'Roid rage & Anal care: lets talk about hemorrhoids!

Happy Mother’s Day! Dedicating this post to a super common #momprob—hemorrhoids.

What are hemorrhoids? Hemorrhoids are veins in the anal wall. They can become dilated, engorged with blood, and even form a blood clot.

Are they common? Studies show the prevalence of symptomatic hemorrhoids is 4.4% but it is likely much, much higher. Peaks between age 45-65.

Risk factors? Older age, pregnancy, pelvic tumors, prolonged sitting, straining, chronic constipation, diarrhea, and anticoagulation/antiplatelet therapy

Tell me more about hemorrhoids in pregnancy?! 35% of women studied experienced anal issues postpartum, with 20% having thrombosed external hemorrhoids and 15% having anal fissures. Larger infants and traumatic delivery are possible risk factors

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Symptoms? Bleeding, prolapse, itching and pain if there is a thrombosis (hard blood clot)

 

There are 2 types of hemorrhoids- internal and external. Let's get into the detail. 

Internal hemorrhoids

- originate above the dentate inside the rectum  (“superior hemorrhoidal plexus”)

- not seen from outside unless the prolapse (fall out)

- not sensitive to pain, touch, or temperature

- CAUSE:  loss of connective tissue support and resulting prolapse, so veins are more susceptible to trauma from straining or passing of hard stool

- More likely to cause symptoms with constipation, loose stools, or if you sit on the toilet for prolonged periods of time

- Types

  1. grade I may bleed but do not prolapse
  2. grade II protrude with pooping and reduce spontaneously
  3. grade III prolapse and require manual reduction
  4. grade IV remain prolapsed, high risk for blood flow to get cut off

External hemorrhoids

- below the dentate line(“inferior hemorrhoidal plexus”)

- seen and felt from outside

- Can be extremely painful if they get thrombosed (blood clot) and will feel hard, look blue.

 

Treatment:

INCREASE water intake (6-8 glasses daily)

- INCREASE fiber intake with a high-fiber diet or fiber supplement (20-30 g daily) (keep a fiber diary!)—this is a lifetime commitment as it will prevent recurrence of these bothersome little piles

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  • A meta-analysis of seven trials found a significant and consistent benefit from fiber supplementation in improving bleeding (RR 0.50, 95% CI 0.28-0.68)

- AVOID straining and prolonged time on the toilet (if you use the squatty potty it will help!!)

- If stools remain hard, start stool softeners (docusate sodium, "Colace"), and if that doesn't work-- add polyethylene glycol 3350 ("miralax")

-  Proper anal hygiene! Delicate washing of the anal area and avoidance of aggressive wiping with harsh tissue (itching is usually due to fecal soiling of the perianal area!)- splurge on the good super soft toilet paper! A topical astringent such as witch hazel is great for cleaning and getting your bum so fresh & so clean, clean!

- Sitz baths (literally a “sitting bath” for your bum)

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  • Just pour warm water (don’t add anything) into a basin (or buy a kit at a drugstore) and sit your bum in it for 10-15min 2-3x/day
  • You can also just fill up a bathtub with 2-3 inches of warm water and sit in it
  • Afterward, towel or blow dry (low heat!) the anus area well to avoid moisture retention which can lead to symptoms
  • Relieves irritation, pain, and itching by relaxing the internal anal sphincter and improving blood flow to the anal mucosa

- Topical creams such as Preparation H Cream (phenyleph-min oil-petrolatum) or Anusol-HC cream (glucocorticoid-based) may temporarily improve pain or itching (use for one week MAX)

- When medical treatment fails, talk to your doctor about aggressive treatment...

  • Rubber band ligation (grades 2 or 3 internal hemorrhoids)
  • Sclerotherapy (grade 1 and 2 bleeding internal hemorrhoids)
  • Infrared coagulation (grades 1 or 2 bleeding internal hemorrhoids)
  • Surgery (grade 4 (sometimes 3) internal hemorrhoids or painful thrombosed external hemorrhoids or failed all other conservative therapy).

Hemorrhoids are the WORST. Prevent them with proper anal care as outlined above and keep that anus looking & feeling good!