Just an review: scientific diagnosis of hemorrhoids

Perhaps there is no other condition that is as often misdiagnosed as hemorrhoids. Both patients and physicians tend to blame ‘‘hemor- rhoids’’ for a multitude of problems in the anorectal area, often with dangerous consequences. I have seen many cases where ‘‘hemorrhoids’’ were blamed for the patient’s symptoms and even treated for years, when the actual pathology was either a fissure, fistula, prolapse, anal papilla, or in some cases even a carcinoma.
It should be made clear right at the outset that
the diagnosis of ‘‘hemorrhoids’’ should be reached only after confirming the hemorrhoids on visual and anoscopic examination and only after other sources of anorectal symptoms have been excluded. Needless to say, if a proper history is taken and a complete anorectal exam is performed, there should be no difficulty in reaching the correct diagnosis.
As with any other medical condition, diagnosis requires a proper history and a detailed physical examination. A properly taken history and physical exam will not only help make the diagnosis of hemorrhoids but also steer the surgeon towards making the correct treatment choice for a particular patient. In my opinion, the true caliber of a colorectal surgeon can be judged not by his degrees but by the care and expertise he demonstrates in the diagnosis of common anorectal ailments such as hemorrhoids.
History taking should not be considered a menial task delegated to the most junior member of the team. Instead, a thorough and systematic approach should be taken. History should be directed not only towards the symptomatology of hemorrhoids and confirming the diagnosis but also towards excluding other more sinister conditions. In addition, a proper history should assist the colorectal surgeon in making the appropriate decisions for the treatment of hemorrhoids.
The surgeon should inquire about the nature,duration, and severity of symptoms and the extent of discomfort the hemorrhoids are causing. It is also important to get a good idea about what the patient’s expectations are. Certainly a patient who has an occasional asymptomatic prolapse and is otherwise not incapacitated by the disease may not want a painful recovery from an excisional hemorrhoidectomy. Most patients with hemorrhoids have symptoms for a long period of time before they seek medical attention. Often the patients have self-diagnosed the problem and have spent months or even years trying to treat themselves with over the counter medications or ointments. Some patients, however, especially those with a nervous predisposition, present early or even after a single episode of bright red rectal bleeding. While taking the history, the proctologist should focus on the following aspects:

Age: Most patients who develop hemorrhoids are between the ages of 30 and 50. In patients who present at an unusually early age, extra care should be exercised in excluding other diagnostic possibilities such as inflammatory bowel disease, juvenile polyps, polyposis syndromes, etc. On the other hand, in older patients, the diagnosis of carcinoma should always be borne in mind.

Gender: Hemorrhoids occur in both sexes. How ever, pregnancy and childbirth are the prime causes of hemorrhoids in young females. The hormonal milieu of pregnancy, venous congestion, and increased pelvic pressure in late pregnancy and delivery all contribute to the development of hemorrhoids. Once the pregnancy is over, the hemorrhoids tend to improve over the next few months.

Medical history: Some patients with leukemia or bleeding diathesis will have complications from hemorrhoids. Others may be on anticoagulants, nonsteroidal antinflammatory drugs, or Plavix1. These patients will also have a tendency to bleed. If surgery is being contemplated, these drugs will have to be stopped before surgery. Patients who smoke should be counseled to stop before surgery.

Family history: Family history should include questions directed towards excluding familial col- orectal neoplastic syndromes. In certain individuals, there may be a genetic predisposition towards development of hemorrhoids. The vein walls or venous valves may be weak. These patients will have a positive family history of hemorrhoid problems.

Bowel habits: (a) Excessive straining will predispose to hemorrhoids. Some individuals habitually strain for a bowel movement. Such constant pressure causes engorgement and stretching of the vascular anal cushions. Ultimately the supporting connective tissue holding the vascular cushions is stretched and broken and the vascular cushions slide downward, presenting as hemorrhoids. 
(b) Some patients with chronic constipation suffer from hemorrhoid problems. It is not clear if constipation causes hemorrhoids but constipation and straining can certainly aggravate hemorrhoids. The combination of constipation and ‘‘hemorrhoids’’ should always raise the possibility of a low-lying rectal cancer.
(c) On the other hand, patients with chronic diarrhea also develop hemorrhoids. Tenesmus from diarrhea does cause straining, and the constant irritation from loose stools will also damage the delicate hemorrhoidal veins. The combination of diarrhea and hemorrhoids should also raise the possibility of inflammatory bowel disease.

Dietary habits: The surgeon should enquire about the adequate intake of water and fiber in diet. Lack of fiber in diet is perhaps the most common predisposing factor in the development of hemorrhoids. The intake of constipating foods such as cheese and milk should be ascertained. On the other hand, diarrhea may be caused by beer, citrus fruits, lactose intolerance, and caffeine, once again aggravating the symptoms of hemorrhoids. Treatment of hemorrhoids without correcting these simple factors is doomed to fail.

Social history: It is important to enquire about social issues and lifestyle before embarking upon treatment of hemorrhoids. Treatment of hemorrhoids without correcting these factors is destined to failure: (a) Spending hours or reading books on the bathroom commode, while attempting to defecate, is an ominous sign, and any operative treatment in these patients is doomed to fail unless the habit is broken before embarking upon surgery. If the patient continues to strain for defecation after surgery, the hemorrhoids are sure to recur. (b) Some athletes, such as weight lifters and tennis players, exert themselves in extreme bursts of muscular activity which raises the intraabdominal pressure and can be associated with prolapse of internal hemorrhoids or thrombosis of external hemorrhoids. (c) Hemorrhoids may also become aggravated and irritated in patients who practice anorectal intercourse. In these patients, it is important to exclude other diseases such as abscess, fissure, or ulcers, and to evaluate the immune system before undertaking treatment. (d) Prolonged sitting and lack of activity has also been reported to predispose to hemorrhoids.

 Azzimudin Kawajja
Surgical Treatment of Hemorrhoids

Straightforward Guidance And Tips For Coping With Hemorrhoids

The first time you get hemorrhoids may have you should go see a doctor because of the doctor. The doctor will give you an exam and then advise you about treatment options. They should not require prescription medicines.

Take stool softener on a regular basis.Pushing hard when moving your bowels can increase the pain and may make you more susceptible to issues.

This cushion is designed specifically to provide maximum comfort as you deal with hemorrhoids.

Drink a lot of water and supplement your diet with high fiber items if you suffer from hemorrhoids. Softer stools prevent hemorrhoids because there won't be as much strain. You can increase your consumption of specific fruits,such as melons and papaya, and papaya to help soften your stool. Veggies like okra and cabbage also contain fiber which will help the process since they have a lot of fiber. Drink plenty of water during the day to increase the effects.

Aloe Vera juice is a product that will help loosen bowels when ingested. Drinking more than the recommended amount can give you stomach discomfort.

Hemorrhoid pads are the best over the counter to treat hemorrhoids.These pads provide a safe to use on hemorrhoids.

Ice is usually pretty good for hemorrhoid pain.Hemorrhoids can cause a good bit of discomfort and pain. An ice pack will help reduce both pain and pain. Alternate the use of an ice pack with the use of a warm compresses. You can reduce the size of your hemorrhoids by alternating sitting in a warm bath and using an ice pack to the inflamed area.

Steer clear of caffeinated beverages, hot foods and caffeine.These foods have an irritating affect on your hemorrhoids. In fact, eating spicy foods can inflame hemorrhoids to a point of painful burning, so it is best to avoid them.

While hemorrhoids are probably to blame, check with your doctor to make sure. Blood in the stool or bleeding from the rectum can signal a more serious illness, even cancer. Get your condition diagnosed to know exactly what you can stop worrying.

Water is an effective way to reduce the symptoms of hemorrhoids. Soak in lukewarm water for 10 minutes after passing a bowel movement and then try using cold wet towel to reduce the inflamed area. You might consider investing in a sitz bath from your local pharmacy.

Sit in a warm bath while keeping your knees. The warm water should make the inflammation and reduce inflammation. Warm water will help blood to get to the hemorrhoid, and helps reduce swelling and pain.

When fighting hemorrhoids, avoid exposing irritated and inflamed tissues to personal hygiene products which have dyes, oils or dyes in them, and fragrances.

You can find comfort if you're suffering from hemorrhoid pain in a number of places. Take several, for about ten minutes each time. Another way to combat the pain and discomfort of hemorrhoids is to apply a cold pack to the affected area.

Drink lots of water if you suffer from frequent hemorrhoids.Keeping yourself properly hydrated can help to soften your stool. You should avoid alcohol or products with caffeine.

Increasing your fiber you are having a hemorrhoid flare-up. Hemorrhoids can be created because you have been excessively straining through bowel movement. This will help your hemorrhoids heal and prevent hemorrhoids.

A sitz bath after each bowel movement when you are having hemorrhoid issues. This soothes the inflammation and itchiness that remains afterwards. After the bath is complete, pat dry your buttocks instead of rubbing them.

Do not sit on the commode until you need to go. While you're sitting, they may actually be straining without thinking about it. Gravity also plays a part in affecting your hemorrhoids, so ensure that you are ready to go before you sit on the toilet.

If you are eating food high in sugar and fat, you are just exposing yourself to the bloating, discomfort and bloating, which can make hemorrhoids harder to take care of.

It is possible to push hemorrhoids back into the anus. This treatment is not for the squeamish - or for severe cases - but minor hemorrhoids can be pushed back in, but the minor hemorrhoids may be pushed back gently and carefully. Hemorrhoids can be protected inside your anus and are less likely to suffer irritation or itch.

You can soften your stool softer by consuming plenty of fruit and fruits.

A paste comprised of water and powdered myrrh could help reduce both swelling and pain. Put this on the hemorrhoids and let it sit for 30 minutes. You can get powdered myrrh at beauty stores and health stores.

One of the things that cause hemorrhoids is pushing too much straining during bowel movements. Eating fewer processed foods and drinking plenty of water will allow the stools to come out easier. Squatting can also help pass a bowel movements without straining. Use a small stool that is placed underneath of your feet when you go to the toilet.Hemorrhoids are less common occurrence among places in the world where the people squat to produce a bowel movement.

A long-term effective treatment for uncomfortable and painful hemorrhoids from forming is to eat plenty of fiber. Include fiber-rich foods like leafy green vegetables, whole grain breads, leafy greens, wheat pasta and oatmeal. Fiber encourages bowel motility and helps ease strain that can cause hemorrhoids.

As previously mentioned, seeing a physician generally isn't necessary if you develop hemorrhoids. Most people use home treatment and prevention methods, such as eating a nutritious diet that includes plenty of fiber, grains, and vegetables, staying well-hydrated with water, and exercising routinely.