal diseases. The physician must therefore rely on a thorough history to help narrow the differential and must perform an adequate physical examination (including anoscopy when indicated) to confirm the diagnosis.

* An adequate history should include the onset and duration of symptoms. In addition to characterizing any pain, bleeding, protrusion or change in bowel habits, special attention should be placed on the patient's coagulation history and immune status.

* Bleeding is the most common presenting symptom. Blood is usually bright red and may drip or squirt into the toilet bowl. The physician should inquire about the quantity, color, and timing of any rectal bleeding. Darker blood or blood mixed with stool should raise suspicion of a more proximal cause of bleeding.

* A patient with a thrombosed external hemorrhoid may present with complaints of an acutely painful mass at the rectum (see Image 1). Pain truly caused by hemorrhoids usually arises only with acute thrombus formation. This pain peaks at 48-72 hours and begins to decline by the fourth day as the thrombus organizes. New-onset anal pain in the absence of a thrombosed hemorrhoid should prompt investigation for an alternate cause, such as an intersphincteric abscess or anal fissure. As many as 20% of patients with hemorrhoids will have concomitant anal fissures.

* The presence, timing, and reducibility of prolapse, when present, will help classify the grade of internal hemorrhoids and guide the therapeutic approach.

o Grade I internal hemorrhoids are usually asymptomatic, but at times may cause minimal bleeding.

o Grades II, III, or IV internal hemorrhoids usually present with painless bleeding but also may present with complaints of a dull aching pain, pruritus, or other symptoms due to prolapse.

* Familial predisposition, diet, history of constipation or diarrhea, and history of prolonged sitting or heavy lifting are also relevant, as are weight loss, abdominal pain, or any change in appetite or bowel habits. Presence of pruritus or any discharge should also be noted.

Physical: In addition to the general physical examination, physicians should also perform visual inspection of the rectum, digital rectal examination, and anoscopy or proctosigmoidoscopy when appropriate.
The preferred position for the digital rectal examination is the left lateral decubitus with the patient's knees flexed toward the chest. Topical anesthetics (eg, 20% benzocaine or 5% lidocaine ointment) may help to reduce any discomfort caused by examination.

* External findings important to note include any of the following:

o Redundant tissue

o Skin tags from old thrombosed external hemorrhoids

o Fissures

o Fistulas

o Signs of infection or abscess formation

o Rectal or hemorrhoidal prolapse, appearing as a bluish, tender perianal mass

* During the digital rectal examination, assess for any masses, tenderness, mucoid discharge or blood, and rectal tone. Internal hemorrhoids are usually not palpable unless thrombosed.

* Current guidelines from most gastrointestinal and surgical societies advocate anoscopy and/or flexible sigmoidoscopy to evaluate any bright-red rectal bleeding. Colonoscopy should be considered in the evaluation of any rectal bleeding that is not typical of hemorrhoids such as in the presence of strong risk factors for colonic malignancy or in the setting of rectal bleeding with a negative anorectal examination.

Causes: Although many patients and clinicians believe that hemorrhoids are caused by chronic constipation, prolonged sitting, and vigorous straining, little evidence to support a causative link exists.

* Other risk factors historically associated with the development of hemorrhoids include the following:

o Pregnancy

o Lack of erect posture

o Familial tendency

o Higher socioeconomic status

o Chronic diarrhea

o Colon malignancy

o Hepatic disease

o Obesity

o Elevated anal resting pressure

o Spinal cord injury

o Loss of rectal muscle tone

o Rectal surgery

o Episiotomy

o Anal intercourse

* Varicosities caused from portal hypertension are a distinct entity from hemorrhoids.

Source:www.emedicine.com

Treatment of Hemorrhoids

Hemorrhoids are normal anatomic features of the human anal canal, forming pads that bulge into the lumen. The anorectal area has a mucosal lining, a framework composed of blood vessels, smooth muscle and supporting tissues, as well as an anchoring connective tissue system that secures the hemorrhoidal tissues to the internal sphincters. This hemorrhoidal system is reported to cushion the anal canal during defecation.l

The anal canal submucosa is discontinuous and composed of three complexes located at the right posterior, right anterior and left lateral anal wall.2-4 These three areas are often referred to as the anal canal cushions. Their distribution is important because the discontinuous arrangement allows the anal canal to distend, when signaled by the pressure receptors, during a bowel movement. In addition, these cushions have a rich vascular system, both arterial and venous.3

The dentate, pectinate or anorectal line is the point where squamous epithelium of the outer anal skin transitions to a mucosal glandular epithelium. This is significant to note because pain fibers generally cease at the dentate line. As a result, hemorrhoidal disorders above the dentate line rarely cause discomfort and those below the line usually cause pain.3,4

Also important to the anatomy of the anorectal area are the encircling muscles. The internal and external sphincters control the passage of fecal material into and out of the anal canal. The involuntary muscle responsible for the control of defecation is the internal sphincter. Feces are passed into the canal via autonomic stimulation. On the other hand, the external sphincter is under voluntary control and remains closed to prohibit the passage of fecal materials out of the rectum.4,5

Hemorrhoidal disease is present when there are alterations to this normal anatomy, causing blood vessels that lie beneath the anal mucosa and perianal skin to dilate. In addition, the muscular and connective tissue supports may become damaged, resulting in the downward displacement of hemorrhoidal cushions. These events then lead to symptomatology and possible complications of hemorrhoids.

Classification of Hemorrhoids

Hemorrhoids are classified by their point of origin: internal, external, and internal-external.

Internal Hemorrhoids: Internal hemorrhoids originate above the pectinate or dentate line in the anal canal and are covered by a mucous membrane. The internal hemorrhoids become symptomatic when the anal lining and connective tissues become loose and weakened and the vascular system becomes engorged. A grading system has been defined for internal hemorrhoids to assist with the selection of a treatment plan. The grade of the hemorrhoid depends on the extent of descent into the anal canal and out of the anus. First degree internal hemorrhoids are enlarged; however, they never prolapse and rarely produce symptomatology. Second degree internal hemorrhoids prolapse with defecation but they return to their original position spontaneously. Neither first nor second degree hemorrhoids can be visualized during an external examination but require the use of a proctoscope. On the other hand, third degree internal hemorrhoids prolapse with each bowel movement and even with physical exertion. These specific hemorrhoids require manual replacement back to their point of origin. Fourth degree internal hemorrhoids are permanently prolapsed despite attempts to reintroduce them to their original position.1-4 They are especially at risk for thrombosis, severe pain and bleeding.

External Hemorrhoids: External hemorrhoids are swollen areas of skin and blood vessels around the anus (below the dentate line).4 They are lined with squamous epithelium that is highly innervated and sensitive.3 These particular hemorrhoids are also at risk for thrombosis.3,4

Internal-External: When internal and external hemorrhoids occur simultaneously, they are referred to as mixed hemorrhoids.3,4

Epidemiology/Etiology

Hemorrhoidal disease is a common disorder of the anorectal area. It has been estimated that hemorrhoids affect over 10 million individuals in the United States.l,4 Reports suggest that one-half of all Americans over the age of 50 have suffered from hemor-rhoids.4-6 The exact cause of hemorrhoids has not been determined. However, several factors appear to contribute to their etiology. Patients with a low dietary fiber intake may be at risk for developing hemorrhoids.1,4,5 Typically, these patients’ stool is hard with very little bulk or moisture, thereby increasing the risk of straining during a bowel movement. This results in elevated pressure in the rectal vascular system which could lead to hemorrhoidal disorders.5

Pregnancy is another factor linked to hemorrhoids. Due to the in utero placement of the fetus, pregnant women have increased pressure in the anorectal area which may result in internal hemorrhoids.l,4,5 In addition, labor may aggravate the condition, prolonging symptoms after the birth process.4

Another population at risk for hemorrhoids are those individuals whose occupations require heavy lifting or prolonged standing.2,5 Heavy lifting may put additional strain on both the muscles and venous system in the anorectal area, making hemorrhoidal development a possibility. Prolonged standing may cause blood to pool in the rectal vascular system, especially since there are no venous valves in this area, thus predisposing workers to hemorrhoidal problems.

Decreased physical activity may also contribute to hemorrhoidal development.5 Less active individuals may experience a decline in muscle tone of the anorectal area, thereby making the patient prone to weak hemorrhoidal cushions. Other patients at risk for the development of hemorrhoids are those who overuse stimulant laxatives. These individuals are at risk of chronically straining the anal sphincters during defecation, which may result in symptomatology.5

Finally, there may be a genetic link toward the development of hemorrhoids.2-4 However, whether this trend is due to a familial trait (e.g., weak blood vessels) or to similar environmental factors (e.g., dietary habits) is unclear.

Signs and Symptoms

Signs and symptoms of hemorrhoidal disease are the result of vascular congestion that occurs when veins become engorged secondary to obstructed blood flow. In addition, collagen and elastin that support the anorectal region weaken, causing hemorrhoidal cushions to lose their support and become displaced.

Bleeding: One of the most common symptoms of hemorrhoids is bleeding from the rectal area before, during and after defecation. The anal mucosa becomes eroded, releasing a bright red blood usually evident to the patient via blood-tinted toilet bowl water, stool or toilet tissue. The blood may result from external or internal hemorrhoids.1,2,4

Itching: Itching may result secondary to mild inflammation usually associated with prolapsed internal hemorrhoids that secrete a mucous discharge. Further irritation and itching can occur when dyes and perfumes in fabrics and toilet tissue come into contact with the already sensitive area.4

Inflammation and Swelling: Inflammation and swelling may result from trauma imposed on the anorectal area due to engorged hemorrhoidal tissues. Inflamed tissues may cause pain, especially to a patient with external hemorrhoids. Standing for prolonged periods of time or defecation may intensify the pain. As expected, those with uncomplicated internal hemorrhoids should not feel pain secondary to an absence of pain receptors above the dentate line.4

Seepage: Seepage of fecal matter or mucus may occur if persistent swelling or inflammation in the anorectal area prevents the anal sphincter from closing properly.4

Protrusion and Prolapse: A frequent sign of uncomplicated internal or external hemorrhoids is protrusion, a projection of tissue outside the anal canal. The protrusion may be evident following a bowel movement, prolonged standing or physical exertion. Unless the protrusion becomes thrombosed, infected, or ulcerated, it is painless. A prolapsed hemorrhoid is an internal hemorrhoid that protrudes beyond the dentate line and is seen at the anal orifice.4

Thrombosis: When hemorrhoids remain persistently prolapsed, patients are at risk for thrombosis. This is a lump or clot that may cause severe pain in the rectal area for approximately a week.2,4 The lump does slowly disappear; however, a skin tag remains evident. If, by chance, the thrombosed hemorrhoid does not heal, then gangrene as well as ulceration may ensue, leading to further complications of the anorectal area.4

Assessment

Pharmacists should question patients about the nature of their signs and symptoms to determine whether self-treatment is an option or whether a visit to the physician is best. Mild hemorrhoidal symptoms may be relieved by self-medication; therefore, the pharmacist should be able to assist the patient with proper drug selection based on the reported symptoms.4,5 No medications cure hemorrhoids; however, products are available to ease patients’ discomfort. The goal of self-medication is to ease those symptoms described by the FDA as burning, discomfort, inflammation, irritation, itching, pain, soreness and swelling.5 Pharmacists may also educate the patient about the causes of hemorrhoids and recommend ways to alter their lifestyle in order to prevent future hemorrhoidal problems.

Advanced cases of hemorrhoidal disease with more severe symptoms (e.g., seepage, protrusion, prolapse, thrombosis, abdominal discomfort, persistent bleeding, pain, and itching) may indicate potentially serious medical conditions for which self-treatment is not adequate or advisable. Patients with severe symptoms should see a health care provider for a thorough examination.4

Treatment

Hemorrhoids that respond to self-treatment are usually mild and self-limiting and should heal without medication. There are numerous nonpharmacological ways to manage hemorrhoids. All patients are encouraged to sit in warm water or sitz baths for 15 minutes, three to four times a day, and to cleanse the anorectal area with mild, unscented soap and water after bowel movements to decrease symptoms.4,6 Serious cases of hemorrhoids (third and fourth degree) may require hemorrhoidectomy, rubber band ligation, sclerotherapy, infrared photocoagulation, cryotherapy, bipolar diathermy or laser therapy.

The most important aspect of hemorrhoid management is prevention. The following measures not only will help prevent hemorrhoids but may also cause shrinking of less severe cases:

* Avoid constipation by not postponing the urge to defecate;
* Eat a balanced, high-fiber diet;
* Drink plenty of water, fluids;
* Exercise; and
* Avoid excessive pressure and straining during defecation.6,7

Other advice for the patient may be found in TABLE 1. There are a variety of over-the-counter (OTC) pharmacologic agents for symptomatic management of hemorrhoids including vasoconstrictors, astringents, protectants, local anesthetics, keratolytics, hydrocortisone and antipruritics (TABLE 2). Most hemorrhoidal symptoms should resolve within seven days of treatment with the available products.5,8 If symptoms do not resolve, a physician should be consulted due to the threat of other, more serious, anorectal conditions.


The FDA has divided these products into those that can be inserted intrarectally for internal hemorrhoids and those intended for external use only. Astringents, protectants and vasoconstrictors can be used for internal hemorrhoids. No ingredients are approved by the FDA for intrarectal use to alleviate pain, soreness or burning.5,8

Astringents: Astringents coagulate the proteins in surface skin cells, which results in decreased cellular volume and a leaves a thin layer protecting underlying tissue. In addition, these agents decrease mucous and other secretions in order to decrease inflammation and irritation of the area.4-6,8 Astringents also provide relief of burning and itching but not of pain.4,5,8 Calamine and zinc oxide (in concentrations of 5%–25%) are recommended for both internal and external use up to six times a day, whereas witch hazel, also known as hamamelis water (concentration of 10%–50%), is recommended for external use, providing temporary relief of itching, discomfort, irritation and burning.4

Protectants: Protectants form a physical barrier over the skin and mucous membranes, thereby decreasing inflammation and preventing water loss from the stratum corneum.4-6,8 When protectants such as absorbents, adsorbents, demulcents and emollients are included in an OTC formulation, they should make up at least 50% of the dosage unit.4,6 Recommended protectants include: aluminum hydroxide gel, cocoa butter, glycerin in aqueous solution, hard fat, kaolin, lanolin, mineral oil, white petrolatum, petrolatum and topical starch.4 All of these are approved for intrarectal and external use with the exception of glycerin, which is reserved for external use only.4 Calamine, zinc oxide, cod liver oil and shark liver oil are recommended only when combined with one to three other protectants listed above. Side effects are minimal but may include hypersensitivities.4,6

Vasoconstrictors: Vasoconstrictors stimulate the alpha-adrenergic receptors in the vasculature and promote constriction of the blood vessels.4-6,8 One sequela of hemorrhoids is the pooling of blood in dilated veins. The vasoconstrictors may be used to reduce swelling of these engorged blood vessels.4,5,8 Vasoconstrictors relieve itching, discomfort and irritation due to a slight anesthetic effect.4-6,8 These products, ephedrine sulfate and phenylephrine hydrochloride, are chemically similar to naturally occurring catecholamines (i.e., epinephrine and norepinephrine). Serious adverse effects of vasoconstrictors include elevation of blood pressure, cardiac arrhythmias, nervousness, tremor, insomnia, and aggravation of symptoms of hyperthyroidism.4,8 Vasoconstrictors should be avoided in patients with diabetes, hyperthyroidism and hypertension, as well as patients who experience difficulty urinating due to enlarged prostate or those patients taking monoamine oxidase inhibitors or tricyclic antidepressants.4

Local anesthetics: Anesthetics relieve the sensations of pain, burning, itching, discomfort and irritation by reversibly blocking nerve conduction.4-6,8 These products should be used externally on the perianal area due to the sensory nerve endings saturated in this area.4-6,8 If absorbed by the rectal mucosa, potential toxic effects can occur systemically. Allergic reactions can also occur, including burning and itching, which can aggravate the already inflamed tissues.4,6 Active ingredients often found in local anesthetics include benzocaine, benzyl alcohol, dibucaine, cyclonine, lidocaine, pramoxine and tetracaine.4

Keratolytics: Keratolytics cause desquamation and sloughing of the epidermal surface of cells in the perianal area.4-6,8 This turnover and debridement of the epidermis allows exposure of inflamed tissues to therapeutic agents.4,6 Keratolytics are also useful in reducing itching and discomfort.4 Keratolytics, aluminum chlorhydroxy allantoinate (alcloxa) and resorcinol are for use in external hemorrhoids only.4,5,8 Pharmacists must warn against using products containing resorcinol near open wounds around the perianal area.4

Antipruritics: Formerly classified as counterirritants, antipruritics have now been redesignated by the FDA as "analgesics, anesthetics, and antipruritics."4-6,8 These products stimulate the cold receptors and depress cutaneous sensory receptors in the perianal area, resulting in sensations that distract from the annoying symptoms of hemorrhoids.4-6,8 Analgesics, anesthetics, and antipruritics include menthol, juniper tar, and camphor; however, menthol, camphor and turpentine oil are not considered safe or effective.4

Hydrocortisone: Hydrocortisone is safe and effective for relief of anorectal itching and swelling; however, OTC products containing hydrocortisone are not recommended by the FDA for anorectal use.4-6,8 Anorectal products containing hydrocortisone must be obtained by prescription. Hydrocortisone has anti-inflammatory, lysosomal membrane stabilization, antimitotic and vasoconstrictive properties that may be beneficial in relieving hemorrhoids.4,5,8 Like other ingredients, hydrocortisone can cause local irritation and allergic reactions that would interfere with the healing of perianal tissue.5

Live yeast cell derivative (LYCD): This has recently been removed from the list of safe and effective active ingredients and is prohibited in OTC hemorrhoidal products such as Preparation H and Wyanoids.4-6,8,9 The manufacturers of LYCD claimed that it effectively promoted wound healing and tissue repair in the anorectal area, resolving symptoms such as pain, itching, burning, swelling, and irritation.4,5,8,9

Dosage Forms

There are a variety of dosage forms for the treatment of hemorrhoids. For internal use, suppositories, creams, ointments, gels and foams are available. Some have applicators and pile pipes while others require manual insertion.4,6 Products approved for external use include creams, ointments, gels, pastes, wipes, liquids, pads, and foams.4

Topical ointments, creams and gels should be applied as a thin covering to the perianal area, and some of these products have rectal pipes or applicators to allow intrarectal administration.4,6 Caution should be used with these devices so the inflamed tissues receive no further trauma.4 Foams have no significant advantages over ointments, creams, and gels except for their rapid onset of action.4 However, these may be more difficult to apply and sometimes demonstrate erratic absorption depending on the concentration of the bubbles.4 Suppositories may decrease the straining associated with defecation; however, they are not considered the ideal dosage form since they can be inserted too deeply.4-6

Product Selection

Pharmacists play an important role in assisting patients in selecting a nonprescription product for the treatment of hemorrhoidal symptoms. Prior to recommending any OTC product, pharmacists must determine the type of hemorrhoid from which the patient suffers. Nonprescription products containing a vasoconstrictor, astringent or protectant are the only FDA-approved agents for treating internal hemorrhoids. For external hemorrhoids, the symptoms that the patient describes dictate the appropriate OTC therapy.4,6

Products containing vasoconstrictors should not be recommended for a patient who has a diagnosis of diabetes, hypertension, hyperthyroidism, difficulty in urinating or is taking a prescribed drug for depression, especially a monoamine oxidase inhibitor or a tricyclic antidepressant. Additional precautions for products containing local anesthetics are that certain individuals may be allergic or hypersensitive to the ingredients. If swelling, irritation, redness, pain or other symptoms develop or increase, the patient must notify his/her physician. Also, the patient should contact a physician if seepage, bleeding, protrusion or severe pain occurs. If the symptoms have worsened or not improved after seven days of hemorrhoidal self-treatment, the patient should consult the physician.4,6

Conclusion

Symptomatic hemorrhoids can be self-treated by nonpharmacological methods including avoidance of chronic constipation and straining during defecation. Also, bulk-forming laxatives or stool softeners may provide relief of hemorrhoidal symptoms. Sitz baths or sitting in warm water for 15 minutes at a time, increasing fiber in the diet, drinking plenty of fluids, and exercising are all recommended. OTC products may also be suggested to relieve symptoms. It is imperative that only FDA-approved hemorrhoidal products be recommended. However, the pharmacist must elicit a detailed patient history prior to recommending a product.


source:www.uspharmacist.com

Hemorrhoids

What are hemorrhoids?

A precise definition of hemorrhoids does not exist, but they can be described as masses or clumps (“cushions”) of tissue within the anal canal that contain blood vessels and their surrounding, supporting tissue made up of muscle and elastic fibers. The anal canal is the last four centimeters through which stool passes as it goes from the rectum to the outside world. The anus is the opening of the anal canal to the outside world.

Although most people think hemorrhoids are abnormal, they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems and be considered abnormal or a disease.

Prevalence of hemorrhoids

Although hemorrhoids occur in everyone, they become large and cause problems in only 4 percent of the general population. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.

Anatomy of hemorrhoids

The arteries supplying blood to the anal canal descend into the canal from the rectum above and form a rich network of arteries that communicate with each other around the anal canal. Because of this rich network of arteries, hemorrhoidal blood vessels have a ready supply of arterial blood. This explains why bleeding from hemorrhoids is bright red (arterial blood) rather than dark red (venous blood), and why bleeding from hemorrhoids occasionally can be severe. The blood vessels that supply the hemorrhoidal vessels pass through the supporting tissue of the hemorrhoidal cushions.

The anal veins drain blood away from the anal canal and the hemorrhoids. These veins drain in two directions. The first direction is upwards into the rectum, and the second is downwards beneath the skin surrounding the anus. The dentate line is a line within the anal canal that denotes the transition from anal skin (anoderm) to the lining of the rectum.

Formation of hemorrhoids

If the hemorrhoid originates at the top (rectal side) of the anal canal, it is referred to as an internal hemorrhoid. If it originates at the lower end of the anal canal near the anus, it is referred to as an external hemorrhoid. Technically, the differentiation between internal and external hemorrhoids is made on the basis of whether the hemorrhoid originates above or below the dentate line (internal and external, respectively).

As discussed previously, hemorrhoidal cushions in the upper anal canal are made up of blood vessels and their supporting tissues. There usually are three major hemorrhoidal cushions oriented right posterior, right anterior, and left lateral. During the formation of enlarged internal hemorrhoids, the vessels of the anal cushions swell and the supporting tissues increase in size. The bulging mass of tissue and blood vessels protrudes into the anal canal where it can cause problems. Unlike with internal hemorrhoids, it is not clear how external hemorrhoids form.

source:www.medicinenet.com

Hemorrhoid/Wasir

Hemorrhoid, ambein, atau wasir dapat dialami oleh siapapun. Namun seringkali penderita merasa malu atau dianggap tidak penting maka kurang memperhatikan gangguan kesehatan ini. Secara anatomi ambeien bukanlah penyakit, melainkan perubahan fisiologis yang terjadi pada bantalan pembuluh darah di dubur, berupa pelebaran dan pembengkakan pembuluh darah dan jaringan sekitarnya.

Fungsi bantalan ini sebagai klep/katup yang membantu otot-otot dubur menahan feses. Bila terjadi gangguan (bendungan) aliran darah, maka pembuluh darah akan melebar dan membengkak, keadaan ini disebut ambeien.


Secara umum, ambeien dibagi dua yaitu Internal Hemorrhoid dan External Hemorrhoid.

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Ambeien Internal, pembengkakan terjadi dalam rektum sehingga tidak bisa dilihat atau diraba. Pembengkakan jenis ini tidak menimbulkan rasa sakit karena hanya ada sedikit syaraf di daerah rektum. Tanda yang dapat diketahui adalah pendarahan saat buang air besar. Masalahnya jadi tidak sederhana lagi, bila ambeien internal ini membesar dan keluar ke bibir anus yang menyebabkan kesakitan. Ambeien yang terlihat berwarna pink ini setelah sembuh dapat masuk sendiri, tetapi bisa juga didorong masuk.
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Ambeien Eksternal menyerang anus sehingga menimbulkan rasa sakit, perih, dan gatal. Jika terdorong keluar oleh feses, ambeien ini dapat mengakibatkan penggumpalan (trombosis), yang menjadikan ambeien berwarna biru-ungu.
Penyebab

1.

Faktor keturunan
2.

Kehamilan karena perubahan hormonal
3.

Obstipasi (konstipasi/sembelit) yang menahun.
4.

Penyakit yang membuat penderita sering mengejan, misalnya: pembesaran prostat jinak ataupun kenker prostat, penyempitan saluran kemih, dan sering melahirkan anak.

5.

Penekanan kembali aliran darah vena, seperti pada kanker dubur, radang dubur, penyempitan dubur, kenaikan tekanan pembuluh darah porta (di dalam rongga perut), sakit lever jenis sirosis (mengkerut), lemah jantung, dan limpa bengkak.
6.

Banyak duduk.
7.

Diare menahun.
8.

Peregangan. Ini misalnya terjadi pada seseorang yang suka melakukan hubungan seksual yang tidak lazim yaitu anogenital.

Gejala

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Pendarahan dubur. Darah yang keluar bisa berupa tetesan namun juga bisa mengalir deras. Darah berwarna merah muda. Penderita biasanya tidak merasa sakit.
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Rasa mengganjal. Setelah BAB (buang air besar) ada sensasi rasa mengganjal. Kondisi ini menciptakan kesan bahwa proses BAB belum berakhir, sehingga seseorang mengenjan lebih kuat. Tindakan ini justru membuat ambeien semakin parah.
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Gatal. Karena bagian yang terasa nyeri di dubur sulit bersihkan, virus akan sangat mudah menyebabkan infeksi kulit yang memicu rasa gatal.

Ambeien pada ibu hamil

Hal ini terjadi pada ibu hamil akibat tekanan pertumbuhan janin pada vena hemorrhoid. Ibu hamil sangat rentan menderita ambeien karena meningkatnya kadar hormon kehamilan yang melemahkan dinding vena di bagian anus. Banyak ibu hamil yang menderita ambeien setelah 6 bulan usia kehamilan karena adanya peningkatan tekanan vena dalam area panggul.

Beberapa ibu hamil juga mengalami ambeien selama proses persalinan akibat tekanan bayi yang kuat. Komplikasi setelah melahirkan juga memicu ambeien. Sebagai contoh, lembutnya daerah vagina dan bagian anus acap menyebabkan ibu menunda buang air besar, sehingga memicu terjadinya sembelit dan wasir.

Ada banyak hal yang bisa dilakukan untuk mencegah berulangnya kekambuhan wasir. Di antaranya:

1.

Hindari mengejan terlalu kuat saat BAB.
2.

Cegah konstipasi (sembelit - Red) dengan banyak mengonsumsi makanan kaya serat (sayur dan buah serta kacang-kacangan) serta banyak minum air putih minimal delapan gelas sehari untuk melancarkan BAB.
3.

Segera ke belakang jika niat BAB muncul, jangan menunda-nunda sebelum feses menjadi keras.
4.

Makan sayur dan buah yang cukup banyak.
5.

Kurangi konsumsi cabe dan makanan pedas.
6.

Tidur cukup.
7.

Jangan duduk terlalu lama.
8.

Senam/olahraga rutin.

Pemeriksaan dan Pengobatan
Sebelum dapat dilakukan pengobatan, diperlukan pemeriksaan yang teliti.
1. Anamnesa atau riwayat penyakit.

2. Pemeriksaan fisik yaitu inspeksi dan rektaltouche (colok dubur).

3. Pemeriksaan dengan teropong yaitu anuskopi atau proktoskopi dan rektoskopi.

4. Rontgen (colon inloop) dan/atau kolonoskopi.

5. Pemeriksaan darah, urin, feses sebagai pemeriksaan penunjang.

Pengobatan Wasir
Ada dua macam pengobatan yaitu tanpa operasi/oninvasiv dan dengan cara operasi/invasiv. Kedua macam cara ada keuntungan dan kerugiannya. Pada cara pertama dapat dilakukan dalam rangka rawat jalan sedang pada cara kedua pasien harus dirawat karena dilakukan dalam pembiusan.

SOURCE:www.conectique.com