Today I saw a patient with painful external hemorrhoids. It was the first time he ever got them and he was extremely anxious and embarrassed. I felt so badly for him. I decided I had to write a blog to help others with this “embarrassing” but COMMON condition.
Internal hemorrhoids are within the body but they can protrude out of the anus and cause pain, itching, bleeding, pressure, mucous discharge and a feeling of having to have a bowel movement. External hemorrhoids are outside or around the anus and can cause many of the same symptoms. They can be especially painful due to the abundance of nerve endings around the anus. If an external hemorrhoid becomes a swollen lump that looks like a grape it may have a clot inside.
You may find this hard to believe but just about everyone has hemorrhoids. They just don’t protrude and become problematic in everyone. Hemorrhoids can become disturbed by constipation, diarrhea, straining, and time. By time I mean age. The older you get the more likely hemorrhoids will sag and cause symptoms. Any straining or pressure in that area can cause the veins to bulge and swell.
The good news is that they will usually calm down within 1-4 weeks with conservative treatment. Conservative treatment relies heavily on proper diet. Drink plenty of water and eat fiber to prevent constipation. This will make stools softer and easier to pass without having to bear down or strain. Aim for 35 grams of fiber per day. You may want to try a product that contains psyllium fiber to meet this goal. Stool softeners such as colace (available over the counter) can be helpful as well. Remember to drink plenty of plain water with fiber containing products. Fiber without water will just turn into a hard lump and cause constipation to get worse. That is the opposite of what we want.
Warm baths or “sitz baths” can help relax the anal muscles and provide temporary relief. You can buy one to put on your toilet or just use your own bath tub and sit in warm water. For extremely painful hemorrhoids you may want to try the sitz tub over your toilet and even sit in it to have a bowel movement. Hemorrhoids can be really painful and this can help by keeping those muscles relaxed while you do your business.
Another product to try is witch hazel. It may help numb the pain of hemorrhoids temporarily. Ice packs can help in much the same way. You may also try an oral medication to reduce inflammation such as Ibuprofen. However, check with your medical provider about this first as it may interfere with some of your other medications or medical conditions.
Preparation-H is a topical product that may sooth the outside of the anus. It has an anti-itch ingredient in it called Pramoxine and also contains phenylephrine, which might help temporarily shrink the hemorrhoids. Topical steroids or suppositories with hydrocortisone are known to decrease inflammation. Steroid creams are available in up to 1% strength OTC and can be prescribed at higher dosages if needed. They are especially helpful if you have an external hemorrhoid with a clot in it. Usually these measures will help everything resolve without surgery.
It’s important to call your medical provider to get an accurate diagnosis if you think you have hemorrhoids. I hope this article helps reduce your anxiety until you can there. It’s a very common problem that usually takes care of itself.
Barbara Grubbs, Nurse Practitioner.