Treating HemorrhoidsUsing Non-Surgical Methods

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When Hemorrhoids SwellHemorrhoid tissues are a network of blood vessels located in and around the anal canal (the last few inches of the rectum). When these veins swell, you can have symptoms such as:

• Painoraburningsensation

• Bleedingduringbowelmovements

• Protrusionoftissuefromtheanus

• Itchingaroundtheanus

What Causes Hemorrhoids?There’snosinglecauseofhemorrhoids.Mostoften,though,theyarecaused by too much pressure on the anal canal. This can be due to:

• Chronic(ongoing)constipation

• Strainingduringbowelmovements

• Diarrhea

• Pregnancyandchildbirth

• Sittingtoolongonthetoilet

• Strenuousexerciseorheavylifting

• Aging

A Common ProblemIf you have hemorrhoids, you’re not alone. They’re a very common problem. In fact, hemorrhoid tissues are a natural part of the body. Most of the time you don’t notice them as they help during bowel movements. But if these tissues become swollen or inflamed, they can cause uncomfortable symptoms. The good news is that hemorrhoids can be treated so you feel better.

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

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What You Can DoHemorrhoidsaren’tlife-threatening.Butthesymptomstheycausearehardtoignore.Fortunately,therearemanytreatmentsthatcanprovidereliefrightaway.Mostofthesetreatmentsdonotinvolvesurgery.You canalsolearnsimplewaystohelpkeephemorrhoidsfromreturning.

Table of ContentsUnderstanding Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Your Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Self-Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Removing Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

After Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Preventing Future Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

EvaluationThefirststeptofeelingbetterisseeingyourhealthcareproviderforanevaluation.You’llbeaskedquestions about your symptoms andhealth.You’llalsobeexam-ined.Youmayhavesometeststomake sure your symptoms aren’t caused by other problems.

TreatmentYourtreatmentwilldependon theseverityofyoursymptoms.Formanypeople,achangeindietandbowelhabitsareenoughtorelievetheproblem.Inothercases,thehemorrhoids may need to be removed.Yourhealthcareprovidercanexplaintheseoptions.

PreventionTreatmentandpreventiongohandin hand. That’s because measures suchaseatingahigh-fiberdietdomore than just ease constipation. They also help prevent hemorrhoids fromcomingback.Havinggoodbowelhabitsandgettingmoreexercisewillalsohelp.

The rectum is the last several inches of the colon. This is where stool is stored prior to bowel movements.

Anal sphincters are ring-shaped muscles that expand and contract to control the anal opening.

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Understanding HemorrhoidsHemorrhoid tissues are “cushions” of blood vessels that swell slightly during bowel movements. Too much pressure on the anal canal can make these tissues remain enlarged and cause symptoms. This can happen to hemorrhoids both inside and outside the anal canal. To diagnose hemorrhoids, your doctor will rule out other problems that can cause symp-toms similar to hemorrhoids.

Small intestine

Normal Hemorrhoid Tissue Hemorrhoid tissues play an importantroleinhelpingyourbodyeliminatewaste.Food passesfromthestomachthroughthe intestines.The waste (stool) thentravelsthroughthecolon totherectum.Itisstoredintherectum until it’s ready to be passedfromtheanus.Duringbowel movements, hemorrhoids swell with blood and become slightlylarger.Thisswellinghelps protect and cushion the anal canal as stool passes from the body. Once the stool has passed,thetissuesstopswellingand return to normal.

Rectum

The anus is the passage between the rectum and the outside of the body.

Anus

Parts of the Anal Canal

Internal hemorrhoid tissue is in the upper area of the anal canal.

Colon

External hemorrhoid tissue lies under the anal skin

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Problem HemorrhoidsPressureduetostrainingorotherfactorscancausehemorrhoidtissuestoremain swollen. When this happens to the hemorrhoid tissues in the anal canal they’re called internal hemorrhoids.Swollentissuesaroundtheanalopeningarecalledexternal hemorrhoids.Dependingonthelocation,your symptoms can differ.

Internal HemorrhoidsInternalhemorrhoidsoftenoccurinclustersaround the wall of the anal canal. They are usuallypainless.Buttheymayprolapse (protrudeoutoftheanus)duetostraining orpressurefromhardstool.Afterthebowelmovement is over, they may then reduce (returninsidethebody).Internalhemorrhoidsoftenbleed.Theycanalsodischargemucus.

External HemorrhoidsExternalhemorrhoidsarelocatedattheanalopening,justbeneaththeskin.Thesetissuesrarely cause problems unless they thrombose (form a blood clot). When this occurs, a hard, bluishlumpmayappear.Athrombosedhemor-rhoidalsocausessudden,severepain.Intime,theclotmaygoawayonitsown.Thissometimesleavesa“skintag”oftissuestretchedbytheclot.

Other Anal ProblemsBelowarecommonproblemsthatcancausesymptomssimilartohemorrhoids.Yourdoctorcanexplainyourtreatmentoptions.

• A fissure is a small tear or crack in the liningoftheanus.Itcanbecausedbyhardbowel movements, diarrhea, or inflammation intherectalarea.Fissurescanbleedandcause painful bowel movements.

• An abscess isaninfectedglandintheanalcanal. The infected area swells and often causes pain.

• Afistula is a pathway that may form when an anal abscess drains. The pathway may remainaftertheabscessisgone.Fistulas arenotusuallypainful.Buttheycancausedrainagewherethepathwaymeetstheskin.

Fistula (after an abscess has drained)FissureAbscess

Prolapsed internal hemorrhoid External hemorrhoid

Internal hemorrhoids

Skin tag

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Your EvaluationTo learn more about your symptoms, you’ll 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 that’s best for you.

Pregnancy and HemorrhoidsManywomendevelophemorrhoidsduring pregnancyandchildbirth.This is likely caused by pressure on the pelvis and byhormonalchanges.Inmost cases, the hemor-rhoidswilleventuallygoawayontheirown.Inthemeantime, talk with your doctor about ways to help relieve your symptoms.

Physical ExamDuringaphysicalexam,you’llbeaskedtolieonanexamtable.You’llthenbeexaminedforsignsofswollenhemorrhoidsandotherproblems.Theexamtakesjustafewminutes.Itisusuallynotpainful.

• A visual exam is used to view the outer anal skin.

• A digital rectal exam is used to check for hemorrhoids or other problemsintheanalcanal.Itisdoneusingalubricatedglovedfinger.

• An anoscopic examisdoneusingaspecialviewingtubecalledananoscope. The scope helps your doctor view the anal canal.

Grading HemorrhoidsBasedonthephysicalexam,yourdoctormayassignagradetointernalhemorrhoids.Thegradesarebasedontheseverityofyoursymptoms.

• Grade I hemorrhoids do not protrude from the anus. They may bleed, but otherwise cause few symptoms.

• Grade II hemorrhoidsprotrudefromtheanusduringbowel movements.Theyreducebackintotheanalcanalwhenstrainingstops.

• Grade III hemorrhoidsprotrudeontheirownorwithstraining.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.

Medical HistoryAmedicalhistoryhelpsyourdoctorlearnmoreaboutyoursymptomsand overall health. This often includes questions about your bowel habitsanddiet.Youmayalsobeaskedhowoftenyouexercise,andwhetheryoutakeanymedications.Besuretomentionifanymembers of your family have had cancer or polyps of the colon.

A colonoscope is used to view the entire colon.

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Your Treatment PlanAfteryourexamandanytests,yourdoctorwilldiscusstreatmentoptionswithyou. Inmanycases,justmakingsimplechangesinyourdietandbowelhabitsareenough torelieveyourhemorrhoids.Butifyoursymptomsaresevere,yourdoctormay recommendremovingahemorrhoid.Keepinmind,therearemanythingsyoucandoonyour own to relieve symptoms. Read on to learn more about how self-care can help you.

Barium is used to make the colon appear white on x-rays.

Diagnostic TestsDiagnostictestshelpmakesureyour symptoms aren’t caused by other problems, such as polyps or colorectal cancer. These tests include a fecal occult blood test, which checks for hidden blood in thestool.Youmayalsohaveteststo take a closer look at your colon.Sometestsaredonein your doctor’s office. Others are doneinahospitalorradiology (x-ray)center.Afteranyofthesetests,you’llbeabletogohome the same day.

SigmoidoscopyYourdoctorusesathin,lightedtubecalledasigmoidoscopetoview the rectum and lower colon. This test is done in your doctor’s office.Ittakesjustafewminutes.

Sigmoidoscope

A sigmoidoscope is used to view the lower colon.

Barium EnemaAradiologistinjectsaliquid barium solution into the colon. The barium acts as a dye that makes the colon easier to see onx-rays.Thistestisdoneat ahospitalorradiologycenter.

ColonoscopyYourdoctorusesalong,thin,lighted,flexibletubecalledacolonoscope to view the entire colon. This procedure is usually doneinahospital.Medicationshelpyourelaxduringthetest.

Colonoscope

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Relieving SymptomsWhen hemorrhoids are swollen and painful, it’s hard to think about anythingelse.Butyoudon’thavetosufferforlong.Yourdoctormayprescribe anti-inflammatory medication to help ease your symptoms. Thefollowingtipswillalsohelprelievepainandswelling.

Take Sitz BathsTakingasitzbathmeanssittinginafewinchesofwarmbathwater. Itmaysoundsimple.Butsoakingfor15to20minutestwiceadaycanprovidewelcomerelieffrompainfulhemorrhoids.Itcanalsohelpthearea stay clean.

Self-CareWhen it comes to treating hemorrhoids, nonsurgical treatments are often used first. Follow your doctor’s advice about caring for your hemorrhoids at home. Some treatments help relieve symptoms right away. Others involve making changes in your diet and exercise habits. These can help ease constipation and prevent hemorrhoids from coming back.

Develop Good Bowel HabitsEachperson’sbowelhabitsaredifferent.Sofollowyourownrhythm.Usethebathroomwhenyouneedto.Don’tignoretheurgetogo.Thiscanleadtoconstipation,hardstools,andstraining.Also,don’treadwhileonthetoilet.Sitonlyaslongasneeded.Wipegentlywithsoft,unscented toilet tissue or baby wipes.

Use Ice PacksPlacinganicepackonathrombosedexternalhemorrhoidcanhelprelievepainrightaway.Itwillalsohelpreducethebloodclot.Usethe icefor15to20minutesatatime.Keepaclothbetweentheiceand yourskintopreventskindamage.

Use Other MeasuresLaxativesandenemascanhelpeaseconstipation.Butusethem onlyonyourdoctor’sadvice.Forsymptomrelief,tryusingcotton padssoakedinwitchhazel.Theseareavailableatmostdrugstores. Over-the-counter hemorrhoid ointments and petroleum jelly can also provide relief.

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Drink More WaterAlongwithahigh-fiberdiet,drinkingmorewatercanhelp ease constipation. This is because insoluble fiber absorbswater,makingstoolssoftandbulky.Besuretodrinkplentyofwaterthroughouttheday.Drinkingfruitjuices, such as prune juice or apple juice, can also help prevent constipation.

Get More ExerciseRegularexerciseaidsdigestionandhelpspreventconsti-pation.It’salsogreatforyourhealth.Sotalkwithyourdoctoraboutstartinganexerciseprogram.Low-impactactivities,suchasswimmingorwalking,aregoodplacestostart.Takeiteasyatfirst.Andremembertodrinkplentyofwaterwhenyouexercise.

High-Fiber FoodsHigh-fiberfoodsoffermanybenefits.Bymakingyourstoolssofter,theyhelp heal and prevent swollen hem-orrhoids. They may also help reduce the risk of colon and rectal cancer. Bestofall,they’reusuallylowincaloriesandtastegreat.Herearesomeexamplesoffiber-richfoods.

• Whole grains, such as wheat bran, corn bran, and brown rice.

• Vegetables, especially carrots, broccoli,cabbage,andpeas.

• Fruits, such as apples, bananas, raisins, peaches, and pears.

• Nuts and legumes, especially peanuts, lentils, and kidney beans.

Easy Ways to Add Fiber It’snotalwayseasytochangeyourdiet.Butthetipsbelowoffersomesimplewaystoaddmorehigh-fiberfoods to your meals.

• Startyourdaywithahigh-fiberbreakfast. Eat a wheat bran cerealalongwithaslicedbanana.Or, try peanut butter on whole- wheat toast.

• Eatcarrotsticksforsnacks.They’re easy to prepare, taste great,andarelowincalories.

• Usewhole-grainbreadsinstead of white bread for sandwiches.

• Eatfruitsfortreats.Tryanappleand some raisins instead of a candy bar.

Add Fiber to Your DietAddingfibertoyourdietcanhelprelieveconstipationbymakingstoolssofterandeasiertopass.Toincreaseyourfiber intake, your doctor may recommend a bulking agent, suchaspsyllium.Thisisahigh-fibersupplementavailableatmostgroceryanddrugstores.Eatingmorefiber-rich foods will also help. There are two types of fiber. Bothhelpkeepyourbowelshealthy:

• Insoluble fiberisthemainingredientinbulkingagents.It’salsofoundinfoodssuchaswheatbran,whole-grainbreads,freshfruits,andvegetables.

• Soluble fiber is found in foods such as oat bran. Althoughsolublefiberisgoodforyou,itmaynoteaseconstipationasmuchasfoodshighininsolublefiber.

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Removing Hemorrhoids If your symptoms persist, your doctor may recommend removing the hemorrhoid. This can be done in your doctor’s office or at a surgical center. In most cases, no special preparation is needed. Keep in mind that your treat-ment may differ depending on your symptoms and the location of the hemorrhoid.

Risks and Complications The possible risks and complications of the treatmentsdescribedonthesepagesinclude:

• Infection

• Bleeding

• Troubleurinating

• Narrowingoftheanalcanal(veryrare)

Thrombosed External HemorrhoidsExternalhemorrhoidsareoftenverypainful.That’sbecausetheswol-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.Youmayneedtorestforafewdaysbeforereturningtowork.

Numbing the HemorrhoidYou’llbeaskedtolieorkneelonatable.Thehemorrhoidistheninjected with a local anesthetic. This may cause some discomfort foramoment.Butwithinashorttimeyourdoctorwillbeabletoremovethehemorrhoidwithoutcausingpain.

Removing the HemorrhoidAsmallincisionismadetoremovethebloodclot.Thehemorrhoidmay 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 forafewdays.Butyourpainshouldimprovesoonaftertheprocedure.

Thrombosed hemorrhoid

Incision

Before treatment, a thrombosed external hemorrhoid causes painful swelling around the anal opening.

Removing the blood clot helps ease pain. The incision may be closed with stitches or left open to heal.

Internal HemorrhoidsYou’llbeaskedtolieorkneelonatable.Yourdoctortheninsertsanano-scope to view the anal canal. To treat the hemorrhoid, your doctor will useoneofthemethodslistedbelow.Becauseinternalhemorrhoidsdonothavenervesthatsensepain,youwon’thavetoomuchdiscomfort.Youcanoftenreturntoyournormalroutinethesameday.Ifyouhavemanyhem-orrhoids, you may need repeated treatments.

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When to Call Your DoctorAfteranyofthetreatmentsdescribedonthese pages,callyourdoctorifyouhave:

• Increasingpain

• Feverorchills

• Persistentbleeding

• Troubleurinating

BandingThebandingmethodisdone byplacingtightelasticbandsaround the base of the hemor-rhoid. This cuts off blood supply tothehemorrhoid,causingittofall off. This usually takes about a week. The area then heals within a few days.

Infrared CoagulationThisprocedureisdoneusingasmallprobethatexposesthehemorrhoid to short bursts of infraredlight.Thissealsoffthebloodvessel,causingittoshrink.Slightbleedingmayoccurforafew days. The area usually heals within a week or two.

SclerotherapySclerotherapyisdoneby injectingachemicalintothe tissue around the hemorrhoid. The chemical causes the hemorrhoid to shrink within afewdays.Bleedingusually stopsinabout24hours.

Bands

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After Treatment Once you’re back at home, you’ll need to take it easy for a few days. To help speed your recovery, follow all your doctor’s 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.

Manage PainIt’snormaltohavesomepainaftertreatment.Tohelpyoufeelbetter, yourdoctormayprescribepainmedication.Don’twaitforyourpainto getbad.Takethemedicationontimeasdirected.Beawarethatsomepainmedicationscancauseconstipation.Soyourdoctormayalsoprescribealaxativeorstoolsoftener.Ifyouhavepainorburningafterbowelmove-ments,sitzbathscanhelpproviderelief.

Avoid Straining on the ToiletYoumaybenervousabouthavingabowelmovementaftertreatment. Butdon’tignoretheurgetogo.Thiscanleadtoconstipationand strainingonthetoilet.Forthefirstfewdays,youmayhaveminor bleedingormusclespasmsduringbowelmovements.Youcanalso haveswellingthatfeelslikeunpassedstoolorahemorrhoid.Call your doctor if you’re unable to have a bowel movement within the first few days after your procedure.

Reclining on a soft chair or sofa can help you feel better after treatment.

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Stay ActiveRegularexercisecanhelppreventcon-stipation.It’salsogreatforyouroverallhealth.Sotrytobeactiveatleastafewtimesaweek.Itdoesn’treallymat-terwhatyoudo.Walking,swimming,tennis—thechoiceisuptoyou.Forbestresults, choose an activity you enjoy. This makes you more likely to stick with it. Yourdoctorcanalsoadviseyouaboutan exerciseprogramtosuityourneeds.

See Your DoctorIfneeded,besuretoseeyourdoctor for follow-up appointments. These help ensureyou’rehealingwell.Youshouldalso contact your doctor if you have any neworunusualsymptoms.Duringofficevisits,askyourdoctoraboutregularscreeningforcolonandrectalcancer.These problems are best treated when detected early.

Preventing Future ProblemsOnce you’ve been treated for hemorrhoids, you don’t 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.

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Feeling Good AgainAnyone can have trouble with hemorrhoids. But you don’t 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.© 2010 The StayWell Company. www.krames.com 800-333-3032 All rights reserved.