Hemorrhoids

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Today we are going to talk about the part of your body you sit on. There used to be a Preparation H commercial that showed a hard wooden stool and said, “Does this scare you?” I thought this was a great way to use humor to start the conversation about an embarrassing topic. Discomfort around the anorectal area cause problems for about half the population at some point in their life. Unfortunately, as this is an embarrassing topic, many people simply suffer in silence. Others will use over the counter products instead of seeing their doctor. Since hemorrhoids are so common, let’s try to get more comfortable with them so the wooden stool won’t scare you.

What are hemorrhoids? They are swollen, twisted veins in the walls of the rectum or anus. If they are outside the anus they are called external hemorrhoids. If they are inside the anus, they are called internal hemorrhoids. External hemorrhoids may cause a lump. If a blood clot forms in the swollen, twisted vein, the lump may become more swollen and painful. Internal hemorrhoids may not form a lump or become painful, but they often bleed during bowel movements. Signs included blood streaked stool or toilet paper.

What causes hemorrhoids? Hemorrhoids happen when there is an increase in pressure in the veins of the anorectal area. The increase in pressure can be from pregnancy, heavy lifting, or straining when you go to the bathroom. Straining is often caused by constipation, so we want to keep stools soft. This leads us to believe that high fibre diet may help prevent hemorrhoids, while a low fibre diet (which leads to small hard stools) may help cause hemorrhoids. Hemorrhoids don’t seem to be passed on genetically. There seems to be no discrimination between men and women. (However, pregnancy makes hemorrhoids more likely.) You are more likely to get hemorrhoids the older you get. We used to say that straining to pass stool caused hemorrhoids, but more recent research suggests that sitting on the toilet for a long time may be a more likely culprit.

How can you treat hemorrhoids? If they aren’t causing you any discomfort, they don’t need to be treated. If you wish to prevent or treat hemorrhoids yourself, first consider fluids and fibre Eight glasses of water per day is recommended to establish good bowel habits. Water helps expand the fibre in the stool to make it bigger and softer. So, the next thing to do is increase the amount of fibre one eats. Unprocessed wheat bran is an excellent choice. Vegetables and fruit vary in their ability to absorb moisture. Carrots have the greatest absorption capacity of the vegetables, about half that of bran. Other high absorption vegetables are brussel sprouts, eggplant, spring cabbage and corn. High-absorption fruit include apples, pears, and oranges. Adding 20 to 30 g of fibre to your diet will help with symptoms of mild hemorrhoids. If you can’t seem to eat enough bran and veggies, consider a fibre supplement like Metamucil with psyllium in it. The final non-drug measure to relieve hemorrhoids is a sitz bath. A sitz bath is a tub of warm water (46oC) in which the person sits for 15 minutes at a time. Plastic sitz baths may be fitted over the toilet seat rim for greater convenience.

Without a prescription one can get a variety of hemorrhoid products. They have various ingredients in them like protectants and local anesthetics. There are a dozen or more different products, so instead of list them all, I'll just say ask your pharmacist. The key is though, don't self treat for more that 7-10 days. If the symptoms haven't cleared in 7-10 days, see your doctor.

What are some of the other red flags? If you experience any rectal bleeding, any rectal tissues protruding from the anal opening after a bowel movement, or if the patient is under 12 years old, see your doctor.

As always if you have any questions or concerns about these or other products, ask your pharmacist.