How To Cure External Hemorrhoids

What Can You Do For Relief

If you have hemorrhoids, lifestyle changes may help them heal faster. One cause of hemorrhoids is straining during bowel movements. Adding more high-fiber foods to your diet, such as vegetables, fruits, and whole grains, can help soften your stool and make it easier to pass.

You should also drink plenty of water to help relieve constipation and reduce straining during bowel movements.

Here are some additional things that may help relieve symptoms:

• Minimize the time you sit on the toilet.
• When you feel the urge to move your bowels, go as soon as possible.
• Put your feet on a small stool during bowel movements to change the position of your rectum.
• If youre pregnant, sleep on your side. This will help relieve some of the pressure around your anus.
• Ask your doctor about taking a stool softener or a fiber supplement, such as psyllium or methylcellulose . A tablespoon of mineral oil added to food can also help soften stools.
• Keep the anal area clean. Take regular showers, and use moist wipes to clean the area around your anus after you pass a bowel movement.
• Use a sitz bath or sit in a warm tub for a few minutes to bathe the anal area.

You may also try using over-the-counter topical medications to ease discomfort, such as phenylephrine hemorrhoidal gel . These products are used if the hemorrhoids are bulging and inflamed.

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Avoid Holding Your Breath Or Straining

Whether you are working out, lifting something, or going to the bathroom, you should always practice proper breathing methods while you do so. This can greatly reduce the amount of strain you put on your body. A lot of people dont realize that the hard work they do on a daily basis may be the cause of their hemorrhoids. When you hold your breath as you are pushing, pulling, and making an effort at anything, you can cause swelling in the lower part of your body. This may ultimately lead to hemorrhoids.

Causes Of External Hemorrhoids

The most common cause of external hemorrhoids is repeated straining during a bowel movement, leading to the veins of the anus or rectum becoming dilated or enlarged. Because external hemorrhoids result from excessive pressure in the rectums veins, certain factors can increase the chances of external hemorrhoids forming.

Some of the most common external hemorrhoid causes include:

• Pregnancy.
• Heavy weight lifting.
• Obesity.

Each of the above places added pressure on the rectal veins, which may eventually cause increased swelling in the external hemorrhoids. For example, in pregnant women, the uterus puts extra pressure on these veins and can cause them to enlarge. To reduce the likelihood of developing external hemorrhoids or prevent symptoms from worsening, limit the amount of time you spend on the toilet to two minutes and make sure you always practice proper form when heavy lifting.

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How A Doctor Can Help

Doctors can recommend medical treatments and procedures that can reduce or get rid of hemorrhoids. Some of these procedures can be done right in a doctors office and involve very little discomfort.

• Medicated creams/ointments. If an OTC hemorrhoid cream isnt enough, doctors can prescribe stronger creams and ointments.
• Minimally-invasive procedures. There are some minimally-invasive procedures that a doctor can do in their office or in an ambulatory surgery center that typically doesnt require anesthesia or long recovery times. Some of these procedures include rubber band ligation, sclerotherapy injections, and laser/infrared coagulation treatments.
• Thrombectomy. For severe cases that develop blood clots and cause a lot of pain, your doctor can perform an external hemorrhoid thrombectomy to remove the hemorrhoid. Thrombectomies are most effective when performed no more than 72 hours after severe symptoms emerge.
• Surgery. There are several surgical options available when other treatments and procedures havent worked or if you have very large hemorrhoids. If youve struggled to find relief, talk to your doctor to learn if surgery is right for you.

Treatment Of External Hemorrhoids

The best treatment for hemorrhoids is reducing the likelihood of them in the first place. For example, eating a healthy, fiber-rich diet and drinking plenty of liquids. Try to avoid sitting for long periods by taking regular stretch breaks, or incorporate exercise into your routine if it isnt already a normal activity for you. Physical activity reduces pressure on the veins in the rectum and prevents constipation.

Unfortunately, once an external hemorrhoid has formed, it most likely will not go away on its own. However, there is still a wide variety of external hemorrhoid treatment options to alleviate hemorrhoid symptoms or take care of the problem altogether.

You can temporarily relieve hemorrhoid symptoms on your own by using over-the-counter topical creams as well as natural remedies, such as apple cider vinegar and witch hazel. Keep in mind that at-home treatments and positive lifestyle changes may reduce hemorrhoid flare-ups, but the symptoms likely wont completely go away without professional treatment under the supervision of an experienced physician. Seeing a physician is essential for combating the underlying causes of hemorrhoid flare-ups or treating advanced piles, such as grade IV hemorrhoids.

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Add Fiber To Your Diet

Adding fiber to your diet can help relieve constipation by making stools softer and easier to pass. To increase your fiber intake, your healthcare provider may recommend a bulking agent, such as psyllium. This is a high-fiber supplement available at most grocery stores and drugstores. Eating more fiber-rich foods will also help. There are two types of fiber:

• Insoluble fiber is the main ingredient in bulking agents. Its also found in foods such as wheat bran, whole-grain breads, fresh fruits, and vegetables.

• Soluble fiber is found in foods such as oat bran. Although soluble fiber is good for you, it may not ease constipation as much as foods high in insoluble fiber.

Classification Of Internal Hemorrhoids:

• Grade 1 – A hemorrhoid is present but only visualized by a doctor with ansocopy or colonoscopy. The hemorrhoid does not extend out the anus.
• Grade 2 – The hemorrhoid extends out of the anus with a bowel movement or with straining. After your BM, the hemorrhoid goes back inside on its own.
• Grade 3 – The hemorrhoid extends out of the anus with a bowel movement or with straining. You have to manually push the hemorrhoid back inside the anus. If you have this, you should seek medical attention, but it is not urgent.
• Grade 4 – A hemorrhoid extends outside the anus and are not able to be manually pushed back inside. If you have this seek medical attention immediately. There are significant potential complications.

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What Are The Signs And Symptoms Of An Internal Or Prolapsed Hemorrhoid

Most often, internal hemorrhoids have no symptoms but are only found if there is bleeding with a bowel movement or if the hemorrhoid prolapses so that it can be felt outside of the anus. This may lead to itching and pain as well as the bleeding.

Prolapse of an internal hemorrhoid occurs when the internal hemorrhoids swell and extend from their location in the rectum through the anus. A prolapsed internal hemorrhoid:

• Can be felt as a lump outside the anus
• Can be gently pushed back through the anus, this may resolve the location of the hemorrhoid, but does not fix the hemorrhoid itself
• May enlarge and swell even more if it cannot be pushed back
• May become entrapped, which requires more urgent medical attention

Hemorrhoids may also cause anal itching , and a constant feeling of needing to have a bowel movement .

Internal hemorrhoid severity can be graded:

• Grade I: Prominent blood vessels with no prolapse
• Grade II: Prolapse with bearing down but with spontaneous reduction
• Grade III: Prolapse with bearing down but requiring manual reduction
• Grade IV: Prolapse with inability to manual reduction

How Can I Treat My Hemorrhoids

You can most often treat your hemorrhoids at home by

• taking a stool softener or a fiber supplement such as psyllium or methylcellulose
• drinking water or other nonalcoholic liquids each day as recommended by your health care professional
• not straining during bowel movements
• not sitting on the toilet for long periods of time
• taking over-the-counter pain relievers such as acetaminophen, ibuprofen, naproxen, or aspirin
• sitting in a tub of warm water, called a sitz bath, several times a day to help relieve pain

Applying over-the-counter hemorrhoid creams or ointments or using suppositoriesa medicine you insert into your rectummay relieve mild pain, swelling, and itching of external hemorrhoids. Most often, doctors recommend using over-the-counter products for 1 week. You should follow up with your doctor if the products

• do not relieve your symptoms after 1 week
• cause side effects such dry skin around your anus or a rash

Most prolapsed internal hemorrhoids go away without at-home treatment. However, severely prolapsed or bleeding internal hemorrhoids may need medical treatment.

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What Do External And Internal Hemorrhoids Look Like

Normal hemorrhoidal tissue cannot be seen since they must first swell and become inflamed or develop a clot to cause symptoms. One can see swollen external hemorrhoids or internal prolapsed hemorrhoids exposed outside the anus but internal hemorrhoids cannot be seen because they remain inside the anus. A thrombosed hemorrhoid will appear as a lump at the anal verge, protruding from the anus, and will be dark bluish in color because of the blood clot contained inside the swollen blood vessel. Non-thrombosed hemorrhoids will appear as a rubbery lump. Often more than one swollen hemorrhoid appears at the same time.

Hemorrhoids In Immunocompromised Patients

In general any intervention or operation should be avoided, or performed with a careful consideration in immunocompromised patients because of an increases risk of anorectal sepsis and poor tissue healing in such cases. A conservative measure is the mainstay for the treatment of hemorrhoids in this group of patients. If required, injection sclerotherapy appeared to be a better and safer alternative to banding and hemorrhoidectomy for treating bleeding hemorrhoids. Antibiotic prophylaxis is always given before performing any intervention, even a minor office-based procedure, due to the possibility of bacteremia.

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When To Seek Medical Help

Maintaining A Healthy Weight

Being overweight is another factor that may contribute to the development of haemorrhoids. You can lose weight by exercising regularly, eating a low-fat diet and moderating your alcohol intake.

More information about food and nutrition is available in our healthy eating section and from the Nutrition Australia website.

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What Are The Symptoms Of Haemorrhoids

If you have haemorrhoids you may notice bright red blood on the toilet paper or in the toilet when you have a bowel motion . There may be some itchiness, discomfort or pain around the anus. Sometimes there can be a noticeable lump that protrudes out of the anus.

Many people experience no symptoms or very mild symptoms that disappear after a couple of days. For other people, haemorrhoids are more painful.

Internal haemorrhoids are classified into 4 different types based on their degree of prolapse .

• First degree haemorrhoids often bleed a little bit when you pass a bowel motion, but stay inside the anus and are not usually very painful.
• Second degree haemorrhoids bleed and protrude out of the anus when you pass a bowel motion. Once the bowel motion is over, they disappear back inside the anus by themselves.
• Third degree haemorrhoids have to be physically pushed back inside the anus after passing a bowel motion. They may be painful if they are large.
• Fourth degree haemorrhoids are larger lumps that protrude out of the anus permanently, and cannot be placed back inside. The blood inside these haemorrhoids may clot and the lumps can become very painful.

External haemorrhoids occur as a lump outside the anus. A thrombosed haemorrhoid occurs when there is a blood clot in the skin overlying the anus this can cause severe and constant pain.

Hemorrhoids: Diagnosis And Treatment Options

TIMOTHY MOTT, MD, Naval Hospital Pensacola, Pensacola, Florida

KELLY LATIMER, MD, MPH, U.S. Naval Hospital Sigonella, Catania, Italy

CHAD EDWARDS, MD, Hamilton Medical Center, Dalton, Georgia

Am Fam Physician. 2018 Feb 1 97:172-179.

• References

Hemorrhoids develop when the venous drainage of the anus is altered, causing the venous plexus and connecting tissue to dilate, creating an outgrowth of anal mucosa from the rectal wall. However, the exact pathophysiology is unknown. Hemorrhoids occur above or below the dentate line where the proximal columnar transitions to the distal squamous epithelium . The anus is approximately 4 cm long in adults, with the dentate line located roughly at the midpoint.2 Hemorrhoids developing above the dentate line are internal. They are painless because they are viscerally innervated. External hemorrhoids develop below the dentate line and can become painful when swollen. The extent of prolapse of internal hemorrhoids can be graded on a scale from I to IV, which guides effective treatment . This grading system is incomplete, however, because it focuses exclusively on the extent of prolapse and does not consider other clinical factors, such as size and number of hemorrhoids, amount of pain and bleeding, and patient comorbidities and preferences.3

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Increasing fiber intake is an effective first-line, non-surgical treatment for hemorrhoids.

FIGURE 1.

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Can Hemorrhoids Be Prevented Or Avoided

Just about everyone has hemorrhoids at some time. But some things may make you more likely to get them. People whose parents had hemorrhoids may be more likely to get them. Pregnant women often get hemorrhoids because of the strain from carrying the baby and from giving birth. Being very overweight or standing or lifting too much can make hemorrhoids worse.

Easy Ways To Add Fiber

The tips below offer some simple ways to add more high-fiber foods to your meals.

• Start your day with a high-fiber breakfast. Eat a wheat bran cereal along with a sliced banana. Or, try peanut butter on whole-wheat toast.

• Eat carrot sticks for snacks. Theyre easy to prepare, taste great, and are low in calories.

• Use whole-grain breads instead of white bread for sandwiches.

• Eat fruits for treats. Try an apple and some raisins instead of a candy bar.

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Increasing Your Fibre Intake

You can gradually increase the amount of fibre in your diet by eating foods including:

• fresh fruit and vegetables
• nuts and seeds
• pulses

Commercial fibre supplements are also available and can be useful if you think you are not getting enough of the above foods in your diet.

Make sure you increase your fibre gradually so your digestive system has time to adapt.

Its also important to increase your fluid intake at the same time. This is because fibre in the stools acts like a sponge, absorbing moisture from the body. Try to drink lots of water. Cutting down on sugary drinks will also help you to cut down on calories that cause weight gain.

Getting Rid Of Hemorrhoids

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