Let's not talk about the hemorrhoids!

I asked my medical assistants what topic they think I should address and I was very surprised that they said, "Hemorrhoids". They said that questions about hemorrhoids was one of the most common phone calls that they get. I guess it is easier to talk about them over the phone than in the office!

So, while hemorrhoids are usually under the hospices of the general surgeon, here I go to review them briefly.

What is a hemorrhoid? Hemorrhoids are just varicose veins around the anus and rectum. Some are more external and some are internal. Just like other varicose veins, there are usually from a blockage and backup of blood in those veins. Most commonly in my office, the blockage comes from a pregnancy. The pressure on those veins back up the blood and the veins swell until they are easy to see and become irritated. Once the blockage is removed, the veins usually decompress pretty quickly. Like a balloon though, the first time the veins are expanded it takes some force, but once they have been stretched they can pop right back up again with minimal pressure.

Symptoms: Varicose veins, in and of themselves, are not usually a problem. You may just feel them when you wipe. Usually the external ones are soft and fleshy. When they get swollen, irritated, or if a clot forms in them they suddenly become a much bigger, "pain in the butt". They are often the cause of painless bleeding with bowel movements. (Painful, tearing bowel movements that cause bleeding is usually a fissure).

Treatment: The treatment for the swelling and irritation is usually a hemorrhoid cream that includes a steroid. Topical ointments and pads, such as tucks, are soothing but don't offer any anti-inflammatory action. Prep H., anusol etc, have some hydrocortisone (a steroid) in them which will work much more effectively in reducing the irritation. These need to be used regularly, at least 2-3 times a day and maybe even 4 times a day until things get better. There are some prescription strength creams that are effective as well.

In additional to topical medications, the pressure has to be off. This means, no heavy lifting or straining. Stools should be the texture of a ripe banana. You may have to take fiber drinks-metamucil, citracel etc. to get your stools softer. (hint. start slowly with the fiber drinks and work your way up to the dose that gets you results. Going to fast will make you very gassy and bloated). Stools softeners like colace will work for the short term but if you are prone to constipation you may need the fiber for the long term.

After a pregnancy with normal bowel function, decreased lifting, topical creams and time, the hemorrhoids should go away until your next pregnancy.

If you get a clot in one of the veins you will know it. The pain is pretty intense and instant and will probably bring you to the ER. There, they will just incise the veins and remove the clot. Relief is almost instant with this treatment.

Surgical treatment of hemorrhoids is the very last resort and some say the surgery can be worse then the hemorrhoids. It is definitely worth the slimy orange drinks and the creams to avoid needing surgery.

Prevention: Preventing hemorrhoids is difficult, particularly in a pregnancy. Not allowing for on going constipation is the best prevention. Choosing your parents wisely will help too as hemorrhoids can have a large genetic predisposition.

Warning: Hemorrhoids that seem way out of proportion for your situation, that get worse and worse, or that bleed a lot, need to be seen. Severe hemorrhoids can be a sign of other problems such as colon cancer. Obviously rare in younger women who are having children, but not unheard of. Never be too embarrassed just to have them checked if they are not improving as expected.

Well, hopefully that answered some of your questions that maybe your were afraid to ask! Now back to the gynecology!