Dr. Lauren Parmer is a family physician at AAMG Pasadena Primary Care, a practice of Anne Arundel Medical Center.
Dr. Lauren Parmer is a family physician at AAMG Pasadena Primary Care, a practice of Anne Arundel Medical Center. (Courtesy of Anne Arundel Medical / Baltimore Sun)

Women who have been pregnant or anyone who has been constipated may have experienced hemorrhoids, the swollen rectal veins that can make for a very uncomfortable situation. Most people, however, can learn to control flare-ups with over-the-counter remedies and lifestyle changes, says Dr. Lauren Parmer, a family physician at AAMG Pasadena Primary Care, a practice of Anne Arundel Medical Center.

What are hemorrhoids, and who is prone to get them?

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Hemorrhoids are swollen veins in the rectum. They can become inflamed and irritated, leading to pain and itching. Occasionally. they can even bleed during a bowel movement.

There are internal and external hemorrhoids. Internal hemorrhoids are located inside the rectum where they are not seen. They don't usually hurt because there are few pain-sensing nerves in the rectum. Bleeding may be the only sign that they are there. Sometimes internal hemorrhoids prolapse, or enlarge and protrude outside the anal sphincter. External hemorrhoids are located in the anus and are usually painful. External hemorrhoids can also prolapse to the outside during a bowel movement. Occasionally, they can form blood clots, causing an extremely painful condition called a thrombosis.

Approximately 4.4 percent of adults in the U.S. suffer from hemorrhoids. Most are between the ages of 45 and 65. Risk factors for developing hemorrhoids include things that increase the pressure inside the abdomen, [such as]pregnancy, constipation and prolonged straining.

Can they become harmful, and can they go away (and return) on their own?

Hemorrhoids are rarely dangerous. They usually resolve on their own but often recur. There are a few things people can do to help prevent recurrence: increase fiber in their diet, use stool softeners and increase exercise to help stimulate bowel function.

Which over-the-counter remedies work best?

Most hemorrhoid treatments aim to minimize pain and itching. Several over-the-counter remedies are available, and those containing a local anesthetic can temporarily soothe pain. Creams and suppositories containing hydrocortisone are also effective. Sitz baths (warm water baths for buttocks and hips) can be helpful to decrease anal sphincter spasm and to help relieve severe itching. You can purchase small plastic tubs that fit over a toilet seat, or you can sit in a regular bathtub with a few inches of warm water. The warm sitz bath should be used two to three times a day. People who wish to prevent hemorrhoids should increase fiber intake with supplements containing psyllium and methylcellulose, along with increased water to help prevent constipation.

When should you seek professional help?

You should see your health care provider if you have severe pain, if home remedies have not helped, if you experience rectal bleeding or if you have any questions or concerns. Most people can tolerate hemorrhoids and learn how to prevent flare-ups. However, definitive treatment requires a procedure to have them removed.

Is surgery the most permanent option, and how successful is it?

Once you develop hemorrhoids, they don't usually go away completely unless you undergo a procedure to have them removed. There are several options for removal. One option is an injection, usually given by a gastroenterologist. The solution in the injection creates a scar and closes off the hemorrhoid. The second option is called banding. Hemorrhoids that are hanging out of the rectum are closed off by using a tiny rubber band. It takes about one week for the hemorrhoid to shrink, and it will eventually fall off. A third option for removal is using either an electric probe, a laser beam or an infrared light to cause a tiny burn that will painlessly seal the end of the hemorrhoid, causing it to close off and shrink. The last option is a surgery called hemorrhoidectomy. This is often reserved for large internal hemorrhoids or extremely uncomfortable external hemorrhoids.

Have a discussion with your physician to determine the option that may be best for you.

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