Managing Hemorrhoids: Symptoms, Causes, and Treatment Options

Q: Managing Hemorrhoids: Symptoms, Causes, and Treatment Options

Hello, Xiao Feng： Based on your description, it seems you have significant internal and external hemorrhoids along with severe habitual constipation. <br>The "flesh ball" you mentioned is actually an external hemorrhoid, and if it is large enough to protrude from the anal opening

What should I do if I have hemorrhoids?

Hello Doctor: When I sit on the toilet or squat for about a minute, the tissue in my anus bulges out and becomes larger.
Not to mention, it always protrudes when I have a bowel movement.
However, the tissue cannot be pushed back inside.
I have had this issue for over a year, but it seems to have worsened recently.
In addition to the larger tissue in my anus, there is also a smaller tissue next to it that is not painful.
Sometimes there is bleeding.
Could this be hemorrhoids? I have been suffering from chronic constipation for many years.
As a student, I cannot avoid sitting or standing for long periods, and I do not drink much water (because I feel embarrassed to go to the restroom frequently during class).
I go to the bathroom about once every five days, and sometimes it can be up to two weeks.
Recently, the color of my stool varies from light yellow to brown, dark brown, and sometimes dark green (almost black).
Sometimes I experience diarrhea, other times I cannot pass anything, and sometimes the stool is thin and elongated.
Additionally, I am 152 cm tall and weigh 43 kg, but my abdomen is quite large and does not seem to reduce despite my efforts.
Could this be bloating? Or is it due to retained stool? A few weeks ago, I had bright red blood in my stool for two or three days, but it stopped afterward.
Initially, I thought it was my menstrual period, but later realized it was not.
Recently, I have been alternating between constipation and diarrhea, and sometimes I feel the urge to go but cannot, always feeling like my bowel is not completely empty.
What should I do? Do I need to see a doctor? If so, what tests should I undergo? Or should I just improve my lifestyle habits? Thank you.

Xiao Feng, 20~29 year old female. Ask Date: 2009/11/22

Dr. Ke Fangxu reply Surgery

Hello, Xiao Feng: Based on your description, it seems you have significant internal and external hemorrhoids along with severe habitual constipation.
The "flesh ball" you mentioned is actually an external hemorrhoid, and if it is large enough to protrude from the anal opening, it indicates a more serious condition.
The issue of bright red blood in your stool is typically associated with internal hemorrhoid bleeding, which often presents with a large volume of blood, bright red color, and no pain.

Additionally, young women who are slender often experience habitual constipation, with severity ranging from three days to over a week.
Generally, this can be resolved through lifestyle modifications.
Interestingly, this group of patients can experience remarkable benefits from fiber supplementation; however, it is necessary to consume about 15 grams of dry weight of fiber daily, which translates to approximately 3-5 kilograms of fresh fruits and vegetables.
If you can increase your fiber intake in your daily diet, it would greatly help alleviate your constipation symptoms.
If that is not feasible, you may need to consult a physician for fiber supplements.
What to do about hemorrhoids? Typically, I would recommend surgery only if there is severe bleeding, intense pain, or significant prolapse, as at that point, topical and oral medications may not be effective.
However, if you experience pain and prolapse that do not significantly affect your daily life, surgery may not be necessary and is not life-threatening.
Nevertheless, given your young age and the presence of prolapsed hemorrhoids, I would still recommend surgical treatment to prevent worsening conditions during future pregnancies.
All of the above suggestions are based on your description and are speculative.
Ultimately, I encourage you to muster the courage to visit a hospital for a thorough examination to obtain an accurate diagnosis.
Wishing you a speedy recovery.

Reply Date: 2009/11/22

More Info

Managing hemorrhoids can be a challenging issue, especially when accompanied by symptoms such as bleeding, pain, and discomfort. Based on your description, it seems likely that you are experiencing hemorrhoids, which are swollen veins in the lower rectum and anus. They can be classified into two types: internal hemorrhoids, which are located inside the rectum, and external hemorrhoids, which develop under the skin around the anus.

Symptoms and Causes
The symptoms you describe—prolapse of tissue (the "meatball" you mentioned), bleeding during bowel movements, and the presence of both larger and smaller lumps—are characteristic of hemorrhoids. The fact that you have a history of chronic constipation is a significant contributing factor. Straining during bowel movements can increase pressure in the rectal area, leading to the formation of hemorrhoids. Additionally, your irregular bowel habits, including long intervals between bowel movements, can exacerbate this condition.

The alternating patterns of constipation and diarrhea you mentioned can also contribute to hemorrhoid flare-ups. When you are constipated, you may strain more, and when you have diarrhea, the frequent bowel movements can irritate the anal area. The color changes in your stool, including the presence of fresh red blood, are concerning and should be evaluated by a healthcare professional.

Treatment Options
1. Lifestyle Modifications:
- Diet: Increase your fiber intake by consuming more fruits, vegetables, whole grains, and legumes. This can help soften your stool and promote regular bowel movements.

- Hydration: Drink plenty of water throughout the day. Staying hydrated can help prevent constipation.

- Exercise: Regular physical activity can help stimulate bowel function and reduce the risk of constipation.

2. Bowel Habits:
- Try to establish a regular schedule for bowel movements. Do not ignore the urge to go, and avoid prolonged sitting on the toilet.

- Consider using a footstool to elevate your feet while sitting on the toilet, which can help facilitate easier bowel movements.

3. Over-the-Counter Treatments:
- Topical treatments, such as creams or ointments containing hydrocortisone or witch hazel, can help relieve itching and discomfort.

- Oral pain relievers, such as acetaminophen or ibuprofen, can help alleviate pain associated with hemorrhoids.

4. Medical Intervention:
- If your symptoms persist or worsen, it is important to consult a healthcare provider. They may recommend procedures such as rubber band ligation, sclerotherapy, or, in more severe cases, surgical options to remove the hemorrhoids.

When to Seek Medical Attention
Given your symptoms, especially the presence of blood in your stool and the significant changes in your bowel habits, it is advisable to seek medical attention. A healthcare provider may perform a physical examination and possibly recommend a colonoscopy to rule out other conditions, such as anal fissures, polyps, or more serious gastrointestinal issues.

Conclusion
In summary, it is crucial to address both your hemorrhoids and your bowel habits. Implementing lifestyle changes can significantly improve your symptoms, but given the complexity of your situation, including the blood in your stool and the alternating constipation and diarrhea, a visit to a healthcare professional is warranted. They can provide a thorough evaluation and guide you on the most appropriate treatment options tailored to your needs.

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