Hemorrhoids
Hemorrhoids are one of the most frequent problems people in westernized countries face. An estimated 50 percent of those over the age of 50 years require some type of conservative or operative therapy. (4)
There are estimates of up to 75 to 90 percent occurrence rates of hemorrhoids in the U.S. population (1, 2, 3, 4, 5).
The cost to the community, both financial and in lost work days, is great; and by any standards, this condition must be considered a major health hazard (7).
Hemorrhoids have plagued men and women for centuries, inflicting pain equally on individuals at all levels of society and of all occupations: Emperors (Napoleon); U.S. Presidents (Jimmy Carter); baseball sluggers (George Brett); judges; policemen; truck drivers; cab drivers; and jockeys (6). It has been said that Napoleon’s hemorrhoids were troubling him during the battle of Waterloo (7, 9).
“I saw a sign one time that said ‘Hemorrhoids awareness week’ at the doctor’s office. Let me tell you, if you got hemorrhoids, I am sure you are aware of it. You don’t need a sign to tell anybody about it.”
Larry the Cable Guy
What are hemorrhoids?
A hemorrhoid is defined as “a mass of dilated, tortuous veins in the ano-rectum involving the venous plexuses of that area.”
Taber’s Cyclopedic Medical Dictionary, Edition 18
There are internal hemorrhoids and external hemorrhoids. Internal hemorrhoids are higher up in the rectum and cause rectal bleeding. External hemorrhoids protrude into and beyond the anal opening and cause itching, swelling, bleeding and pain. People with external hemorrhoids seek relief from products such as “Preparation H.”
Hemorrhoids in The Western World
Today, hemorrhoids are considered to be one of the most common ills of men and women, a judgment made by those with vision limited to the Western World (7).
Hemorrhoids in “Third World Countries”
The high rate of hemorrhoids in westernized societies contrasts sharply with Third World countries. Only about one in 25 to one in 30 individuals is thought to have hemorrhoids compared to one in two individuals in Westernized societies. One doctor recounted in 30 years’ practice in Africa, one of the only two patients he saw with severe hemorrhoids was a prince taking a semi-European diet (5, 7).
What causes hemorrhoids?
Hemorrhoids are thought to be caused by, or associated with, increased intra-abdominal pressure resulting from:
- chronic straining to pass constipated stools,
- heavy physical work, or
- the effects of erect posture (3).
If constipated, hemorrhoids tend to worsen. Try not to strain when you have a bowel movement. Eat a diet high in fiber; and, if necessary take a fiber supplement daily with a lot of water.
Pregnancy is a risk factor for hemorrhoids
“About 40 percent of pregnant women develop symptoms they attribute to hemorrhoids (Simmons, S. C. 1972).”
Pregnancy may predispose women to hemorrhoids because of:
- a) increased intra abdominal pressure from the pregnant uterus,
- b) constipation,
- c) hormonal venous dilation (hemorrhoidal tissue contains high levels of estrogen receptors, Saint-Pierre, A., et al., 1982), and
- d) increased circulating blood volume (3).
Hemorrhoid problems are more common in pregnancy. The large uterus can compress veins which return blood from the legs and rectum promoting swelling. Also labor and delivery generates tremendous stress on hemorrhoids. Manage hemorrhoids the best you can before and after labor and delivery of your baby.
Hemorrhoids are common among driving workers
External compression from poorly designed seating concentrates forces on small areas of the body. This results in high localized pressure.
The pressure can compress nerves, vessels, and other soft tissues, resulting in tissue-specific damage. These changes may themselves result in disease or predispose other tissues to damage.
Medical studies have shown a high rate of hemorrhoids among truck drivers, cab drivers, and even police officers. This could be due to the additional ergonomic risk factor of vibrations during driving.
Heavy lifting, standing in the cold and medications can aggravate hemorrhoids
Heavy lifting aggravates the problem. Try to avoid it.
Standing out in the cold with insufficient clothing causes you to shiver and tense your abdomen, which is considered to be straining by some doctors. The recommendation is to stay bundled up when standing out in the cold.
Also medications, such as codeine, can cause constipation which could cause a hemorrhoidal flair up.
Minimize external compression to reduce risk factors for hemorrhoids
Preventative measures to reduce risk factors for the development of hemorrhoids should be taken before it is too late. It is important to minimize external compression from poorly designed seating as much as possible.
Standing can cause hemorrhoids to swell
“Also, when you are standing, the pressure in your hemorrhoids increases, and they tend to swell more. Periods of rest — sitting and especially lying down — can be very beneficial if you are suffering with hemorrhoids.”
Joseph R. Duba, M.D., “Understanding Hemorrhoids”
Hemorrhoids are the most common cause of rectal pain and/bleeding
The term hemorrhoids can be misleading because patients often attribute all rectal complaints to hemorrhoids. Rectal pain and/or bleeding are common complaints among the general population. Hemorrhoids are the most common cause of these complaints.
Discuss hemorrhoidal symptoms with your doctor
The public and some members of the medical profession deem these symptoms, which are commonly attributed to hemorrhoids, harmless. However, the same set of symptoms can herald serious colorectal disease. Feelings of embarrassment or apprehension about treatment may make individuals reluctant to discuss rectal symptoms with their physician (4).
Do not be embarrassed to discuss rectal problems with your care-giver because if it is discovered to be colorectal cancer, and it is detected early, there is an 85 percent cure rate (2).
Industrialized Countries at Increased Risk of Colorectal Cancer
Industrialized countries are at a relatively increased risk (for colorectal cancer) compared to less developed countries that traditionally had high fiber/low fat diets.
“This point is exemplified by the fact that persons from a low risk country who migrate to the United States over time develop colorectal cancer rates similar to those among native U.S. citizens.”
Fry, R., et al., 1989; Levin K., et al., 1991
Smoking Increases Risk of Colorectal Cancer
“Cigarette smoking and alcohol consumption have been reported to increase the relative risk of an individual to develop colorectal cancer, (Kune, G., et al. 1992; Martinez, M., et al., 1995).”
Complaints that can be Confused with Hemorrhoids
“Anorectal disorders represent some of the most common yet poorly understood conditions in primary care.” (2) Patients often attribute all anorectal complaints to hemorrhoids.
Other conditions include:
- Anal fissures (tares);
- Anorectal abscesses (infection);
- Fistula (channel) ;
- Incontinence;
- Pruritus ani (itching and burning of the anal skin);
- Infectious proctitis (rectal inflammation);
- Hidradenitis suppurativa (disease of sweat gland);
- Condyloma acuminatium (genital warts);
- Anal carcinoma (cancer).
Anal fissures
Anal fissure – A fissure is a crack or tear in the anal mucosa usually caused by the passage of a hard stool. “Nearly half of the patients present with the complaint of hemorrhoids,” (Mazier, WP, 1994).
Anorectal abscess
Anorectal abscess – An anorectal abscess results from cellulitis or infection (Stahl T.H., 1992). Anorectal abscesses usually are obvious, producing diffuse swelling, redness, and pain around the anus. Most abscesses are aggravated by sitting, coughing, sneezing and defecation (Goligher, J., et al., 1984).
Anal fistula
Anal fistula – A tract from the rectum to the surrounding skin that bowel contents can escape from. Anal fistulas are predominantly found in middle aged men. (Goligher J. et al., 1984)
Anal incontinence
Anal incontinence – Loss of control of flatus and feces. Young patients with incontinence may suffer enlargement of the colon from chronic constipation or trauma to the anal sphincter apparatus (Goligher, J. Et al. 1984).
“Older women are particularly at risk for incontinence due to progressive denervation (loss of nerves) of the pelvic floor musculature (muscles) from prior birth-related injury.”
Toglia, M.R., 1996
Pruritus ani
Pruritus ani – intense itching and burning discomfort of the perianal skin.
Excessive cleaning of the anal area with soap and water can cause big problems if you are suffering with hemorrhoid pain / irritation because you remove the natural oils from the area. The area should be kept lubricated with Vaseline if necessary.
When you are having external hemorrhoid pain/irritation, make sure that you use toilet tissue with added lotion, (for example Puffs Plus).
Proctitis
Proctitis – an inflammation limited to the distal 10 cm of the rectum (Centers for Disease Control and Prevention, 1993).
Hidradenitis suppurativa
Hidradenitis suppurativa – a chronic inflammatory disease of the sweat glands of the skin (Goligher, J. Et al., 1984). It is usually common in people with oily skin.
Anal condylomas
Anal condylomas – warts are caused by the human papilloma virus (HPV). It is known that HPV is linked to cervical cancer in women. “Anal warts appear to be most common in young men especially those engaging in anal intercourse,” (Tedesco, F., et al., 1980).
References:
1. Primary Care, Volume 26, Number 1, March, 1999, “Hemorrhoids,” by Joy N. Hussain, M.D., Cairns Base Hospital, Australia.
2. Family Medicine Principles & Practices, 1998, Fifth Edition: Chapter 91, “Diseases of the Rectum and Anus,” by Thomas J. Zuber; 2b.
3. Family Medicine Principles & Practices, 1998, Fifth Edition: Chapter 92, “Colorectal Cancer,” written by Gregory L. Brotzman and Russell G. Robertson.
4. MJA, Vol. 167, July, 1997, Clinical Practice, “Hemorrhoids: A Clinical Update,” written by Adrian L. Polglase, M.S., FRACS, Clinical Associate Professor and Colorectal Surgeon, Australia.
5. American Family Physician, September 1, 1995, “Non-surgical Treatment Options for Internal Hemorrhoids, written by John Pfenninger, M.D., and James Surrel, M.D.
6. Surgical Clinics of North America, Vol. 65, No. 6, December, 1988, “Hemorrhoids, Non-operative Management,” written by A. R. Dennison, M.D.; D.C., Wherry, M.D.; and D.L. Morris, M.D., Ph.D.
7. Southern Medical Journal, Vol. 81, No. 5, May, 1988, “Alternatives in the Treatment of Hemorrhoidal Disease,” by Emmet F. Ferguson, Jr., M.D., University of Florida, School of Medicine, Jacksonville, F.L., U.S.A.
8. Postgraduate Medical Journal, September, 1975, 51, 631-636, “Hemorrhoids – Postulated Pathogenesis and Proposed Prevention,” written by D. P. Burkitt, C.M.G., M.D., F.R.C.S., F.R.S., and C.W. Graham-Stewart, MS, F.R.C.S.
9. The American Journal of Proctology, Vol. 21, No. 3, June 1970, “An Epidemiological Investigation of Hemorrhoids, written by John Philpot, Ph.D., Rutgers, The State University, New Jersey, U.S.A
10. “Napoleon’s Hemorrhoids and Other Small Events that Changed,” History by Phil Mason
