Diet high in fiber can ease this pain

Ask The Expert Robert Akbari St. Joseph Medical Center

March 23, 2009|By Liz Atwood | Liz Atwood,

Hemorrhoids are swollen and inflamed veins in the anal area. Also called piles, this common condition can be quite painful. Often a modification in diet is all that is needed to reduce the discomfort, says Dr. Robert Akbari, colorectal surgeon at St. Joseph Medical Center in Towson.

What causes hemorrhoids?

They are largely blamed on the low-fiber Western diet, which is constipating. People who strain a lot with a bowel movement are more prone to develop them. Pregnancy, with changes in hormones and bowel movements, can lead to hemorrhoids. Expectant mothers can either develop new hemorrhoids, or their old ones can get a lot worse.

How common are they?

They are very common in men and women of all ages. Even kids can get them. Hemorrhoids have played a role in history, believe it or not. It's said that hemorrhoids may have contributed to General Napoleon's loss of the Battle of Waterloo. He apparently had a hemorrhoid flare and couldn't sit down on his horse due to the pain. The battle was postponed by three hours, and he may have not been in top form.

How are hemorrhoids diagnosed?

They are diagnosed by a physical examination by a doctor.

Are there health risks associated with the condition?

Not for the most part. However, if you are on blood thinners or have liver cirrhosis, hemorrhoids can bleed significantly.

When should one see a doctor?

If someone suspects he has a hemorrhoid, he should see a doctor because a hemorrhoid can easily be confused with other conditions that have similar symptoms, such as an abscess, anal fissure, anal fistula or even cancer. All these conditions can masquerade as hemorrhoids.

What are the treatment options?

Eighty percent of hemorrhoids can be managed in an office setting. Treatment begins by having the patient increase fiber intake and drink more fluids. Sometimes I recommend a supplemental fiber product. The over-the-counter topical creams do not cure or get rid of hemorrhoids, but they can offer some relief. Fiber can help prevent new hemorrhoids and can shrink old hemorrhoids.

Another treatment is banding, which is something done in the office, in which a small rubber band is applied, and the hemorrhoid eventually falls off.

Thrombosed hemorrhoids are a type of hemorrhoid that contains a blood clot and is very painful. Although we don't know exactly what causes the blood clot, it's probably stagnant blood flow in a very swollen hemorrhoid that causes the clot. These patients often cannot sit down due to the pain. These patients often end up in the emergency department. To treat this, a hemorrhoid thrombectomy, which is a bedside procedure, can be done. There are other bedside-procedure options as well.

If these treatments don't work, there are two main surgical options. These may be needed for the larger, more symptomatic hemorrhoids - the ones that are extremely painful, prolapsing (which means jutting out) and bleeding. There is a standard closed hemorrhoidectomy, also called a Ferguson hemorrhoidectomy. The other is a PPH procedure, which is where we use a circular stapler. The downside is that recovery from either surgery can be uncomfortable. They do, however, take care of the hemorrhoids in one shot.

Are there risks associated with these treatments?

Any operation has risks, which is why we don't rush into it. The most common risk is bleeding, which is usually minor. ... There are also small risks of infection and changes in bowel continence.

Can hemorrhoids go away without intervention?

This goes back to dietary modification, with which they may shrink away to nothing. Larger hemorrhoids are less likely to disappear on their own.

How can hemorrhoids be prevented?

A high-fiber diet can prevent hemorrhoids. I also feel that Americans have more hemorrhoids because of the Western toilet being more comfortable. In other cultures, people squat down and are quick and brief. Americans read books and newspapers and take their time. The more time you spend pushing, the more you can cause the veins to swell.

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