WHAT ARE HEMORRHOIDS?
Hemorrhoids are dilated, bulging blood vessels that occur in the tissues around the anus and lower rectum. All humans have “anal cushions” in the anal canal which help ease the passage of stool. These cushions exist in 3 fairly constant anatomic locations and contain a large number of veins. With increased pressure from sitting on the toilet for prolonged periods (reading), rectal strain from chronic diarrhea or laxative use, prolonged standing or pregnancy, these tissues will stretch and the veins inside them will dilate. As these veins dilate their walls become thin and they may bleed.

Hemorrhoids may be internal (inside the anal canal) or external (located in the sensitive skin at the opening of the anus).

WHAT ARE THE SYMPTOMS OF HEMORRHOIDS?
If the hemorrhoid is located in the sensitive external skin (external hemorrhoid) the blood vessel may clot and a sensitive lump may be present at the anal verge. If this clot occurs suddenly, or is particularly large, it may be associated with a great deal of pain. External hemorrhoids usually do not bleed unless they rupture. Internal hemorrhoids are usually painless. Depending on their severity, they may protrude during bowel movements. Bleeding is often a symptom and may be cause for alarm when first noticed. If internal hemorrhoids are severe enough, they may protrude out of the anus so much that they cannot be pushed back in—at this point they are called prolapsed hemorrhoids and may cause severe pain, nausea and urinary retention.

HOW ARE HEMORRHOIDS TREATED?
The majority of hemorrhoids can be treated without surgical intervention. The primary goal of nonoperative treatment is to increase fiber and fluid intake to the point that bowel movements are bulky and consistent. This lessens the degree of pressure and rectal strain that is required for the evacuation of stool and subsequently decreases the size of the hemorrhoidal cushions. Sitz baths are used as an adjunct to decrease swelling and provide relief from irritation. Nonoperative treatment of hemorrhoids is fully detailed in the postoperative treatment section (hemorrhoids:postop).

Injection or coagulation is a relatively rapid, painless treatment of bleeding hemorrhoids that do not prolapse. These treatment modalities cause shrinkage of hemorrhoidal cushions.

Ligation or banding of hemorrhoids is an effective, relatively painless method of treating bleeding hemorrhoids that protrude out of the anus during bowel movements. This method involves the placement of a small rubber band over the hemorrhoid; this will cut off its’ blood supply and the hemorrhoid and band will fall off in a few days.

Hemorrhoidectomy, or surgical removal of hemorrhoids, is the only permanent method of curing hemorrhoids. Under a local or general anesthesia, the hemorrhoidal tissue is completely excised. Because there is a certain degree of pain involved, the patient may be hospitalized for a short period of time. Laser hemorrhoidectomy offers no advantage over standard hemorrhoidectomy in terms of efficacy or postoperative pain control.