Nikki Sommer, a nurse practitioner with Key West Surgical Group, joined Good Morning Keys on Keys Talk 96.9/102.5FM this morning for Medical Matters.
Hemorrhoids affect millions of Americans and they are quite painful.
Sommer said, “Many people assume hemorrhoids are just the annoying part of getting older, while others panic at the first sign of rectal bleeding. So, we’ll talk about hemorrhoids, what they really are, why they happen, and how they’re treated and when your symptoms actually need medical attention, so we’re going to jump into the pain in the bottom.”
Are are two types of hemorrhoids – internal and external.
Sommer said, “Internal hemorrhoids are located inside the rectum, and they usually aren’t painful because there are very few pain nerves in that area, their most common symptom, bright red rectal bleeding. So, a lot of times, as this happens at all ages, somebody will call in a panic because there’s bright red blood, it’s painless, they have it when they wipe. External hemorrhoids are a little different. They develop under the skin around the anus, so they’re the ones that can be irritating and very painful, and sometimes they form a blood clot, and they are called the thrombosed, and sometimes you need to have them lanced, those are the painful ones. When I worked in urgent care, we saw this a lot. The thrombosed hemorrhoids, they’ve been painful, and if you come in when they first start, like I said, they can be lanced and that pain can be relieved. Otherwise, you have to wait until the clot hardens or the body will eventually absorb it on its own, but it’s more painful than if you come in and get it lanced straight right away.”
Everybody actually has hemorrhoids.
Sommer said, “They’re actually cushions of blood vessels, they help keep the stool from coming out. They actually serve a purpose. They assist with bowel control. So, grade one hemorrhoids, they still remain inside the rectum. They’re not necessarily a problem. You can have a little bit of bleeding from them, but they’re considered one. Grade two will prolapse during a bowel movement, but then they go back in on their own. Grade three, you need to gently push them back inside. Grade four, they remain outside and cannot be pushed back in, so that usually determines a surgical consult or trip to the doctor to find out what best treatment is to treat them.”
What are some risk factors?
Sommer said, “The biggest thing is straining during your bowel movements, and that usually occurs with constipation. Think about squeezing a tube of toothpaste every time you strain, pressure builds up inside those blood vessels over months or years. They stretch and enlarge and begin to prolapse. Other common factors include chronic constipation, chronic diarrhea, low fiber diets, not drinking enough water, sitting on the toilet too long. Pregnancy, obesity, heavy lifting, chronic coughing, and aging is a cause because there’s a muscle, it weakens over time.”
The longer you sit on the toilet, the more pressure is placed on the hemorrhoidal veins.
Sommer said, “Remember, that’s what they are, they’re veins. So the toilet is just what it’s supposed to be. Don’t bring anything else into the bathroom with you.”
What symptoms do hemorrhoids cause?
Sommer said, “Bright red blood on the toilet paper, like I said, in the toilet or from the stool. Other symptoms again include the itching, the burning, you might have some mucus drainage, feeling like something is bulging, difficulty cleaning, feeling incomplete emptying, and then remember internal hemorrhoids usually do not hurt, so if you’re having severe pain, another condition might be responsible, including an anal fissure, infection or an abscess. Those situations deserve prompt intervention. Bleeding is just from the pressure. The hemorrhoids, they’re engorged, right? So, you can have bleeding, and if you’re straining, it’s like very fragile tissue.”
When should you be concerned?
Sommer said, “Working with Doctor Smith for the last six years, this is a common phone call where people will call and be like, yeah, I’ve had some bleeding, but I’ve had hemorrhoids, and then they’re overdue for colonoscopy, so yes, hemorrhoids are the most common cause of bright rectal bleeding. However, they are not the only cause, so bleeding can also come from colon polyps, colon cancer, diverticular disease. Remember, we talked about those weakened pouches in the colon that they become inflamed and bleed as well. If you have inflammatory bowel bowel disease or the start of inflammatory bowel disease, but haven’t been diagnosed yet, that also is a cause of rectal bleeding, anal fissures, and infections. So, rectal bleeding should never be ignored if it’s something that is constantly occurring or occurring more often. You should just have it evaluated. Heavy bleeding, or black and tarry stools. Pepto Bismol can cause black and tarry stools. There’s other medications too, but that is a popular one, because when people have GI upset, that’s the first thing they grab. Otherwise, that is a big concern. Unexplained fatigue, we talked about iron deficiency anemia before. Any change in your bowel habits, severe pain, or a family history of colon cancer.”
Hemorrhoids can be prevented.
Sommer said, “The goal is keeping your bowel movement soft and easy to pass. Eating fiber, aim for about 25 to 35 grams every day, from fruits, vegetables, beans, whole grains, and fiber-rich foods. Also, fiber supplement, it’s very easy to put in any liquid, is odorless and tasteless, dissolves in hot or cold water. Supplementation is okay, and Metamucil is also very good in the sense that if sometimes you’re too backed up or sometimes you’re too loose, Metamucil helps regulate you and even you out, but the key for it to work at all is to drink enough water. So, if you take fiber with not enough water, it’s not going to work the way you want it to. Don’t hold your bowel movements and avoid straining. And again, don’t stay on the toilet longer than necessary. Don’t make it your second home. Sometimes we want to run away from things. We can go in the bathroom and lock the door, get off the toilet.”
Treatment usually starts conservatively.
Sommer said, “Just like we talked about the fibers of fluids and avoiding straining. You can soak them in warm water to relieve the discomfort. Then, if the symptoms continue, office procedures are available. Most common for internal hemorrhoids is if you have rectal bleeding,it’s very large, it’s engorged, it’s rubber band ligation. She actually does this in the office, where you place a tiny rubber band around the hemorrhoid, and it cuts off the blood supply, and then it shrinks, and it falls off.”
Infrared coagulation can also be used.
Sommer said, “A lot of times, if people come in because they’re having rectal bleeding and they need a colonoscopy, she will go in during the procedure and possibly either rubber band them or do some coagulation or sclerotherapy to help shrink that hemorrhoid. Hemorrhoids are extremely common, they’re a pain in our bottom that could bother us daily. They’re nothing to be embarrassed about. Most people don’t want to talk about them. I know we sit and we laugh, but they can be very, very uncomfortable. So, most symptoms can improve with better, healthy habits, more fiber and avoiding excess straining. Just one thing to remember, even if you have hemorrhoids and you have rectal bleeding, just don’t assume that it is the hemorrhoids, because it could be a more serious condition, including colon cancer, and the sooner you have a colonoscopy, if you’re having any type of symptom, and if you have a polyp, even if it’s cancer polyp, if you catch it in the early stage, it’s treatable.”
For more information on how Key West Surgical Group can help, click here: https://www.keywestsurgicalgroup.com/