My Hemorrhoid Pain Was So Bad, I Could See Why People Have Surgery

As a medical writer, my friends often share their health adventures with me. Now that I’m in my 50s, the stories get more interesting. A friend told me recently he had hemorrhoid surgery. A high school swim and tennis coach, he’s the picture of health. So, I was a bit surprised that he needed surgery.

But then I had a days-long bout of terrible hemorrhoid pain and could totally understand why lots of people get a hemorrhoidectomy. Just like it sounds, this is surgery to remove hemorrhoids. Hemorrhoids are swollen veins either inside your rectum or on the anus. They show up right where poop leaves your body.

I’ve been dealing with constipation – a common cause of hemorrhoid pain – my whole life. So going to the bathroom has never been fun for me. But recently, I felt throbbing pain not just when going to the bathroom. I was in pain when I sat, stood, or lay down. For three days.

I was in tears by the time I called my doctor’s office. I thought for sure I had something more severe.

What You Think is

Hemorrhoid Pain Could Be Something Else

Interestingly, hemorrhoids are often not the cause of severe rectal pain, explains colon and rectal surgeon Traci Hedrick, MD.

“People have a lot of misconceptions about hemorrhoids,” Hedrick says. “When someone has rectal pain, they automatically assume it’s hemorrhoids. It’s not actually hemorrhoids for about 40 to 50% of the people I see, who come and complain of hemorrhoids. It’s more commonly a tear in the lining of the anus. So, it’s important to get an accurate diagnosis.”

1 of 3 things can cause sudden and severe rectal pain, Hedrick says:

1. A firm and purple (thrombosed) hemorrhoid that you can feel on the outside of the anus. This happens when a blood clot forms inside a hemorrhoid.
2. A tear in the lining of the anus (anal fissure). This can be caused by a severe bout of constipation or diarrhea. You can develop a skin tag that looks like a hemorrhoid but is swelling that the tear causes.
3. An anal gland infection (perirectal abscess) that Hedrick describes as “horribly, horribly painful.”

Get Urgent Care But Skip the ER

If you have severe rectal pain that doesn’t go away, call your primary care provider so they can refer you to a colorectal surgeon at the UVA Digestive Health Center. “You really need to be seen by someone who deals with this a lot. We have urgent appointments available for very severe pain. We have clinic 4 days a week and even 5 days if we need to,” Hedrick says.

Relief for Rectal Pain

You can usually treat an anal tear with a cream, but it sometimes requires surgery. Antibiotics can treat abscesses, which usually need to be drained when they don’t pop on their own.

You can treat most hemorrhoids by:

• Applying hemorrhoid cream from your local drugstore
• Sitting in warm water for 10-15 minutes a few times a day

• Not straining while going to the bathroom

• Drinking plenty of fluids
• Eating lots of fiber-rich foods like whole grains, fruits, and vegetables

Who Needs a Hemorrhoidectomy?

Surgery’s a good option for people with large hemorrhoids. These can cause:

• Long-lasting pain
• Lots of blood loss
• Leaking stool or mucous

During this outpatient procedure, the surgeon cuts away the hemorrhoid. Doctors can use lasers, staples, and other tools. But removing them with a sharp blade is “the safest and best way to prevent them from coming back,” Hedrick says.

“The vast majority of hemorrhoids don’t require surgery. But it is a common surgery. At UVA, we see hundreds of patients with hemorrhoids and do between 75 to 100 hemorrhoidectomies each year,” says Hedrick. She’s one of three UVA colon and rectal surgeons who do these procedures.

“The biggest downside to surgery is an uncomfortable recovery,” she adds. “It’s going to take 2 to 4 weeks to recover, and the first week is when bowel movements are the most painful. We give a numbing medicine that lasts 2 to 3 days. And taking acetaminophen or ibuprofen can help relieve pain. We try not to use opioids, as they can constipate you.”  

Hedrick adds, “Patients are happy after they’ve done the surgery but usually only after about a month. ”

Hemorrhoids Can Bleed a Lot

There are two types of hemorrhoids: inside and outside. The outside ones on the anus cause the discomfort, pain, and itching. The internal ones don’t typically cause pain (no nerve sensors in the rectum, Hedrick explains).

Still, the internal ones can cause bleeding. They sometimes slip outside the anus (prolapse). They can occasionally cause so much blood loss, Hedrick says, that people become anemic and need blood transfusions.

Bleeding typically happens during a bowel movement. But people can also bleed through their pants while shopping or going about their day.

Surgeons can remove small internal hemorrhoids with an office-based banding procedure that cuts off the blood supply. But a hemorrhoidectomy is needed to remove large internal hemorrhoids that cause lots of bleeding.

Cancer or polyps can also cause bleeding. So, if you have rectal bleeding, you should get a colonoscopy. That way, if you do have polyps, surgeons can take them out before they turn into cancer.

What Causes Hemorrhoids?

Major causes are:

• Constipation
• Straining while going to the bathroom (don’t force anything)
• Pregnancy

3 Ways to Prevent Hemorrhoids

Hemorrhoids are a normal part of life and become more common as we age, according to Hedrick. She says, “Everybody is going to have them to some degree.” To prevent them from becoming a problem, she recommends that you take these steps every day:

• Drink lots of water and get plenty of fiber
• Get exercise
• Don’t sit on the toilet too long

Constipated & Middle Aged Like Me?

Constipation can cause hemorrhoids but can also be a sign of colon cancer.

Colon Cancer Screening Options

Would a stool help? You’ve probably seen the commercials for special stools that give you a more “natural” position when sitting on the toilet. These actually can help, Hedrick says. A stool under your feet helps waste move through your bowels easier and with less strain.

How I Found Relief & the Joys of the Fiber Cocktail

Fortunately, my hemorrhoid pain went away pretty quickly. How did I do it? I:

• Gladly paid more than $80 on prescription-strength hemorrhoid medication (who knew insurance doesn’t cover suppositories?)
• Took a few baths, which I remember worked like a charm after giving birth 16 and 20 years ago
• Skipped squat poses during yoga
• Took a laxative left over from my colonoscopy prep
• Drank a lot of water
• Avoided bagels and pizza, which I love but always constipate me

Now, I don’t go a day without an after-dinner glass of water mixed with a heaping teaspoon of psyllium husks powder. It’s kind of like drinking very fine sawdust (I avoid the brands with added sweeteners). It can make you a bit gassy. But the morning after is much more pleasant. I am so grateful to a good friend who introduced me to the wonders of fiber-laden psyllium husks.

My Colonoscopy Found More Than a Polyp

I’m also grateful that I got my first colonoscopy screening last year. I was not surprised to read in my colonoscopy report that I have an internal hemorrhoid, which explains the blood when I go.

I also wasn’t surprised that I had a polyp in my colon, the kind that could become cancer. My maternal aunt and grandfather both died of colon cancer because they never had a colonoscopy screening. Over the years, my mother and father have both had lots of polyps removed during their colonoscopies.

During my colonoscopy, my polyp was also removed – along with its potential to become cancer. Hopefully, I won’t need to worry about having any hemorrhoid removed. I just need to keep up with my nightly fiber cocktail. Cheers to fun-for-the-go fiber and life-saving colonoscopies!

Treating hemorrhoids: Everything you wanted to know but were afraid to ask

You may be surprised to hear that everyone has hemorrhoids. In fact, I often introduce the topic to my medical students by walking around the room and pointing to unsuspecting individuals exclaiming, “I know you have hemorrhoids!”

Did you know you have #Hemorrhoids? Everyone does, but they’re practically invisible until they become inflamed.

On the #LiveWellHealthy blog, Dr. Stein shares everything you wanted to know about hemorrhoid treatment but were afraid to ask: https://bit.ly/2Tn10At.

Click to Tweet

So, what are hemorrhoids?

Hemorrhoids are a normal part of the anal canal that help us to control bowel function. There are two locations where hemorrhoids can be found. Internal hemorrhoids exist within the lining of the rectum and anal area, or the inside of the body. In contrast, external hemorrhoids are located on the outside of the body where the skin has very sensitive nerve endings.

When hemorrhoids become inflamed, they can become extremely painful, especially if they’re located externally. Unfortunately, over 10 million people suffer from inflamed hemorrhoids every year. How can something so small cause so much pain and discomfort?

Symptoms of hemorrhoids.

Hemorrhoid symptoms vary based on which ones are causing the problem.

External hemorrhoids often bring on abrupt excruciating—and sometimes debilitating—pain. Bleeding and a formed clot that stretches the skin of the anal area are the cause of the pain.

Internal hemorrhoids are graded on a scale of one to four, with painful symptoms that increase as the grade does. They’re rarely painful, although you can experience some bleeding and burning.

• Grade 1: Painless rectal bleeding
• Grade 2: Pain and discomfort from prolapsing or protruding from the anal opening
• Grade 3: Pain and discomfort from prolapsing or protruding from the anal opening that requires you to manually push them back inside
• Grade 4: Pain and discomfort from hemorrhoids that are stuck in the prolapsed position and generally require surgery

It’s important to note that some symptoms may be similar to other conditions, such as colon cancer. If you are over the age of 40 and experiencing bleeding, talk to your doctor about getting screened for colon cancer to rule out anything life-threatening.

Causes of hemorrhoids.

A lack of fiber. There are a variety of things that can cause hemorrhoids to inflame, but the most common reason is a lack of fiber in your diet. The United States Department of Agriculture (USDA) recommends that women eat a minimum of 25 grams of fiber and men consume over 30 grams of fiber every day. Yet many of us don’t eat enough fiber.

Irregular bathroom habits. Still, even if you eat enough fiber, it’s possible to develop an inflamed hemorrhoid. Constipation, straining, and irregular bowel habits are also common causes of hemorrhoids. That’s why expecting women are also prone to developing inflamed hemorrhoids—as if they don’t suffer enough uncomfortable symptoms during pregnancy. Individuals with Inflammatory Bowel Disease (IBD) may also be at an increased risk of developing hemorrhoids.

Genetics. Unfortunately, if your parents frequently developed inflamed hemorrhoids, there’s a greater likelihood that you will, too. Over fifty percent of patients with hemorrhoids have a family history of dealing with the same affliction.

Treating hemorrhoids.

Sometimes, people with inflamed hemorrhoids don’t experience any symptoms. Other times, symptoms may dissipate quickly as hemorrhoids can resolve themselves within a few days. However, for some unlucky individuals, the only way to get hemorrhoid relief is by seeking treatment from a doctor.

Request an appointment.

Treating hemorrhoids at home.

Over-the-counter medications like Preparation H may offer some pain relief for hemorrhoids. But unless you modify your fiber intake, they’ll probably keep coming back. If you have internal hemorrhoids, I will almost always recommend diet modifications to incorporate more fiber. A high-fiber diet is the best way to eliminate and prevent most cases of hemorrhoids, as fiber helps to regulate bowel movement. 70% of the time, eating more fiber will relieve symptoms of internal hemorrhoids.

Consider upping your fiber intake with the following high-fiber foods:

• Berries
• Nuts
• Legumes
• Veggies
• Whole grains

Treating hemorrhoids at the doctor.

No one dies from hemorrhoids. But if you’ve had one, you may wish that you had! Living with persistent hemorrhoid pain is miserable and there are many treatment options available so you don’t have to. Treatment options vary based on the location and severity of your hemorrhoid.

Treatment for internal hemorrhoids.

When dietary adjustments don’t relieve pain, you may benefit from a quick, in-office procedure to remove internal hemorrhoids grading one or two. Called rubber band ligation, this simple procedure involves placing a small rubber band around the hemorrhoid to help it naturally fall off within ten days. It can be uncomfortable, but it’s not painful and it’s extremely effective.

If neither diet nor rubber band ligation provide relief, there are numerous surgical options that, while painful, are effective in eliminating hemorrhoids. These include:

• Hemorrhoidectomy: When a large piece of skin is prolapsing every time you go to the bathroom, you may need surgery to remove hemorrhoids. An anesthetic will help to keep you comfortable during the procedure. However, you will likely experience pain for about two to three weeks of recovery.
• Stapled hemorrhoidopexy: This procedure pulls the hemorrhoids back into their usual position with the use of a stapling device. The recovery is significantly less painful than the classic excision.
• Hemorrhoid artery ligation: This new technique uses ultrasound to detect blood vessels supplying the hemorrhoids. Then, your doctor will suture the arteries so no blood enters the hemorrhoids, causing them to shrink.

Treatment for external hemorrhoids.

If you have an external hemorrhoid and see a doctor within three to four days of experiencing symptoms, your doctor can treat it using a procedure called thrombosis. During thrombosis, your doctor will numb the area before removing the inflamed hemorrhoid, resulting in instant relief. Unfortunately, if you’ve experienced symptoms for at least five days, the best thing to do is wait it out as the clot inside the hemorrhoid is likely already going away.

The new Surgical Pavilion at MedStar Franklin Square Medical Center.

If you need surgery for hemorrhoid relief, our new patient-centered Surgical Pavilion is now open. This 82,000-square-foot facility was designed with input from doctors, surgeons, nurses, technicians, and staff who understand the features and amenities that will make your surgery the best experience it can be. The spacious building offers ample suites for privacy, comfort, and social distancing, as well as large operating rooms equipped with state-of-the-art technology to facilitate collaboration across specialties.

While it’s important to be cautious while COVID-19 is still around, you need to take care of your health. If you have painful symptoms that suggest you may have an inflamed hemorrhoid but you’re not sure, talk to your doctor. Your doctor can help to rule out polyps or something more serious while suggesting your best treatment options if you have a confirmed hemorrhoid. If surgery is your best option, you can count on MedStar Health to provide the highest levels of care in a safe environment.

Do you have a hemorrhoid that’s causing you discomfort?
Request an appointment with a MedStar Health specialist today.

Request an appointment.

How to diagnose hemorrhoid pain

How to diagnose hemorrhoid pain – advice from a proctologist

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How to Diagnose Hemorrhoid Pain : Hemorrhoid pain is an unpleasant or painful sensation in the anus, an experience of physical or emotional suffering. Serves as a protective signal of real or suspected tissue damage. The initial diagnosis of pain in hemorrhoids will require an anoscopy and subsequent consultation with a proctologist. As an additional examination, the doctor may prescribe:

• sigmoidoscopy
• MRI of the rectum.

Which doctor treats pain in hemorrhoids: In case of symptoms of pain in hemorrhoids, you should first consult a proctologist, based on the results of the initial examination, the doctor may prescribe an additional consultation with an oncologist.

Hemorrhoids are pathological enlargement of the hemorrhoidal node, which manifests itself as a bump in and around the anus. Often, inflammation of the hemorrhoid disappears on its own a few days after the exacerbation of the disease.

Causes of hemorrhoids

Hemorrhoids are swollen blood vessels located in the lower part of the rectum, outside (in the area at the entrance to the anus). So far, scientists are not completely clear what causes their anomalous increase. It is believed that this pathology can be provoked by:

• constipation
• straining too hard during defecation
• pregnancy
• weightlifting.

Symptoms of hemorrhoids

Symptoms of hemorrhoids include:

• bright red blood in the stool
• anus irritation
• Feeling like you still have to poop after going to the toilet
• mucus on underwear or on toilet paper
• knot protrusion around the anus
• pain around anus.

Diagnosis of hemorrhoids

The patient should consult a proctologist if:

• the hemorrhoid has not improved after 7 days of treatment at home
• there is severe bleeding from the anus
• hemorrhoids accompanied by high fever
• Pus flows from the anus.

The doctor will be able to make a diagnosis during the initial examination. In rare cases, the proctologist may need MRI or CT results to determine treatment tactics.

Home treatment for hemorrhoids

The patient can relieve hemorrhoids by following the doctor’s advice:

• drink plenty of fluids and eat plenty of fiber to keep stool soft
• wipe your bottom with wet toilet paper
• take a warm bath to relieve itching and pain in the anus
• use an ice pack wrapped in a towel to relieve buttock discomfort
• Gently push the protrusion back inward
• keep your anus clean and dry
• exercise regularly
• cut down on alcohol and caffeine (eg tea, coffee and cola) to avoid constipation
• don’t wipe the knowledge pass too hard don’t ignore the urge to poop
• do not take painkillers containing codeine as they cause constipation
• Do not take ibuprofen if your hemorrhoids are bleeding.

A range of over-the-counter hemorrhoid products can be purchased at the pharmacy:

• creams for the relief of pain, itching and swelling in the anus
• preparations to relieve constipation and soften faeces
• cold compresses to relieve discomfort.

If the hemorrhoids do not improve after home treatment, the patient may need hospital treatment. Common hospital therapies include:

sclerotherapy, where fluid is injected from the nodes to reduce inflammation electrotherapy, where the hemorrhoids are subjected to a mild electric current to shrink them

infrared coagulation, where infrared light is used to reduce blood flow to areas of inflammation.

If the above treatments do not work, the patient may need surgery to remove the nodes. Surgical treatments for hemorrhoids include:

• hemorrhoidectomy – removal of hemorrhoids
• stapled hemorrhoidopexy – pushing and sewing hemorrhoids back into the anus
• hemorrhoidal artery ligation – suturing to cut off the blood supply to the nodes so that they shrink.

Author: Telegina Natalya Dmitrievna

Specialization: Therapist

Where does the appointment: MRI Center and Clinic RIORIT

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Literature

1. Aminev A.M. Guide to proctology / A.M. Aminev. – Kuibyshev: Kuibyshev book. ed – in, 1971. – T. 2. – S.8-179.
2. Belausova S.V. Tactics of treatment of patients with hemorrhoids complicated by anemia: author. dis. . cand. honey. Sciences: 14.00.27 / Belausova Svetlana Vasilievna. – M., 2008. – 20 p.
3. Vasiliev S.V. Comparative evaluation of the Longo operation and suture ligation of the terminal branches of the superior rectal artery in the treatment of chronic hemorrhoids / S.V.Vasiliev, K.N.Komyak, A.I. – 2007. – T.186., No. 3. – P.71-72.
4. Goncharuk R.A. The choice of tactics for the treatment of patients with III-IV stages of chronic hemorrhoidal disease: author. diss. . Candidate of Medical Sciences: 14. 01.17 / Goncharuk Roman Anatolievich. – Vladivostok. – 2013. – 21 p.
5. Karpukhin O.Yu. On the question of evaluating the effectiveness of methods of treating chronic hemorrhoids / O.Yu. Karpukhin // Practical Medicine. -2013. – No. 2. – P.77-79.

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Hemorrhoids as it is and how to treat it so that it is not excruciatingly painful

Unfortunately, hemorrhoids, except when they are associated with pregnancy, are a progressive disease, that is, varicose veins of the rectum cannot “dissolve” by themselves .

Manifestations of hemorrhoids begin gradually.

Among its main manifestations are the following:

Feeling of a foreign body in the anus;

Prolapse of hemorrhoids during defecation or excessive straining;

Pain in the anus during defecation;

Bloody discharge during bowel movements, which usually remains on stool or on toilet paper.

However, bleeding from the anus during defecation is not always the initial manifestation of the disease. Often, exacerbation of hemorrhoids is facilitated by factors such as a sedentary lifestyle, diet violations, excessive alcohol consumption or food that provokes exacerbation (spicy, spicy). As a result, not only inflammation can occur, but even infringement of hemorrhoids. In addition to these symptoms, the onset of hemorrhoids can also be manifested by pain during bowel movements.

During an exacerbation of hemorrhoids, the patient from the category of healthy people goes into the category of patients. Further, exacerbations of the disease can occur with varying frequency or intensity, even with minor malnutrition. In the interval between exacerbations of hemorrhoids, the patient feels healthy.

As hemorrhoids progress, exacerbations of the disease become more frequent, and its manifestations become more pronounced. With frequent, though not very pronounced, bleeding, anemia (decreased hemoglobin level) is noted. There is a slight prolapse of the nodes, even with a slight straining.

It is repeated bleeding from the anus and prolapse of hemorrhoids that are considered the main signs of chronic hemorrhoids. In the future, anal itching, discomfort in the anus, as well as mucous discharge may join.

In the “Center of Family Medicine” treatment of hemorrhoids is carried out by an experienced colonoproctologist with extensive experience in this field. The main method of radical treatment in the country remains surgical: hemorrhoidectomy according to Milligan-Morgan, after which a long pain symptom persists, a long-term disability. The techniques that are used in our center are known all over the world. These include ligation of hemorrhoids with latex rings, sclerotherapy, removal of hemorrhoids using the Fotek apparatus, which do not require a hospital stay and are the most comfortable and painless. Good tolerance by patients, simplicity, absence of complications, high efficiency allows their use in outpatient settings.

The most effective method of the above is the ligation of hemorrhoids with latex rings.

The latex ring ligation method is as follows. The surgeon, having gained access to the hemorrhoidal node with the help of an anoscope, with a special tool – a ligator, puts a latex ring on the node. Latex has properties similar to rubber. This ring compresses the leg of the hemorrhoidal node, its nutrition is disturbed, and it dies. After 12 – 14 days, such a node disappears during defecation.

When ligation of hemorrhoids is indicated

The method of ligation of hemorrhoids is indicated for patients with the second or third stage of hemorrhoids. Ligation with latex rings is not carried out in the first stage of hemorrhoids. Sometimes ligation can also be carried out at the fourth stage, that is, with constantly falling nodes, but only if the boundaries are clearly defined and there are no pronounced external hemorrhoids.

If there is no clear boundary between external and internal hemorrhoids, ligation with latex rings is not performed. Usually this occurs with combined hemorrhoids. Such a limitation of the use of this method is due to the difficulty of imposing rings on such nodes.

Contraindications to ligation with latex rings

Ligation of hemorrhoids with latex rings is contraindicated in inflammatory diseases of the rectal area:

anal fissure,

chronic paraproctitis,

Proctitis in the inflammation phase.

Currently, the vacuum ligation technique is considered to be more convenient and simple, in particular, because there is no need to use an assistant during the manipulation. The procedure for ligation of internal hemorrhoids is usually carried out in two, three (most often) or more sessions. The most acceptable is the ligation of one node in one procedure.

Latex rings, which are used in the ligation of hemorrhoids, are made of natural rubber. Their outer diameter is 5 mm and inner – 1 mm. Such a ring stretches well, which allows it to be thrown over the knot, after which it squeezes its leg. Within 12-14 days there is a complete “dissection” of the leg of the node with a ring.

In some cases, it is necessary to resort to additional ligation, when the size of the hemorrhoids is large enough and it is impossible to completely capture the node with the ligator head at one time. In this case, the repeated ligation of the hemorrhoid is carried out no earlier than a month after the previous one.

Results of ligation of hemorrhoids with latex rings

Efficiency of ligation of hemorrhoids with latex rings averages 80%. This procedure is performed on an outpatient basis, that is, the patient does not need to go to the hospital. In this case, the patient can immediately go about his daily activities after the ligation. The best results are obtained in the treatment of patients with the 2nd and 3rd stage of the disease. At the 4th stage, the method of ligation with latex rings is advisable to use only in patients with clear boundaries of prolapsed nodes.

When can sclerotherapy be used

Sclerotherapy is a method of using special drugs – sclerosants – to induce fibrosis and sclerosis in a varicose vein, as a result of which the pathological vein simply grows together. The success and effectiveness of hemorrhoid sclerotherapy is based on modern sclerosing drugs and the use of special tools.

The sclerotherapy method is applicable in patients with the first, second and third stages of internal hemorrhoids, as well as in the case of hemorrhoidal bleeding. In addition, sclerotherapy can be used in patients with the fourth stage of hemorrhoids in order to prepare for the ligation of nodes with latex rings or surgery.

The effect of sclerotherapy appears quickly and lasts for a long time. Approximately 7 to 10 days after the procedure, shrunken hemorrhoids fall off during a normal bowel movement.

Sclerotherapy can be used in elderly patients whose veins are usually fragile and brittle.

Several hemorrhoids can be treated in one session of sclerotherapy.

Contraindications to sclerotherapy

Sclerotherapy is contraindicated in the following cases:

· Acute stage of nodes. The method of sclerotherapy is not recommended for third-degree hemorrhoids due to the risk of thrombosis of the nodes.

Large hemorrhoids. At the same time, the effectiveness of sclerotherapy is quite low.

Severe bleeding. When hemorrhoids are combined with other diseases of the rectum, such as inflammatory diseases (Crohn’s disease or ulcerative colitis), sclerotherapy can cause severe bleeding or ulceration in the colon mucosa.