Hemorrhoids: Modern Remedies for an Ancient Disease

Hemorrhoids have plagued world since ancient times and might have tied influenced world history. The emperor of France, Napoleon Bonaparte, suffered from hemorrhoidal disease. On the day of the decisive conflict at Waterloo, Napoleon was in pain because of a severe case of thrombosed hemorrhoids, which impaired his battlefield conduct. 1 today hemorrhoids remain the most common anorectal disorder and are frequently seen in elementary care clinics, emergency wards, gastroenterology units, and surgical clinics. 1–4 More than half of all people will at some degree develop diagnostic hemorrhoids. however, half of those seeking care for hemorrhoids may in fact have another disorder, such as crack, anal abrasion or irritation, or a skin tag. A patient arrives at your function with a chief complaint of hemorrhoids. Is it truly hemorrhoids, or is it something else ? How are hemorrhoid best treated ? And when should you send the patient to see a surgeon ? Patients frequently complain, “ Doc, I have hemorrhoids, ” equating any anorectal symptoms with hemorrhoidal disease, including bleed, lumps, masses, and trouble. It is authoritative to keep in mind that although hemorrhoids are common, the differential gear diagnoses for anorectal disorders include dermatologic diseases such as pruritus ani, abscess and fistulous withers, crevice, sexually transmitted diseases, warts, HIV, atypical infections such as tuberculosis, inflammatory ulcers such as Crohn ‘s disease, and malignancy. The symptoms of internal and external hemorrhoids are summarized in. Although severe anal pain is frequently attributed to hemorrhoids, they are rarely the induce. In the absence of visible, thrombosed external hemorrhoids ( blood clot and swelling ), severe pain is frequently secondary to anal crack, not an inner hemorrhoid. presents early causes of severe anal pain. Hemorrhoids are vascular cushions in the lower rectum and anus. The function of hemorrhoids is not wholly clear, but it has been proposed that they contribute to sense and continence. There are two types of hemorrhoids : inner and external. internal hemorrhoids are inside the anal canal and are covered by anal mucous membrane. In most patients, one can identify three columns of hemorrhoids, two on the right and one on the left field. however, respective variations exist, and some patients have more than three bundles. external hemorrhoids occupy the inferior aspect of the anal canal and are covered by anoderm and skin. external hemorrhoids can be present in one or more quadrants or can be circumferential.

Evaluation and Management

The medical history should include the duration and nature of the symptoms, intestine habits, comorbid conditions, anterior abdominal or anal surgeries, medications including nonsteroidal anti-inflammatory drugs ( NSAIDS ) and anticoagulants, prior endoscopic examination, and family history of gastrointestinal disorders. The physical interrogation should include ocular inspection of the anal region, digital examen, and anoscopy. Patients younger than age 50 years should undergo a compromising sigmoidoscopy, particularly if bleeding is a award complaint. Colonoscopy is recommended for patients older than age 50 years, patients of any age with bleed and anemia, those with haunting bleeding despite medical therapy, choose patients with significant family history of colorectal malignancy, and patients with other symptoms such as abdominal pain and bloat and diarrhea. contrary to popular impression, not all hemorrhoids require treatment. discussion should be reserved for symptomatic hemorrhoids merely. It is significant to reassure patients that hemorrhoids are partially of normal anatomy and to dispel myths such as “ if they are exit alone, they will turn into cancer ” or “ hemorrhoids are blocking my anus. ” Treatment is not based on hemorrhoid size or aesthetic appearance.

The cornerstone of button-down management is avoidance of stultification and hard stool. dietary change with an stress on increasing fiber consumption is crucial. The diet of the median american contains 10–15 grams per day. For treatment of hemorrhoids, the recommendation is 30–35 grams of daily fiber. dietary sources include beans, fruits, vegetables, and hale grains. Dried figure, prunes, blackberries, boysenberries, raspberries, pears, chickpeas, kidney and pinto beans, lentils, brown rice, and oat bran cereals have a high fiber contentedness. numerous fiber supplements are available ( ). Most roughage products are bulking agents that soften the stool by absorbing water. fleawort is a natural source of pure fiber, sold in powder form from the husks of seeds from the fleawort plant. Patients who are unable to tolerate psyllium-based products because of excessive gasoline or bloat can try FiberCon or Benefiber. Patients should be advised to increase fiber supplementation gradually and in conjunction with adequate fluid intake ( six to eight glasses of a noncaffeinated beverage daily ) and increase in daily natural process indeed as to avoid constipation. To promote patients ‘ complaisance with fiber supplement, it is important to explain the other health benefits of fiber, such as decreasing the incidence of colon cancer and diverticular disease, controlling blood cholesterol levels, improving manipulate of diabetes, and aiding in weight control .

Table 3

Open in a separate window Behavioral modification, such as avoidance of prolong sitting on the toilet, reading while defecating, and excessive strain can alleviate some of the symptoms. Sitz baths ( quick urine, ten minutes, doubly a day, no additives in the water system ) are helpful to patients with anal itch, aching, or burn and those with thrombose hemorrhoids. 5 numerous nonprescription creams and products are available, but most are ineffective or provide little relief. many patients will benefit from zinc oxide cream or Calmoseptine, which is available over the antagonistic, applied as needed once or twice a day inside and outside the anus. short-change courses of hydrocortisone 1 % /pramoxine hydrochloride 1 % ( local anesthetic ) cream or 25-mg hydrocortisone suppositories once or twice a day can be helpful.

treatment should be reserved for diagnostic hemorrhoids only .

Patients with bleeding and prolapsing internal hemorrhoids refractory to bourgeois treatment can undergo ablation. respective office-based procedures are available, including injection sclerotherapy, infrared curdling, and rubber-band ligation. All procedures achieve shrinkage and scar of the internal hemorrhoids. Rubber-band ligation has been the most effective of these modalities. Patients should refrain from taking NSAIDS or anticoagulation for one workweek prior to and one week after rubber-band ligation to minimize the hazard of bleeding. At the initial function sojourn, it is preferable to ligate one hemorrhoid ; if the operation is good tolerated, the affected role can undergo multiple ligations at subsequent visits. The routine should be relatively painless american samoa long as the inner hemorrhoid is ligated above the dentate argumentation. If the patient experiences acuate or severe pain when the pile is grasped, then a unlike hemorrhoid should be tried ; if trouble persists, the procedure should be abandoned. It is our commit to ligate the hemorrhoid that looks most inflame or irritated at time of the visit. Some patients have a vasovagal reaction immediately after the routine, then care must be taken to gradually get the patient off the procedure table. Patients are instructed to take Tylenol and use sitz baths as needed for the dull ache after ligation that normally lasts for 24 to 48 hours. Although ligation is a dependable procedure, austere shed blood and sepsis have been reported to result in some patients. Patients should seek immediate care if any of the following symptoms develop : fever, chills, abdominal or pelvic pain, continuous rectal bleed, purulent anal drain, and urinary memory. The rubber isthmus can fall off soon after the procedure or up to three weeks belated. Patients can normally return to work or normal casual activities after the operation. They are normally seen back in the office three to four weeks by and by .

surgical intervention for hemorrhoids is less frequently undertaken today than in the past .

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