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Hemorrhoids
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A hemorrhoid is a mass of veins located in the anus and lower rectum. Hemorrhoids are part of your
normal anatomy and act as cushions to protect the anal skin from the passage of stool. Hemorrhoids
usually are not painful, but they can hurt if they swell, bleed or protrude out of the rectum to the
outside of the anus. Painful hemorrhoids may make you reluctant to have bowel movements, resulting
in constipation.
Hemorrhoids are either internal (inside the anus) or external -- under the skin around the anus.
Hemorrhoids that come from the inside are covered with the lining of the rectum, called mucosa,
and those that are on the outside are covered with skin. Sometimes the internal hemorrhoids are
connected to external hemorrhoids.
With increased pressure that can be caused by pregnancy, obesity, heavy lifting and chronic straining
to have a bowel movement, hemorrhoids may become bothersome and symptomatic.
Symptoms
Although everyone has hemorrhoids, not all experience symptoms. Internal hemorrhoids may cause
bright red blood in the toilet bowel, a feeling of fullness or discomfort or mucus discharge. They
also can protrude, or pop out, with a bowel movement usually returning to the inside by themselves.
External hemorrhoids are felt as lumps near the anus that can cause pain. The lump is caused by a
blood clot causing a purple-blue color.
Tests
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Because bleeding can be a symptom of cancer in the colon or rectum, a colonoscopy may need to
be done before treating hemorrhoids. It is a diagnostic procedure that involves the use of a lighted,
flexible tube inserted through the rectum. If you have a family history of cancer, are over age 50 or
have other symptoms or risk factors, this test can discover colorectal cancer when it is small. This
procedure is done as an outpatient procedure so you go home the same day. You may be given
medications during this procedure so you don’t experience any undue discomfort.
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Sometimes a smaller procedure called a sigmoidoscopy is recommended. A shorter flexible tube is used
to look inside the rectum and into the colon. This test does not require medications and can be done in
the office. It allows your provider to look for other sources of bleeding in the lower colon and rectum.
Physician Referral Service: 888/689-UCSF
Treatment
There are several ways to treat hemorrhoids. The best way may be to relieve the symptoms and
prevent the hemorrhoids from becoming problematic. This is best done by:
•Taking a warm tub or sitz bath several times a day in plain, warm water for about 20 minutes.
•Using ice packs to reduce swelling
•Ensuring a regular, soft bowel movement by eliminating foods that lead to constipation, adding fiber
to your diet, drinking lots of fluid and exercising regularly
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•Spending less time on the toilet, no more than 5 minutes at a time.
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•Trying to have a bowel movement when you get the urge rather than holding it
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If your hemorrhoids do not respond to the above
therapies other treatments options include:
Rubber Band Ligation
This is a treatment for bleeding internal hemorrhoids or protruding hemorrhoids. Also called banding,
this involves placing a small rubber band around the base of the hemorrhoid inside the rectum. The
band cuts off circulation and the hemorrhoid withers away within seven to 10 days.
This leaves a scar that prevents further bleeding and protrustion of the tissue out of the anus. This is
usually done in the office but sometimes is done in the operating room.
•What to expect from banding:
➤Minor
bleeding in seven to 10 days when the hemorrhoid falls off
➤Bleeding
➤A
with bowel movements
dull ache and fullness in the rectum that may be relieved by an ice pack or warm bath
•If you have increased pain, fever and difficulty urinating, you must return to the hospital immediately
for removal of the rubber band
•Avoid aspirin and non-steroidals (Ibuprofen-type pain pills) for 10 days
•You may return to daily activities right away
Hemorrhoidectomy
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When hemorrhoids are severe, extensive, prolapsing (protruding from the anus), strangulated or
infected, they may require surgical removal under anesthesia. This is known as a hemorrhoidectomy.
Because there is a risk of causing permanent damage to the sphincter—the muscle that controls your
bowel movements—this operation is only done if absolutely necessary. This procedure may be done
for both internal and external hemorrhoids.
•What to expect from hemorrhoidectomy:
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➤A
lot of discomfort
➤You
will not be able to return to regular activities for five to 10 days, sometimes a little longer.
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➤If
you are unable to urinate after the procedure, you must call your doctor
➤Avoid
aspirin and non-steroidal pain medications (like ibuprofen) for 10 days
➤Warm
baths will be soothing
➤Narcotics
➤Stool
➤The
for pain control may be necessary
softeners and added fiber will be necessary to avoid constipation
first several bowel movements can cause bleeding and pain
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Excision of External Thombosed Hemorrhoid
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When a blood clot develops inside an external hemorrhoid, it can be very painful. The pain can be
treated within the first 24 to 48 hours by excision (cutting open the hemorrhoid and removing the
clot). Treatment after excision includes warm baths. If more than 48 hours have passed since the
onset of pain, the clot within the hemorrhoid starts to dissolve on its own and cutting it open will not
help it heal more quickly. Warm baths promote the natural healing of the hemorrhoid and increase
comfort.
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Creams and Suppositories
Generaly we do not recommend creams or suppositories. We believe that these may help but they
can also cause problems. The anal area prefers to be dry and because it is a very sensitive area it
can develop allergies to some preparations.
High-Fiber Diet and Supplemental Water
A high-fiber diet along with supplemental water will help you have a soft, spongy, regular bowel
movement. The best time to have a bowel movement is when your body gives you the urge. This
will minimize problems with hemorrhoids, fissures, itching and other common colon, rectal & anal
problems. A diet high in fiber has about 25 to 30 grams of fiber per day. This can include both
dietary fiber and fiber supplements. Drink six to eight glasses of water each day to avoid worsening
constipation from the fiber.
In general, the average content of dietary fiber per serving of each of the food groups is:
•Fruits and vegetables—1 to 3 grams
•Nuts—2 to 3 grams per ounce
•Beans (kidney,black, pinto, chickpeas), lentils; most berries—4 to 6 grams
•White bread, whte rice, refined pasta—less than 1 gram
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•Unrefined grains such as bran, whole wheat bread, brown rice and barley are excellent sources of
fiber. Read the label on the package to know the amount available in each product. Bulgar, barley,
quinoa, oatmeal and bran cereals have between 3 and 6 grams per half cup.
Caution:
•Do not take if you have a narrowing in your esophagus or in your intestines
•If you are a diabetic, avoid the preparations with sugar
•If you need to watch your sodium (salt) intake, avoid the psyllium preparations
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Fiber Supplements
•If you are taking Tetracycline, avoid the polycarbophils
•If you have phenylketonuria, avoid the preparations with Aspartame
•If you are taking coumadin or warfarin, avoid the preparations with psyllium
Types of Supplements:
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We recommend the powdered fiber supplements rather than the pill/capsules or crackers, because
they seem to work better. Be sure to drink six to eight glasses of water each day to avoid
constipation. It helps to start with a rounded teaspoon for a week and then slowly increase to
heaping tablespoon. You can take more or less until your stools are spongy.
Dose
Available forms
Benefiber
One tablespoon per day,
Unflavored powder, non-gritty,
maximum dose is 5 tablespoons can be mixed with fluids, or
per day.
soft foods, or can be used in
cooked foods to add extra fiber.
It should not be mixed with
carbonated beverages.
Metamucil
One teaspoon or one wafer
equals 3 grams of insoluble
fiber, 2 grams of soluble fiber.
Take up to three times a
day.
Flavored or non-flavored,
Psyllium, 3.4 grams
sweetened or artificially
sweetened, regular or smooth. It
comes in wafers, including apple
crisp & cinnamon spice.
Fiberall
One tablespoon equals
2 grams soluble fiber and 1.5
grams of insoluble fiber.
Flavors include orange and
tropical fruit as well as sugarfree.
Perdiem
One teaspoon equals 4 grams
of psyllium. Take up to 1 to 2
teaspoons four times a day.
Mint flavored
Hydrocil Instant
One teaspoon equals
3.5 grams of psyllium
Psyllium
Konsyl
One teaspoon equals
6 grams of psyllium.
Psyllium
UniFiber
One teaspoon equals
3 grams of cellulose.
Cellulose
Citrucel
One tablespoon one to three
times daily.
Orange-flavored, sugar-free
Methylcellulose, powder
equals 2 grams per
tablespoon
FiberCon
One caplet equals 500 mg of
polycarbophil. Take one to four
caplets a day.
Caplet
Calcium polycarbophil
Form of fiber
Soluble dietary fiber
extracted from the seed
of the cluster bean. Each
serving of Benefiber
provides 3 grams of soluble
fiber
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Name
Psyllium 3.25 grams
(stimulant)
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Please note: you can find fiber supplements other than these in health food stores or Trader Joe’s.
Many chain stores such as Walgreens, CVS or Costco have their own brand of fiber supplements,
which work well and may be more affordable. Some cereals also have added fiber, so check the labels.
Center for Colorectal Surgery at UCSF (415) 885-3606
SDGEN0200 • Rev. 5/10
Physician Referral Service: 888/689-UCSF