Hemorrhoids
by George H. Kreyling, MD

What are hemorrhoids?

Hemorrhoids are a very common problem. They result from engorgement and swelling of the hemorrhoidal veins located in the lower rectum, near the anus. Hemorrhoids then are similar to varicose veins seen in the lower extremities. Problems with hemorrhoids occur when they continue to enlarge and protrude through the anus, when they bleed, and/or when they thrombose (blood in the hemorrhoids clot). Common complaints are itching, bleeding, pain, soiling of clothes and difficulty cleansing after bowel movements. The cause of hemorrhoids is increased pressure in the hemorrhoidal veins. Increased pressure is caused by constipation, straining to have a bowel movement, prolonged sitting on the toilet, pregnancy, and less common causes like tumors and even liver disease. There are four grades used to define the extent of hemorrhoidal disease:

Grade I - Veins that have become swollen and extend into the rectum.

Grade II - Veins protrude from the rectum with defecation but retract on their own afterwards.

Grade III - Veins protrude from the rectum with defecation, and don't retract on their own, but can be manually pushed back inside the anus.

Grade IV - Veins are permanently prolapsed and cannot be pushed back.

What treatments are available for hemorrhoids?
Treatment of grade I and II disease consists of stool softeners, sitz baths (warm water soaks), changing bowel habits, and topical creams such as Preparation H® or Anusol®. Grade III and IV frequently require surgical measures including sclerotherapy, infrared coagulation, banding, and surgical removal. Scerlotherapy involves injecting fluid into the area which causes scaring and obliteration of the hemorrhoid. Infrared coagulation uses heat to weld the vein thus diminishing the swelling. Banding is an application of tight rubber bands around the hemorrhoid causing them to dry-up and fall off. Banding can not be used on clotted hemorrhoids.
Treatment depends on the extent of the disease and development of complications. Care must be taken to be sure signs and symptoms of more serious disease are not confused with hemorrhoids. All rectal bleeding needs further examination and evaluation by your physician to rule out cancer, non-malignant tumors, inflammation of the bowel, and bleeding from ulcers and other diseases.

This information is intended for educational purposes only and is not intended to replace advice from your personal physician.