Hemorrhoids: Painless Rectal Bleeding
Hemorrhoids: Painless Rectal Bleeding
Hemorrhoids are varicose type veins of the anal area. They are much like a surgical glove squeezed in the fingers to create a big bulge. These bulges filled with blood coagulate and form clots. This stretching of the blood vessel causes pain, and the clot maintains stretching of the vein causing continued pain. New straining after original formation of the clot, i.e. from constipation, bowel movements, labor or some other form of constriction of the abdomen can further stretch this already expanded blood vessel and forms a new thin layer around the clot increasing the clot size causing more and more continued pain.
This thin stretched vessel has pressure receptors in it that are perceived as pressure pain and can be inflamed by sitting, direct trauma, toilet paper or restraining. If you’ve ever had them, you know how uncomfortable they can be.
Also known as “piles”, they occur for a number of reasons. One cause is gravity. The veins from higher up on the anus start to drop down due to the laxity of the tissue as we grow older. Another cause is the pelvic congestion caused by prolonged sitting, straining with heavy lifting or trying to have a bowel movement, or perhaps by the pelvic congestion of pregnancy. Initial symptoms can be a bit alarming. Maybe it’s a small amount of fresh blood on the tissue paper after a bowel movement. Then there is the vague itching, generalized discomfort and downright pain that can accompany hemorrhoids. Add to that the discovery of “lumps” in the area by the sufferer, and you have the makings of a panic.
Imagine for a moment that you are looking into the anal area through an anoscope. There is a circular line around the mucosa where muscles attach to the outer anus called the “dentate” (or “pectinate”) line. If hemorrhoids are above the dentate line, they are called “external,” and if they are below the dentate line they are called “internal.” The external ones are more easily seen and felt, while a person may be unaware that they have internal hemorrhoids.
We don’t know for sure what percentage of the population gets hemorrhoids. In America the number who present for medical care of hemorrhoids are about 4%. In Great Britain, where they have Socialized Medicine, about 30% of patients present for treatment of this condition. We know in America that the sale of over-the-counter products for them goes into the billions of dollars.
People who have occupations that require prolonged sitting, for example like truck drivers, get hemorrhoids, as do people who do a lot of heavy lifting. Fighter pilots get hemorrhoids from gravity and fighting against G-forces. Pregnantladies get hemorrhoids, as mentioned, from pelvic congestion, but later from pushing the baby out during the latter part of labor. Probably the most common cause is straining at bowel movement secondary to chronic constipation.
What are the treatments for hemorrhoids? Well, believe it or not, increasing fiber in the diet is an excellent treatment for all symptoms.. Stool softeners haven’t been found to help that much. Fiber decreases bleeding and irritative symptoms. Witch Hazel and glycerin astringent wipes can be very soothing to inflamed hemorrhoids and can often relieve itching. Sometimes, warm sitz baths several times a day can help, as well as sitting on an inflatable “doughnut” cushion (decreases direct pressure and pinching). If there is an acute clot in a hemorrhoidal vein, it may respond to intermittent ice packs. Occasionally, the E.R. or family doctor can make a tiny cut in the hemorrhoid and let the clot out, resulting in great relief and final healing.
What are the physician treatments of hemorrhoids? One of the most effective is the outpatient application of special rubber bands to the hemorrhoids. A patient can have up to three bands a week. Some doctors sclerose (inject it with irritant substance to cause it to shrink) the hemorrhoids by injecting them with 5% oily phenol, but the results are not as good as with banding.. Some clinics use infrared coagulation, cryotherapy (freezing), or various forms of cautery with mixed results. When hemorrhoids are too severe, either open or closed, hemorrhoidectomy is done in the operating room. The results are generally good, but the time to recovery can be lengthy. There have been some good operative results with simply tying off the hemorrhoidal artery.
So, what’s the take-home message? Hemorrhoids are the most common cause of bright red anal bleeding, itching and pain, but this simply cannot be assumed in every case. The doctor is going to have to examine your anus. There are plenty of other things which can cause these symptoms. Please leave your embarrassment in the waiting room and tell the doctor what’s been going on. The one thing to remember when sitting in the waiting room is you’re not alone, and the more open you are with your doctor the better help he/she can provide for you to getting better. If you are over 50 or have risk factors for colon cancer, you probably need anoscopy and colonoscopy. These are very benign tests in this day and age. Once all the more serious possibilities have been ruled out, then you can start a comprehensive program to treat and control hemorrhoids, and you will “live happily ever after.”
John Drew Laurusonis M.D.
Doctors Medical Center
Dr. Laurusonis was conferred his Doctor of Medicine degree in 1983 and has been actively taking care of patients since completing his Internal Medicine residency in 1987 in the Garden State of New Jersey. Dr. Laurusonis has been licensed in four states but ultimately chose to permanently relocate to Georgia with his family and begin a private practice. Through his extensive experience in Internal Medicine, as well as in Emergency Rooms throughout the United States, Dr. Laurusonis saw how traditional Emergency Rooms were often overwhelmed by patients suffering medical conditions that were urgent but may not need the traditional “Level I Trauma Center”. Patients often waited six to twelve hours to be seen by a physician, were riddled with thousands of dollars in medical bills, and were generally unhappy with the system.
Dr. Laurusonis decided to open an Urgent Care Center instead of a 9-5 doctor’s office. Through the last fifteen years he has received accolades from the community and his patients. He has expanded his practice to include many cosmetic therapies that have previously been treated with painful and extensive plastic surgery. He has been invited to the White House numerous times, has been named Physician of the Year, as seen in the Wall Street Journal, and has served as Honorary Co-Chairman on the Congressional Physicians Advisory Board
Dr. Laurusonis and his practice, Doctors Medical Center, is open 7 days a week from 7:30 am to 9:30 pm offering such services as lab, x-ray, EKGs, aesthetics (Botox, dermabrasion, sclerotheraby and veins etc.), cold/flu, sore throats, fractures, sprains, lacerations, GYN, Pediatrics, Anxiety/Insomnia/Depression Treatment, skin tag/mole removal, veins, allergies, asthma, physicals–just to name a few. Dr. Laurusonis welcomes you to either make an appointment or just walk-in to see him. Dr. Laurusonis will take the time to speak with you about your concerns–no problem is too big or too small. If you need additional services we have specialist referrals available or we can refer you to the neighborhood hospital emergency room. Give Doctors Medical Center a call–Dr. Laurusonis will be happy to speak with you.
- rectal bleeding how urgent