Hemorrhoids

Hemorrhoids, whether internal or external, are an uncomfortable intrusion. They can bleed when you have a bowel movement or can cause itching, burning or pain in the rectum or anus. Find out how to prevent and treat them.

What are hemorrhoids?

Hemorrhoids are swollen veins near the anus. These veins are part of the anal sphincter, which is a muscle that opens and closes to let out stool. They can become enlarged and painful from direct pressure or straining.

Although anyone can get hemorrhoids, some people are more predisposed to this problem. About 70% of people will have the following symptoms at least once in their lives:

• inflammation
• itching
• burning
• pain
• bleeding

What causes hemorrhoids?

Many factors can cause hemorrhoids:

• constipation and straining to have a bowel movement
• diarrhea
• sitting or standing for an extended period
• overweight
• heavy lifting
• pregnancy and childbirth

Internal hemorrhoids and external hemorrhoids

The symptoms of internal and external hemorrhoids are different. When hemorrhoids are internal, you can’t see them, and you also don't feel pain as the mucus membranes inside the rectum have no nerve endings. However, these hemorrhoids can bleed, and the blood can show up on toilet paper or in the toilet. They can also cause a feeling of heaviness in the rectum after a bowel movement.

When hemorrhoids are external, they are very painful. They get irritated and enlarged, can cause tingling and itching around the anus, and can bleed. You should see a doctor if they become painful, if they bleed frequently or abundantly, or if the bleeding turns dark red or almost black.

When to consult a doctor

Although hemorrhoid symptoms can seem harmless, some situations require a medical consultation:

• Your symptoms worsen while you are using an over-the-counter (OTC) product.
• Your symptoms persist after you use an OTC product for 7 to 10 days.
• You have abundant bleeding, and the blood is dark.
• Your hemorrhoids stay protruded after you have a bowel movement.
• The affected person is a child under the age of 12.

Can hemorrhoids be prevented?

In the majority of cases, a change in lifestyle and diet is enough to prevent hemorrhoids. Here are a few tips:

• Eat fibre-rich foods, drink plenty of water, and avoid foods that are constipating. If you have to, use fibre supplements so that your stool is softer and more regular.
• Avoid alcohol, coffee, vinegar and spicy foods.
• Exercise, which speeds up intestinal transit.
• Avoid sitting or standing for long periods. If you need to stay seated for a long time and your hemorrhoids are painful, you can try using an eggshell cushion instead of a ring or “donut” cushion, which can actually increase pressure on the rectal muscles.
• Avoid staying on the toilet for too long and straining to have a bowel movement. Have a bowel movement as soon as you feel the need.
• Apply ice or a cold compress for a few minutes as soon as you feel discomfort that could lead to hemorrhoids.

What to do when hemorrhoids flare up?

Here are some recommendations to help heal your hemorrhoids.

• Take a bath or a shower every day and gently clean the skin around the anus with mild soap and water to avoid aggravating the irritation. Dry the region well, as moisture can also aggravate the irritation.
• Clean the anal region with mild soap and water every time you have a bowel movement, if possible. Otherwise, use wet wipes instead of toilet paper. Compresses that contain witch hazel (Tucks™) can temporarily relieve itching and burning.
• Take sitz baths with lukewarm water for 15 minutes, 3 to 4 times a day.
• If an internal hemorrhoid falls outside the anus (prolapse), push it gently back up through the anal canal if this doesn't cause too much pain. If you have pain, consult your doctor.

Hemorrhoid treatment

Medication

In general, hemorrhoids go away on their own in a few days, but they can come back. Aside from surgery, no treatment can cure them. However, your pharmacist can give you advice about OTC medications available to relieve your symptoms:

• Acetaminophen or anti-inflammatories to relieve hemorrhoid pain.
• A stool softener, like docusate sodium.
• Anesthetic creams or ointments. These deaden skin sensations for a few hours, which decreases pain or itching. These products contain different ingredients, such as local anesthetics (benzocaine and pramoxine) and protective compounds (such as petroleum jelly, glycerine and zinc oxide). Local anesthetics can only be used for a maximum of 7 days. The risk of allergic reaction to these products increases with the length of treatment. Note that creams and ointments are more effective than suppositories, which don’t always act on the right area and can irritate the rectum.
• Topical corticosteroids such as hydrocortisone decrease swelling and speed up healing. Hemorrhoid drugs that contain this ingredient can only be obtained with a prescription.

Surgery and medical procedures

If your hemorrhoids are painful or chronic, your doctor can recommend different procedures:

• Rubber band ligation : One or two small elastics are attached around the base of an internal hemorrhoid to cut off its blood circulation. After 7 to 10 days, the hemorrhoid will fall off without pain. The success rate of this procedure is 75%.
• Cryosurgery: Your physician will use liquid nitrogen to freeze the hemorrhoid and remove it. Healing is often long, and the sore can drain abundantly for a long time.
• Injection sclerotherapy : Your doctor will inject a solution that hardens the hemorrhoid so that it shrinks.
• Laser treatment.
• Surgery to remove the hemorrhoid. Because of the significant pain of this procedure, it is only used as a last resort or if the hemorrhoid is very large. 

Don’t be embarrassed to talk to your pharmacist about hemorrhoid treatments and to get a recommendation for the best product for you. If your condition is serious, your pharmacist will let you know if you need to consult a doctor.