Don't Delay Getting Help For Hemorrhoids

Published by Contra Costa Times

Posted on Sun, Jul. 25, 2004

By Jeff Smith, MD

EVEN IN DISCOMFORT, Doug was reluctant to say the name of his problem. Doug has hemorrhoids, also known as "piles." These are a common ailment that few people like to discuss. They can cause rectal bleeding or anal pain, or both.

Doug drives a truck and spends long hours on the road. He gets little exercise and doesn't drink a lot of water because it will force him to stop the truck to use the restroom.

Hemorrhoids are a type of varicose vein that has become inflamed and swollen. "External hemorrhoids" occur outside the anal opening and are often painful, especially when having a bowel movement. "Internal hemorrhoids" can't be seen from the outside and can cause rectal bleeding. Internal and external hemorrhoids can occur simultaneously or separately.

Although generally a nuisance, hemorrhoids can cause life-threatening infections or bleeding. Unfortunately, because of embarrassment, some people wait until the condition is serious before seeking help. I had one hemorrhoid patient who needed a blood transfusion after fainting from loss of blood.

Infections or cracks near the anal opening can also cause pain and can be confused with hemorrhoids. These conditions require different treatments, so it's usually best to consult your doctor.

In some cases, hemorrhoids are an industrial disease, induced by prolonged sitting or standing. Heavy lifting, constipation and diarrhea can also be contributing factors.

One key to preventing hemorrhoids is to move around consistently during the day. Other prevention measures include eating plenty of fiber and drinking plenty of water.

There are a wide variety of treatments for hemorrhoids, including over-the-counter medications.

Over-the-counter remedies are generally either astringents, which help shrink hemorrhoidal tissues, or anti-inflammatory medicines, which reduce hemorrhoidal inflammation and pain. Aside from anti-inflammatory pills or capsules, there are ointments, creams and suppositories, many of which can help reduce the discomfort.

Some physicians recommend warm "sitz-baths," in which the patient sits in warm water for 30 minutes four times a day. On the other hand, some patients find that lying on their stomach, buttocks elevated, with ice packs on the hemorrhoids brings greater comfort. Neither treatment is curative, and whichever best eases your discomfort should be used.

Surgery is an option in serious cases, but not one without some risk. Conventional surgery can cause infection, which can lead to peritonitis, a life-threatening infection of the abdominal area.

Sometimes a less invasive, less risky "phototherapy" surgery is appropriate. In this procedure, a light source coagulates blood vessels in the rectum, thus decreasing pressure on veins and helping shrink inflamed tissues.

Unfortunately, Doug's hemorrhoids required surgery to control his pain and bleeding. Afterward, he changed his diet to increase the amount of fiber and roughage.

I saw Doug recently for an unrelated matter. He's still driving a truck, but he makes a point every day to drink at least six to eight glasses of water, walk around at truck stops and eat three daily servings each of grains, fruits and green, leafy vegetables such as spinach and broccoli. So far, his embarrassing problem has not recurred.

Dr. Jeff Smith is a family practitioner and director of inpatient services at the Contra Costa Regional Medical Center.