Hemorrhoids

Definition




Endoscope view of internal hemorrhoids in a patient's anus. Hemorrhoids are swollen veins in the lining of the anus.





Endoscope view of internal hemorrhoids in a patient's anus. Hemorrhoids are swollen veins in the lining of the anus.
(David M. Martin, M. D./Science Source)

Origins

Ten million people in the United States have hemorrhoids, leading to a prevalence of greater than 4%. Up to one-third of these people require medical treatment, resulting in 1.5 million prescriptions per year. The peak age for hemorrhoids is 45–65 years. The term hemorrhoid is usually related to symptoms caused by hemorrhoids. Hemorrhoids can occur in healthy individuals. It is when they become enlarged, inflamed, or prolapsed that most people refer to the condition as hemorrhoids. They are rarely a serious risk to health and result from too much pressure on the hemorrhoi-dal veins in the rectum. The strain of constipation, diarrhea, or pregnancy can cause the veins to swell. Other factors such as obesity and liver disease can also increase pressure and cause hemorrhoids. There are three types of hemorrhoids:

In the absence of complications, treatment usually involves over-the-counter corticosteroid creams that can reduce the pain and swelling of hemorrhoids and bathing in tubs with warm water to ease painful peria-nal conditions. Another important step in treating hemorrhoids is to relieve anal pressure and straining. This can often be done by controlling constipation with a high-fiber diet.

Description

Foods that are high in fiber have been shown to help in the treatment of constipation and hemorrhoids. The American Academy of Family Physicians recommends the following simple dietary guidelines to prevent or lower hemorrhoids symptoms:

In its most recent public health recommendations for dietary fiber, the National Academy of Sciences established an adequate intake (AI) level of 38 g of total daily fiber for males 19–50 years of age and 25 g for women in this same age range. The following foods are excellent sources of dietary fiber and can be included as part of a hemorrhoid diet:

KEY TERMS
Anus—
The terminal opening of the digestive tract.
Colon—
Part of the large intestine, located in the abdominal cavity. It consists of the ascending colon, the transverse colon, the descending colon, and the sigmoid colon.
Constipation—
The difficult passage of stools or the infrequent (less than three times a week) or incomplete passage of stools.
Digestive system—
Organs and paths responsible for processing food in the body. These are the mouth, the esophagus, the stomach, the liver, the gallbladder, the pancreas, the small intestine, the large intestine, and the rectum.
Feces—
Waste product of digestion formed in the large intestine. About 75% of its mass is water; the remainder is protein, fat, undigested roughage, dried digestive juices, dead cells, and bacteria.
Perianal—
The area surrounding the anus.
Prolapse—
The falling down or slipping out of place of an organ or part.
Rectum—
Short, muscular tube that forms the lowest portion of the large intestine and connects it to the anus.
Venous return—
The blood returning to the heart via the inferior and superior venae cavae.

Function

Eating more high-fiber foods such as fruits, vegetables, and grains softens the stool and increases its bulk, which helps to reduce the straining that can cause hemorrhoids or worsen the symptoms of existing hemorrhoids.

Benefits

Fiber helps to keep stool soft while lowering pressure inside the colon so that bowel contents can move through easily. Eating a high-fiber diet will not only relieve constipation and alleviate hemorrhoid symptoms, it is also beneficial in supporting bowel regularity, maintaining normal cholesterol and blood sugar levels, and keeping excess weight off. Additionally, a high-fiber diet is believed to play a role in the prevention and treatment of the following health conditions:

Precautions

Intake of dietary fiber exceeding 50 grams per day may cause intestinal obstructions. Excessive intake of fiber can also result in body fluid imbalance and dehydration. This is why individuals who start increasing their fiber intake are often advised to also increase their water intake to 2 liters (8 cups) of fluid daily.

Risks

When people increase the fiber content of their diet, they are usually advised to do so gradually, adding small amounts to start with to allow the intestinal tract to adjust. Otherwise, abdominal cramps, gas, bloating, and diarrhea or constipation may result. Excessive intake of dietary fiber has also been linked with reduced absorption of vitamins, minerals, protein, and calories. However, it is unlikely that healthy adults who consume fiber in amounts within the recommended ranges will experience such problems.

QUESTIONS TO ASK YOUR DOCTOR

Research and general acceptance

Most medical experts agree that low-fiber diets result in small stools that increase straining during defecation. This increased pressure causes congestion of the hemorrhoids. Pregnancy can also cause hemor-rhoidal problems. A decreased venous return is believed to be the mechanism of action. Prolonged sitting on a toilet, for instance while reading, is also thought to cause a venous return problem in the peria-nal area, resulting in enlarged hemorrhoids. Aging also weakens the anal support structures, which facilitates prolapse. Weakening of support structures can occur as early as the third decade of life. There is agreement among health practitioners that the best way to prevent hemorrhoids is to keep stools soft so that they can pass easily and to empty bowels as soon as there is an urge. Waiting to pass stool may cause it to become dry and harder to pass.

See also Constipation ; Digestive diseases ; Fiber ; High-fat, low-carb diets ; High-fiber diet .

Resources

BOOKS

Lahr, Christopher. Why Can't I Go?: Answers and Relief for Women with Constipation. Charleston, SC: Sunburst Press, 2004.

Wood, Gayle K. The Complete Guide to Digestive Health: Plain Answers about IBS, Constipation, Diarrhea, Heartburn, Ulcers, and More. Peachtree City, GA: FC&A, 2006.

PERIODICALS

Lohsiriwat, Varut. “Hemorrhoids: From Basic Pathophysiology to Clinical Management.” World Journal of Gastroenterology 18, no. 17 (May 7, 2012): 2009–17.

WEBSITES

Mayo Clinic staff. “Hemorrhoids.” MayoClinic.com . http://www.mayoclinic.com/health/hemorrhoids/DS00096 (accessed April 5, 2018).

ORGANIZATIONS

American Gastroenterological Association, 4930 Del Ray Ave., Bethesda, MD, 20814, (301) 654-2055, Fax: (301) 654-5920, member@gastro.org, http://www.gastro.org .

International Foundation for Functional Gastrointestinal Disorders, PO Box 170864, Milwaukee, WI, 53217, (414) 964-1799, (888) 964-2001, Fax: (414) 964-7176, iffgd@iffgd.org, http://www.iffgd.org .

National Digestive Diseases Information Clearinghouse, 2 Information Way, Bethesda, MD, 20892–3570, (800) 891–5389, TTY: (866) 569–1162, Fax: (703) 738–4929, nddic@info.niddk.nih.gov, http://www.digestive.niddk.nih.gov .

Monique Laberge, PhD

  This information is not a tool for self-diagnosis or a substitute for professional care.