by Dr. Lewis Zulick
My topic for this article concerns a very common condition that many people experience but few like to talk about, even with their doctor. I’ll use the term “hemorrhoids” to describe the topic of this article but it’s important to realize that there are many conditions which involve that part of our anatomy and which tend to get bundled under the term “hemorrhoids” but are often something quite different entirely. What people experience is usually described as swelling, pain, bleeding or itching.
I hope this article can clarify some of the confusion about problems “down there” because I assume this to be a topic that patients are especially likely to google on their own since it can be embarrassing to discuss with someone else. If so, it’s important to be precise because you’re not going to get the answers you need if you’re using the wrong search term.
So, let’s go over some basic anatomy and some conditions that can produce problems in and around the anus. The anus refers to the opening itself and the first inch or so upstream. At that point it becomes the rectum. Hemorrhoids are very thin-walled blood vessels that are present normally in the anorectal region. When they become dilated or swollen, they can cause problems. But it depends on where they’re located as to what kind of problems they cause. Internal hemorrhoids, as the name implies, are found inside the anus. When they become dilated or swollen they often cause bleeding but they will almost never cause pain. The bleeding usually occurs with bowel movements and is typically bright red. Besides bleeding, internal hemorrhoids can also become so large that they actually pass through the anus at the same time as a bowel movement. If that problem, called prolapse, becomes severe enough, it can be a very troublesome condition which can be uncomfortable.
Bleeding problems from internal hemorrhoids can often be treated with simple procedures in the office. It is also important to be sure why the bleeding is occurring because there are other, more serious conditions which can cause bleeding from the anus. Once prolapse develops a more involved procedure is often necessary. There are several types of surgery that can be used for treatment. My usual recommendation is to use a procedure called hemorrhoidal artery ligation. This procedure is simpler than actual surgical removal of the hemorrhoids and is also less uncomfortable.
External hemorrhoids occur on the outside of the anus. This area is supplied with very sensitive nerve endings and when an external hemorrhoid becomes swollen or enlarged, that may cause very intense pain. The pain will often resolve on its own after a couple of days but sometimes requires active treatment to drain the external hemorrhoid.
Other conditions that can cause pain in this area include fissures and infections. A fissure is a small crack or tear at the edge of the anus which probably occurs because of hard or bulky stool. Once the tear occurs, it has difficulty healing because of repeated stretching during bowel movements. These tears tend to be intensely painful especially at the time of a bowel movement and that pain gradually recedes after an hour or so.
Infections around the anus usually occur as an abscess located just under the skin. These abscesses start within the lining of the anus where there are bacteria that can overgrow and invade into the adjacent tissue. As your body strives to push the infection out the abscess will extend towards the skin surface. A very painful swelling develops over the course of about 24 hours. The infection may cause fever and a general sense of feeling unwell. This problem requires active treatment with antibiotics and to drain the infection.
Sometimes just itching is the main symptom. Once again, there are many conditions which can cause this. A common reason is actually over- washing the area using soap and water. Most soap will irritate the skin around the anus which causes the itching as the skin tries to heal. The itching can sometimes be extremely intense and bothersome. Using plain water alone for washing will often solve this problem.
As you can see, this is a complicated subject that affects an area of our anatomy which is extremely important to our daily life and difficult, if not impossible, to evaluate on our own. The important thing is to not suffer in silence but get over your embarrassment and discuss your problem with your primary care physician, a general surgeon, a colorectal surgeon or a gastroenterologist. Often, the problem can be solved with fairly simple measures.
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