Managing Hemorrhoid Issues
Jun 17, 2020 | 2941 views | 0 0 comments | 348 348 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
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Many of us have suffered from inflamed hemorrhoids. Despite their social stigma, we all have hemorrhoids. They’re vascular structures that aid in stool control.

When they become irritated and inflamed, we have symptoms – and often say we “have hemorrhoids” – when we really mean our hemorrhoids are causing us pain.

When they’re irritated, the veins in your rectum become swollen and may alternate between itchy and painful symptoms, making it hard to concentrate and uncomfortable to sit.

They usually bleed, especially during a bowel movement, which may scare us. Fortunately, hemorrhoids are not a harbinger of more serious disease.

There are two types of hemorrhoids: external, occurring outside the anus; and internal, occurring within the rectum.

Fortunately, issues with external hemorrhoids tend to be mild. Most of the time, they are treated with analgesic creams or suppositories that contain hydrocortisone, such as Preparation H, or with a sitz bath, all of which help relieve the pain.

If there is clotting of external hemorrhoids, they may become more painful, requiring medical treatment.

Internal hemorrhoid issues can be more complicated. The primary symptom is bleeding with bowel movement, not pain, since they are usually above the point of sensation in the colon, called the dentate line.

If they fall out of place, or prolapse, due to weakening of the muscles and ligaments in the colon, you may have pain and discomfort, as well.

The first step for treating internal hemorrhoids is to add fiber through diet and supplementation. Study after study shows significant benefit. For instance, in a meta-analysis by the Cochrane Systems Data Review 2005, fiber reduced the occurrence of bleeding by 53 percent.

There are several minimally invasive options, including anal banding, sclerotherapy and coagulation. The most effective of these is anal banding, with an 80 percent success rate. This is an office-based procedure where two rubber bands are place at the neck of each hemorrhoid.

To avoid complications from constipation, patients should also take fiber supplementation. Side-effects of the procedure are usually mild, and there is very low risk of infection. If the procedure fails, surgery would be the next option.

How do you prevent hemorrhoid issues? First, sitting on the toilet for long periods of time puts significant pressure on the veins in the rectum, potentially increasing the risk of inflammation.

Though you may want private time to read, the bathroom is not the library. As soon as you have finished moving your bowels, it is important to get off the toilet.

Eating more fiber helps create bulk for your bowel movements, avoiding constipation, diarrhea and undue straining. Fruits, vegetables, whole grains, nuts, beans and legumes have significant amounts of fiber.

Grains, beans and nuts have among the highest levels of fiber. For instance, one cup of black beans has 12g of fiber.

Americans, on average, consume 16 grams per day of fiber. The Institute of Medicine recommends daily fiber intake for those under age 50 of 25 to 38 grams, depending on gender and age. I typically recommend at least 40 grams.

My wife and I focus on foods that contain significant fiber, and we get approximately 65 grams per day. You may want to raise your fiber level gradually. If you do it too rapidly, potential side-effects are gas and bloating for the first week or two.

Get plenty of fluids, it helps to soften the stool and prevent constipation. Exercise also helps. Do not delay a bowel movement. Go when the urge is there or the stool can become hard, causing constipation.

If you have rectal bleeding and either have a high risk for colorectal cancer or are over the age of 50, you should see your physician to be sure it is not due to a malignancy or other cause, such as inflammatory bowel disease.
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