Hemorrhoids

Nov 16, 2016

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Beards annoy me. Well, shaving does too. Good on all you Movember mustache people! You are raising awareness for men's health issues, but I've given up on mustaches as well. Movember was fun for a few years. Then I noticed the bottom half of my handle bar was completely grey. That made me look way too old. I used to like beards. I grew one in Grade 8 so I could buy beer at the Vendor in Pinawa. No, I don't recommend that my daughter in Grade 9 grows a beard and illegally buys alcohol. I guess there are several reasons that previous sentence is wrong, but I digress. I was in a Men's clothing store in Brandon, and several of the young men in suits helping customers had really nice beards. Beards now seem to be symbols of being young and hip. They certainly weren't when I was in my 20's. I am the victim of another miss timed fashion trend.

Speaking of beards, hemorrhoids. Sometimes, I don't work hard on segues. Hemorrhoids are a normal part of the anal canal. They are sometimes called cushions and are made up of connective tissue, blood vessels and smooth muscle. The fact a person has a hemorrhoidal cushion is not considered abnormal. If the person starts getting symptoms like bleeding, itching, pain or protrusion, then the hemorrhoid is a problem.

Hemorrhoids are very common. Somewhere between 58 and 86% of us will have hemorrhoids annoy us at some point of our lives. They happen about equally often in men and women. The peak age for getting hemorrhoids is between 45 and 65. Hemorrhoids are often divided into two groups: internal and external. Internal hemorrhoids are inside a line on the anal sphincter called the pectinate line. External hemorrhoids are outside the pectinate line. Uncomplicated internal hemorrhoids are often painless as there are no nerve endings where they form. External hemorrhoids can be painful as their area of formation has lots of pain nerve endings.

Internal hemorrhoids are further sub-divided into degrees. First degree hemorrhoids are just a swelling of the cushion because of straining while going to the bathroom. They are painless. Second degree hemorrhoids protrude a little after defecating but spontaneously return on their own. Third degree hemorrhoids protrude after defecating, but must be manually replaced. Fourth degree cannot be manually replaced. Fourth degree hemorrhoids are usually very painful, and if you have them, you should see your doctor.

What causes hemorrhoids? Constipation, pregnancy and age are probably all factors. What are hemorrhoid danger signs? Patients should go see their doctor if: their hemorrhoid protrudes and doesn't go back on its own, they are bleeding and painful, they bleed a lot or the blood is dark in color (as opposed to bright red). Patients under 12 years old with hemorrhoid problems should also see a doctor. Since hemorrhoids are embarrassing, by the time people admit to a pharmacist that they have hemorrhoids, the problem is probably bad enough that they should see their doctor right away.

How do you prevent hemorrhoids? Try to avoid constipation. One shouldn't remain on the toilet for more than 1-2 minutes. Straining on the toilet should be avoided. To avoid constipation, fiber and fluids are usually the first line of attack. Eight glasses of water per day is recommended to establish good bowel habits. Water helps expand the fiber in the stool to make it bigger and softer. The next thing to do is increase the amount of fiber 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 fiber to your diet will help with symptoms of mild hemorrhoids. If you can't seem to eat enough bran and veggies, consider a fiber supplement like Metamucil with psyllium in it.

To relieve the irritation and itchiness of hemorroids, a sitz bath may help. A sitz bath is a tub of warm water (46oC) in which the person sits for 15 minutes at a time 3-4 times per day. Plastic sitz baths may be fitted over the toilet seat rim for greater convenience. One reason sitz baths are believed to work is they seem to relax the internal anal sphincter.

How do we treat hemorrhoids? If they are relatively mild, they can be treated with creams and suppositories. All of these treatments just help symptoms. None of them cure a hemorrhoid. They provide short term relief of pain, burning, discomfort and irritation while the swelling goes down on its own and healing starts. Hemorrhoids preparations can have a variety of ingredients in them. Some have local anesthetics like pramoxine to relieve pain. Prescription creams often have hydrocortisone to reduce inflammation and itching. Witch hazel is the astringent in many pads and wipes. Astringents promote drying of the skin which helps reduce burning, itching and pain. Protectants including shark liver oil help reduce irritation, burning and itching by forming a physical barrier on the skin.

There is a newer oral over-the-counter treatment for hemorrhoids. It is called Hemoval. It has 600 mg of diosmin in it. Diosmin is a flavonoid and might help hemorrhoids. Honestly, I completely dismissed Hemoval the first time I heard of it. Here was an oral, herbal product that claimed to help hemorrhoids. I thought it was bunk. Then patients started coming into the pharmacy asking for it because their doctors had recommended it. I did some reading and here is what I found. It is unclear what flavonoids like diosmin do. They might improve how well blood moves out of capillaries and back to the heart through the veins. They might improve lymphatic drainage and they might be anti inflammatory. The jury still seems to be out amongst the scientists.

One meta-analysis looked at 9 studies covering 783 patients each looking at flavinoids and hemorrhoids. In general, the flavinoids seemed to be better than placebo at reducing hemorrhoid symptoms, but not all the studies were wonderfully well done. On the plus side, Hemoval doesn't seem to have any significant side effects. So it is probably a reasonable over the counter hemorrhoid treatment to try.

Beards are itchy when you are growing them, and food traps when you have a full one. They are symbols of being young and hip, while I am no longer young and have never been hip. But what is the alternative? Covering your face with over-priced spray soap in a can and dragging a sharp piece of metal over your chin. Inevitable cuts and scrapes ensue. Shaving is almost as annoying as beards are. Or maybe it is just Tuesday mornings that are annoying. I think it is just going to be one of those days. So, go annoy the person next to you and let's spread the joy across the Parkland.

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.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

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

 


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