Hemorrhoids can be classified into two types – Internal and External. Internal haemorrhoids lie far enough inside the rectum to be seen or felt. They don’t really hurt that much because there are very few nerve endings to sense the pain. However, External haemorrhoids lie in the anus and are usually painful. Sometimes blood clots in external hermorrhoids causing a condition known as thrombosis which is extremely painful. Although this condition may look frightening, it may not be serious and in most cases resolves itself within a week. Hemorrhoids is very common and almost 40% of the general population is affected by it during sometime in their life.
Hemorrhoids in the true sense are vascular structures that help with stool control in the anal canal. They become diseased when swollen which can occur internally or externally (as explained above) and cause pain if thrombosed. There are a number of factors that can be responsible for this condition, the most common of which is irregular bowel habits including constipation and diarrhea. Other causes include increased intra-abdominal pressure which happens due to prolonged straining and pregnancy. Factors like low fibre diet, lack of exercise and obesity might also be held responsible. In order to prevent thrombosed hemorrhoids, an appropriate amount of fibre and fluid intake is mandatory. Avoiding caffeine and bulk forming laxatives as well.
It is a common misconception that there is only one method of treating thrombosed hemorrhoids and that is surgical. However that is definitely not the case. There are various methods of treating hemorrhoids that are not surgical.
Non-surgical conservative treatment generally includes increasing the amount of fibre in the diet and staying hydrated using oral fluids. Non-steroidal anti-inflammatory drugs and rest are other ways of conservative treatment. The increase in the fibre intake can be achieved by both, increasing the number of fibre rich food in the diet and taking fibre supplements. Steroid containing agents should be used with care and should not be used more than 2 weeks since they cause thinning of the skin.
Rubber band litigation is a technique in which a rubber band is applied to the base of the haemorrhoid. This causes blood flow to stop and hence causes withering of the hemorrhoid. Within a week the hemorrhoid becomes withered and falls off. However this is a treatment for internal hemorrhoid which is at least 1cm above the dentate line. That is because if the hemorrhoid is too close to the dentate line, intense pain results just after the application of the elastic band. There is a another method of treatment called sclerotherapy in which the hemorrhoid is injected with a sclerosing agent (for eg. Phenol) which causes the vein walls to collapse and hence the hemorrhoid shrivels up.
In cases where simple procedures and conservative management fail, surgical practices need to be used. However surgical excision is done only for severe cases since it runs the risk of bleeding, infections, urinary retention and anal strictures.
It is best to avoid hemorrhoids by having a fibre rich diet, appropriate fluid intake and regular bowel habits. Prevention is always better than cure.