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Hemorrhoids are swollen veins in the rectum. (There is another meaning of the word I will explain in a moment.) The veins can swell enough that they prolapse, plopping out the anus. They aren't something you can easily ignore. They feel like you are sitting on yourself. They can become inflamed and irritated and itchy and bloody.

Strictly speaking, a hemorrhoid isn't just a swollen vein. It's a combination of blood vessels and valves and smooth muscles and connective tissue, and even smaller arterial blood vessels can become involved. Hemorrhoids can be external, originating outside the anus, and covered with "skin," or they can be internal, originating inside the anus, covered with the anal membrane, or as previously mentioned, prolapsed, internal in origin but dropping outside the anus. Internal hemorrhoids don't have nerves and aren't painful. External hemorrhoids have nerves and are painful.

Just about anybody can get hemorrhoids. They can even occur before birth. The people who get treatment for hemorrhoids in North America are usually white males from rural areas who have higher than usual incomes, however, or pregnant women of any race or income level. At any given time, about one in 25 people in the world has the condition.

Hemorrhoids are annoying. They make cleaning up after a bowel movement harder to do. They can bleed. When a hemorrhoid is prolapsed, it can become strangulated, and its tissue can die. An internal hemorrhoid doesn't have pain nerves, but it can generate mucus that causes a constant hygiene problem along with never-ending itch.

Most of the time hemorrhoids resolve on their own, whether they are treated or not. Non-surgical treatments result in having hemorrhoids gone for good in about 50 percent of cases. Surgical treatments are about 95 percent successful. However, surgery can have a downside. The anesthetic can paralyze the bladder, resulting in not being able to urinate. Sometimes the anal canal develops a stricture, which makes defecation difficult, and, ironically, causes more hemorrhoids. A rare complication of the surgery is the formation of a fistula, which is in effect a second anus without the muscles that control how it opens and closes.

If you get hemorrhoids and you would just like them to go away, what can you do?

  • Avoid lifting heavy objects or working out in the weight room at your gym (or just using small weights, such as dumbbells or kettle bells, using your arms, not your lower back).
  • Avoid riding bicycles.
  • Drink water, eat fruits and vegetables, avoid dairy products, use stool softeners to stop constipation, making bowel movement less traumatic. Constipation doesn't cause hemorrhoids, but it makes it much more difficult to heal them.
  • Take warm-water sitz baths (sitting in warm water to soothe your hemorrhoids in a bathtub, not a bidet or portable "soaker") daily. Do not use soap or herbal additives other than oak bark, which helps shrink swollen veins. It's OK just to sit in warm water. Do your cleaning in a shower, not in a bath. Don't soak your bottom in anything that forces you to clench your buttocks to get inside it. Sit in a wide tub.
  • Don't strain during bowel movement. Let it drop, even if it takes five or ten minutes. Many Americans get self-conscious about this sort of problem, but don't hurry up just because you are embarrassed that other people know why you are gone. Take all the time you need to defecate without straining.
  • If you have access to a Tojo toilet or a bidet, use them for cleaning rather than toilet paper. However, these devices are for cleaning, not for soaking.
  • Avoid scented toilet paper. Scents and perfumes can cause allergies that add to itch and inflammation.

Doctors have a number of non-surgical methods to treat prolapsed hemorrhoids, including rubber band ligation, cryotherapy, radio wave ablation therapy, coagulation therapy, and electrocautery. It's better to get the doctor to treat the underlying problem rather than just "pushing them back in."


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