Hemorrhoid is a condition associated with swollen blood vessels in or around the rectum or anus and is also commonly known as piles.

For most of the times, hemorrhoid may settle down themselves without any treatment, but may need treatment or medications if severe or prolonged. One may opt to buy the medications directly from pharmacies or may refer to a physician for the same. The following measures can be adopted to treat hemorrhoid:

• Creams and ointments: Corticosteroid creams or suppositories maybe applied to the back area to relieve swelling and inflammation. These can be applied 5-7 times a day in case of a severe inflammation. Besides, there are hydrocortisone sprays available these days which are convenient to use and hygienic as well.
• Warm sitz baths for about 15 minutes 4-5 times in a day is another effective measure for treating piles and relieving discomfort. This is done using 8 cm of warm water for the same number of times as of bowel movement
• Analgesics like paracetamol for alleviating pain and inflammation. These should be consumed in limited quantity as they may increase the sensitivity.
• Local anaestheticsand witch hazel: Local anaesthetics are used for temporary relief of pain in case of painful hemorrhoid. Dabbing with hazel soaked cotton rolls helps in reducing swelling and inflammation.
• Laxatives to relieve constipation. Laxative could be either bulk forming or osmotic to increase the water content of stools and make them softer. But these may be avoided if they cause diarrhoea. Bananas, butter milk, radish or turnip juices may act as good natural laxatives.
• Diet modifications during pregnancy. One must consult the dietician or gynaecologists for the diet modification. The diet should include more of fibres including fruits, vegetables, nuts, whole grains, etc. one may even take supplements in form of stool softeners or bulk forming agents. Taking atleast 6-8 glasses of water each day especially in hot weather conditions is a must. There should be a check on the salt intake to avoid fluid retention and swelling of veins.
• Application of petroleum jelly over the internal hemorrhoid in order to prevent painful bowel.
• Home remedies which include application of baking soda or warm olive oil or crushed bitter gourd to swollen veins orenema with warm water containing boiled neem leaves

If the symptoms fail to subside, other measures may be taken by the doctor and include:

• Sclerotherapy or injection with a chemical solution in order to treat the internal hemorrhoid which may leave a scar after complete healing or closing of hemorrhoid. It is used as an alternative to banding.
• Rubber band litigation or banding in case of prolapsed hemorrhoid. This procedure includes using a small rubber band around the hemorrhoid in order to lower down or remove the blood supply to the hemorrhoidafter which these may shrivel and fall off.
• Cauterization and coagulation using laser beam or electric probe or infrared light for burning up the haemorrhoid and sealing them. These get shrunk or closed after the procedure and are preferred mostly in case of prolapsed hemorrhoid.
• Surgery or hemorrhoidectomy for the removal of grade three or grade four internal hemorrhoid that are extremely painful like thrombosed hemorrhoid.

Surgery is referred to the patients who are unable to make compliance with medications and minimally invasive procedures. Surgical procedures offer long term relief from pain and recurrence as compare to non-surgical procedures.

Kinds of Hemorrhoid Surgery

There are mainly three options for patients who want to undergo surgery for hemorrhoids. These procedures are:

Hemorrhoidectomy

Hemorrhoidectomy is defined as surgery for the removal of hemorrhoid. The procedure involves following steps:

• A local anaesthesia (only part of the body where surgery is being performed is numbed) or general anaesthesia (whole body goes into sleep) is given to the patient.
• A circular incision around the anus is made to remove the hemorrhoid.
• The patient is kept under observation for 24 hours or usually sent home on the same day

Complications: As the surgery is performed in highly sensitive area, therefore, the area becomes painful and tender which may temporarily cause uncomfortable. Also, urinary tract infections or difficulty in urination for temporary period are also associated with complication of this procedure.

Stapled Hemorrhoidectomy

This procedure is less painful than the conventional hemorrhoidectomy. The following steps are performed during this procedure:

• Hemorrhoid tissue is removed using circular stapling device without making any incision.
• The hemorrhoid is lifted from the base and then placed back into the anal canal and “stapled” over there. This step cuts off the blood supply to the hemorrhoids.

Thus hemorrhoids shrink and die. This surgery is more expensive.

Complications: include recurrence of hemorrhoids and rectal prolapse. Rectal prolapse is painful condition in which rectum protrudes from lower part of anus.

Doppler-guided Hemorrhoidectomy

In this procedure, a special probe is used to locate arteries of the hemorrhoid and then less tissue is incised and removed.

Post Surgery Care

Following care is required pot surgery:

• Keep your proper diet. Drink maximum liquid and take bland diet like plain rice , dry toast etc in the first few days after surgery, then gradually increase fibre content in your diet.
• One can apply anaesthetics ointments before and after bowel movements to get relief from pain.
• To reduce swelling and inflammation around anal area, ice-packs are useful.
• Bathing with warm water also help to reduce muscle spasms and pain.
• Antibiotics are prescribed after surgery to prevent infections.
• Follow ups should be done to avoid any complication after every 2- 3 weeks.

The inflammation and swelling up of veins inside or around the anus is called hemorrhoids which occur mostly due to straining in that area. Also known as piles, it can be classified into two types: external and internal hemorrhoids.

External hemorrhoids are the type of hemorrhoids which occur beneath the skin of the surrounding areas of the anus.

Causes of External Hemorrhoids

Hemorrhoids may be caused due to a variety of reasons with straining at the time of bowel being the major cause. Other causes include severe diarrhoea or constipation; or in case of pregnancy in females. All the above factors lead to increased pressure upon the blood vessels around anus leading to lowering of blood flow as well as pooling of blood and thus enlargement of the vessels. Genetics may also play role in occurrence of hemorrhoids. Obesity and long hours of sitting or standing are some other causes for piles.

Signs and symptoms of External Hemorrhoids

The following symptoms may occur with hemorrhoids and depend upon the severity of the condition:

• Formation of lumps or swelling around the anus.
• Pain or tenderness during bowel movement.
• Bleeding during passing of stools
• Discharge of mucous fluids from anus
• Presence of a lump or swelling inside and/or around the anus
• Itching inside the anus.

Diagnosing External Hemorrhoids

Hemorrhoids can be diagnosed by careful clinical examination by the doctor where the doctor examines the anus either with gloved and lubricated finger or through anoscope or a protoscope that are inserted inside the rectum. Other ways may be through colonoscopy or sigmoidoscopy which includes insertion of a flexible tube for viewing the deeper parts of rectum or colon. Barium enema followed by X-ray of lower gastro-intestinal tract may also be helpful.

It is necessary to rule out other diseases associated with anal bleeding. These include Crohn’s disease, anal fissure, colitis and colorectal cancer.

Treatment of External Hemorrhoids

Although hemorrhoids may settle down themselves without any treatment, the following measures can be adopted to treat it:

• Creams and ointments– corticosteroid creams or suppositories maybe applied to the back area to relieve swelling and inflammation. These can be applied 5-7 times a day.
• Warm sitz baths for about 15 minutes 4-5 times in a day or the same number of times as of bowel movement
• Analgesics like paracetamol for alleviating pain and inflammation. These should be consumed in limited quantity as they may increase the sensitivity.
• Local anaesthetics for temporary relief of pain
• Laxatives to relieve constipation. Laxative could be either bulk forming or osmotic to increase the water content of stools and make them softer.
• Diet modificationsespecially during pregnancy or in case of obesity. One must consult the dietician or gynaecologists for the diet modification. In case of constipation also, diet modification is a necessary measure.

If the symptoms don’t subside, other measures may be taken by the doctor and include:

• Sclerotherapy or injection with a scar forming solution to close the hemorrhoid. It is used as an alternative to banding.
• Rubber band litigation in case of prolapsed hemorrhoids. This is done to lower down or remove the blood supply to the hemorrhoids.
• Cauterization and coagulation using laser beam or electric probe or infrared light to burn the lumps.
• Surgery for the removal of grade three or grade four internal hemorrhoids.

Prevention of External Hemorrhoids

One should take necessary measures to prevent the aggravation or occurrence of hemorrhoids. Below are a few ways:

• Modification of diet and lifestyle- eating more of fibrous foods and less of processed food.
• Regular exercise and physical activities to prevent side effects of sedentary lifestyle
• Taking measures to prevent constipation by intake of adequate fluids and laxatives.
• Avoid prolonged sitting in toilet and avoiding straining while bowel movement.

There are two types of hemorrhoids:

1. Internal hemorrhoids: which are located inside rectum.
2. External hemorrhoids: which are located under the outer layer of anus.

The main cause of hemorrhoids is swollen veins in anal and lower part of rectum which occur due to increased pressure on these veins. Due to increase pressure in these veins, blood starts pooling in these veins leading to stretching of these vessels and thus developing into swollen condition. The factors which lead to increased pressure on these veins are:

1. Rushing: Making haste while passing stools or during bowel movement can lead to increased pressure or excess strain on the veins present in rectal part.
2. Constipation or diarrhoea: These conditions may lead to strain and constant pressure on blood vessels present in the anal canal.
3. Obesity: Overweight can also lead to the swollen condition. Excess fat deposition in pelvic and abdomen region can cause increase pressure on the veins.
4. Pregnancy: Pregnancy lead to hormonal changes and especially during labour, contracting and relaxing of muscles and supportive tissue can cause intense pressure on the veins present in anal area. The pressure on rectum and anus could also be due to enlarged uterus. The hormonal changes occurring in pregnancy can also lead to weakening of muscles surrounding rectum and anus. And thus these all events can cause pooling of blood in the veins, leading to swelling.

5. Other medical conditions: Chronic diseases of heart and liver may cause pooling of blood in abdomen and thus causes swelling of veins.
6. Diet: Low fibre diet may also be responsible for the development of this condition. The smaller calibre stool will develop more strain during bowel movement and thus leads to increased pressure within the veins and thus causing them to swell.
7. Anal intercourse: Anal intercourse can lead to pressure on the veins and thus can cause swelling of blood vessels.
8. Poor posture: Your lifestyle behaviour may also lead to development of this condition. Prolonged sitting and poor posture may also cause pressure on the veins.
9. Spinal cord injury: Any kind of injury in spinal cord which leads to poor posture of your body can lead to pressure on veins and development of this condition.
10. Colon cancer: This can also be one of the factor for the development of this disease.

Hemorrhoids or piles are a condition with swollen vascular tissue around and inside the anal area. It is characterized by inflammation and tenderness in and around the anus. It causes severe discomfort during the bowel movement and thus needs immediate treatment. Application of corticosteroid cream is the most common method of treating hemorrhoids. There are several creams available over the counter to take treatment for hemorrhoids from home.

The top 10 creams available in market for treatment of hemorrhoids include:

1. Tronolane anaesthetic haemorrhoidal cream
2. Americaine Hemorrhoidal Ointment (benzocaine)
3. TUCKS Hemorrhoidal Ointment (pramoxine)
4. Preparation H haemorrhoidal cream
5. HemAway fast haemorrhoidal relief cream
6. Botanic choice homeopathic haemorrhoid cream
7. Anusol HC
8. Recticare lidocaine 5% anorectal cream
9. Venapro
10. Avatrol

These creams are used to treat itching, swelling, discomfort and minor pain caused by hemorrhoids. These creams if applied regularly and properly help in reducing redness and discomfort to a large extent. These creams work by causing the hemorrhoids to shrink.

Using the Hemorrhoids creams

• For external application, clean the area affected with piles with water and mild soap, rinse well, and pat dry.
• For application of the cream inside the anus, use an applicator tip or cap or the nozzle as per the instructions given on the product package, or as per the directions of the doctor.
• Fill the medication onto the applicator tip from the tube or container as directed.
• Gradually insert the applicator tip inside the anus to about 1/2 to 1 inch and then apply in and around the anal opening according to the directions.
• Ensure not to insert your finger or any of the part of the tube inside the anus, and avoid inserting the applicator tip/nozzle to more than 1/2 to 1 inch (1.5 to 2.5 cms) into the anus to avoid contamination.
• Avoid using your finger for the application of these medications inside the anus. Prefer use of a single-use tube and applicator that could be discarded after one use.
• For applying the product outside the anus only, apply a small amount of ointment with your finger to the affected area and then rub gently.
• Avoid not covering the area with waterproof or plastic bandages unless directed by the doctor.
• Covering the treated area with bandages may improve the working of drug well, but at the same time, may also increase the side effects.
• Wash your handsafter applying the creams.
• Avoid contact of fingers with eyes, nose, ears or mouth. If the cream gets into these areas, rinse them immediately with cold water.
• Use the creams atleast2 to 4 times daily, or after every bowel movement, as per the directions of your doctor. Do not use these products more often, or longer than the time prescribed by the doctor.
• Dosage of the cream should be recommended by the doctor on the basis of your medical condition and response to therapy.
• Medication should be used regularly for get the maximum benefit.
• One should avoid suddenly stopping the use of creams suddenly without your doctor’s approval.

Thrombosed hemorrhoid is defined as hemorrhoid which has ruptured or become necrotic or developed a clot. This condition can exist in either type of hemorrhoid whether internal or external. It is very common condition that occurs in hemorrhoids. This condition can cause more swelling and discoloration to the hemorrhoid.

If thrombosis occurs in external hemorrhoid then it may become more painful. The pain usually goes away in 2-3 days but the swelling caused due to thrombosis may take longer time to disappear. However, fewer complications are involved with thrombosed external haemorrhoid.

If internal hemorrhoids become necrotic or thrombosed, only then they become painful and causes discomfort.

Cause of Thrombosed Hemorrhoids

Though, there is very limited literature to address the cause of thrombosis in hemorrhoid. However researchers believe that when large amount of pressure is applied on the existing hemorrhoids or anal canal due to the various reasons like vaginal foetal delivery or bouts of constipation, then it is more likely to develop this condition. The condition can be very uncomfortable to the patient and also make the patient suffer from more pain.

Treatment of Thrombosed Hemorrhoids

Home remedies for Thrombosed Hemorrhoids

1. Dietary modification: By simply adding more fibre to your diet and taking large amount of water can help you by acting as stool softening agent. This will help to reduce the strain while passing the stools. This treatment will also reduce the chances of reoccurrence of the hemorrhoids. Besides from these changes, you can also use stool softeners on the recommendation of your physician.
2. Use of Witch Hazel: This is very commonly used treatment at home. It helps in relieving from pain for temporary period. The ointment mainly shows its action by making the haemorrhoid to shrink.
3. Take sitz bath: This is also one of the effective home remedy. Besides using witch hazel, you can also help your body to heal by taking sitz bath. This will not only help in reducing the symptoms but also help you in maintaining better hygiene of the affected area. After taking sitz bath, apply ice packs on the affected area in the next pack. This action will help to reduce the circulation of blood to that area thus shrink the haemorrhoid with time.

Surgical and non-surgical treatment for Thrombosed Hemorrhoids

If home remedies won’t work out, then it’s high time to consult with your doctor. The doctor will take your complete medical history and prescribed you the best suited treatment for you. The various options for the treatment of hemorrhoids will be:

1. Non-surgical treatment

There are three non surgical treatments which are as follows:

• Banding
• Sclerotherapy
• Infrared coagulation

2. Surgical treatment

There are two surgical treatments which are as follows:

• Haemorrhoidectomy
• Stapled hemorrhoidectomy

A hemorrhoid, commonly known as piles is characterized by swollen blood vessels around or inside the anus and rectum. These hemorrhoidal veins are present in the lower part of the anus or rectum. On swelling up, these veins become thin, extended and irritated as the bowel passes through rectum or anus.

One should take necessary measures to prevent the aggravation or occurrence of hemorrhoid. It is necessary to keep the stools soft in order to avoid any discomfort for which, below are a few ways:

• Modification of diet: Eating more of fibrous foods such as fruits, vegetables and whole grains keeps the stools soft and bulky thus reducing the pain while passing the bowel. One must avoid consumption of processed food that may lead to straining as well as worsening of hemorrhoid symptoms. But care should be taken while consuming fibres which may lead to gastric problems like acidity. Thus these fibres should be added gradually in the diet. The recommended required fibre content in the diet should be a minimum of 25 grams a day for females and 38 grams a day in case of males. But some people may not get sufficient fibre from their diet and may opt for supplements like Citrucel and Metamucil to add to the fibre requirement. These supplements are easily available over the counter in various pharmacies. With these supplements the cautionary measure to be taken is that one should take sufficient amount of water each day as these supplements may cause constipation.

• Physical activity: Regular exercise and alteration in the sedentary lifestyle are other ways to reduce the consequences of hemorrhoid and to prevent side effects. These exercises help to prevent exercises and also reduce pressure over veins that may occur while long periods of straining.
• Prevention of constipation: For those who suffer constipation, must take necessary measures to prevent development of piles by intake of adequate fluids and laxatives to immediately relieve constipation when it occurs.
• Avoid prolonged sitting in toilet as it may lead to increased pressure over the veins in anus and rectum.
• Avoid straining while bowel movement and holding breathe for longwhich may again lead to increased pressure on veins.
• Relieve yourself immediately on urge: One must not wait to pass bowel for long as the delay may cause drying as well as hardening of the stools and may cause discomfort. Thus one should pass the bowel as soon as the urge occurs.

Hemorrhoid should be treated only when patient starts complaining of them. In case of symptomatic hemorrhoids, the first line of treatment includes dietary modification. Adequate fluid intake and increased fibre in the diet are recommended to treat hemorrhoids. If dietary modification doesn’t work, then various procedures like sclerotherapy, banding, medication or infrared coagulation are recommended to treat second or third stage hemorrhoids. Also, in case of large external hemorrhoids or fourth stage hemorrhoids, case is referred to surgery.

Medications for Hemorrhoids

The treatment of hemorrhoids depends on the site of hemorrhoids whether it is internal or external. Various medications are prescribed to relieve the patient from pain and strain.

• Stool softeners: It include Docusate Sodium which act as stool softening agent by allowing in cooperation of fat and water into stool thus help in relieving the strain while passing the stools.
• Astringent: Astringents like Hamamelis water helps in controlling itching of hemorrhoids.
• Anaesthetics: Various anaesthetic agents like lidocaine in the form of ointments are prescribed to relieve pain and inflammation.
• Analgesics: These are also prescribed to relieve pain and inflammation.

The only precaution that should be taken while using these ointments, that these creams should not be used for longer period as they can cause thinning of the skin with over use.

In-office procedures for Hemorrhoids

If conservative medical therapy is not enough to treat hemorrhoids, then one should not take longer time to go for minimally invasive procedures. These treatment includes:

• Banding: This is very effective procedure in many cases. In this procedure, the doctor places a small rubber band around the base of hemorrhoid. This step will stop the circulation of blood to the hemorrhoid. And in this way, hemorrhoid will fall off due to decreased blood supply. The complication of this procedure is bleeding that begins after two or three days but this is very rare.

• Sclerotherapy: This is less effective than former. A chemical solution is injected into the hemorrhoid which allows the structure to shrink and thus help in withering of the hemorrhoid.

• Infrared coagulation: This technique cause hemorrhoid to get harden and then to shrivel. This technique can also be done by laser; the only side effect of this technique is chances of recurrence of hemorrhoids with this procedure.

Surgical procedures for Hemorrhoids

Surgical procedures are recommended for the patients with large hemorrhoids or other procedures fail to treat hemorrhoids. These procedures include:

• Hemorrhoidectomy: It includes removal of hemorrhoid by removing excessive tissue and the procedure is performed in general anaesthesia. The procedure is very effective and most commonly used for the treatment of severe and recurrent hemorrhoids. The complications include urinary tract infections or difficulty in urination for temporary period.
• Stapled hemorrhoidectomy: This procedure is less painful than the former one. This procedure blocks the blood circulation to hemorrhoid. However, there is greater risk of recurrence in this procedure as compare to hemorrhoidectomy. The complication include rectal prolapse. This is the condition in which rectum protrudes from lower part of anus.

Hemorrhoids or popularly known as piles is the pathological condition in which vascular veins present in anal and lower part of rectum get swollen due to increased pressure on these veins. The pressure on these veins causes pooling of blood in these veins and thus forming a bulge and thus causing inflammation in the lining of epithelium of these vessels. The blood vessels present in anal and rectal parts, otherwise, work as cushion and help in control of the stools, when present in the normal conditions. There are two types of hemorrhoids:

1. Internal hemorrhoids: which are located inside rectum.
2. External hemorrhoids: which are located under the outer layer of anus.

Signs and symptoms of Hemorrhoids

The symptoms mainly depend on the location of hemorrhoids:

External hemorrhoids are mainly responsible for rectal pain. Blood streaks may get noticed on the toilet paper after passing strain stool.

Internal hemorrhoids exhibit same symptoms as above. Bright red coloured blood starts appearing on the surface of stools as well.

The other symptoms include:

1. Discomfort: Even after passing the stools, urge to pass more stools will be there causing discomfort. This condition arises due to the presence of bulge of hemorrhoid at the end of anal canal. Bigger in size the hemorrhoid is, more will be discomfort.
2. Irritation: Hemorrhoids present at the end part of anus form bulge and may also secrete mucus, thus causing mild irritation around the surrounding skin.
3. Itching: Irritation caused due to mucous secretion by these hemorrhoids lead to itching. This is the most common complaint of the patients suffering from piles.
4. Pain: Pain while passing stools is very common in this condition. Internal hemorrhoids are less painful. But the hemorrhoids that are present at the end part of anus may cause pain if they get swollen or get squeezed by the surrounding muscles during contraction or relaxation. If severe pain is present, then emergency treatment may be required.

Tests for diagnosis of Hemorrhoids

Hemorrhoids can be diagnosed simply by physical examination and medical history of the patient, if it is external hemorrhoid. A doctor needs to do visual examination of the affected anal area to locate and evaluate the size of hemorrhoid so that he can develop treatment plan according to the degree of severity.

To detect possible abscesses or rectal tumours, a digit rectal exam or an anascopy is being done. No more other tests are required, if the patient is younger and do not exhibit any risk for cancer.

A doctor should exclude all those conditions in which rectal bleeding or discomfort are common.  Differential diagnoses of this condition are:

• Colon polyp
• Anal fissure
• Inflammatory bowel disease
• Rectal prolapsed

Other tests may also be performed to make sure that nothing else like cancer is present which lead to the same above symptoms. These tests are generally not performed for the diagnosis of hemorrhoids. These tests are:

• Barium enema
• Flexible sigmoidoscopy: this test helps to have a clear view inside the anus and to look for any abnormal growth inside the track.
• Colonoscopy

Hemorrhoids or piles are a condition characterized by occurrence of swollen blood vessels in and around anus. These are of two types: internal and external hemorrhoids.

Internal hemorrhoids are those which lie inside the rectum, far enough from the anus that one cannot see or feel them.

Causes of Internal Hemorrhoids

Internal hemorrhoids have the same causes as those of external hemorrhoids. Although the exact cause for hemorrhoids is still unknown but hemorrhoids may be caused due to varicose veins which may be inherited or weakness in the veins present in the rectum and anus. Extreme abdominal pressure may lead to swelling up of veins that become susceptible to irritation. Sitting or standing for long durations, obesity, straining on the toilet, pregnancy, sneezing, coughing, vomiting and holding the breath for long time, are some of the factors that may exert pressure on these veins.

Piles are also related with diet. Eating more fibrous diet helps in preventing hemorrhoids while eating processed foods may increase the risk of developing hemorrhoids. Constipation causing factors like inadequate liquid intake or low fibre diet may also irritate the swollen veins, aggravating piles.

Signs and symptoms of Internal Hemorrhoids

These are mostly painless due to presence of lesser number of sensory nerves inside the rectum. But one may be able to see or feel them as pinks and moist pads of skin when these grow abruptly and enlarge to protrude outside the anal sphincter. This is also characterized by inflammation or redness around the protruding hemorrhoids.This happens in case of prolapsed hemorrhoids which are painful due to presence of more sensory nerves in anus. Internal hemorrhoids can be classified into 4 grades depending upon the extent of protrusion as:

Grade 1 – when there is no prolapse

Grade 2 – when these hemorrhoids protrude only at the time of passing bowel and come back inside after some time.

Grade 3 – these protrude at the time of bowel movement but need to be pushed back manually

Grade 4 – these are the most severe kind of internal hemorrhoids and cannot be pushed back manually.

Bleeding is the most common feature of this type of hemorrhoids which helps to recognise its existence when pain is absent. One may see bright red streaks of blood along with bowel or on toilet paper especially while passing out stools. Sometimes the bleeding can be chronic and profuse with more than just streaking.

Sometimes, there is discomfort and pain during the bowel movement due to rubbing of the walls of hemorrhoids by the bowel.

Diagnosis of Internal Hemorrhoids

Internal hemorrhoids can be diagnosed by careful clinical examination by the doctor where the doctor examines the anus either with gloved and lubricated finger or through anoscope or a protoscope that are inserted inside the rectum. Other ways may be through colonoscopy or sigmoidoscopy which include insertion of a flexible tune for viewing the deeper parts of rectum or colon. Barium enema followed by X-ray of lower gastro-intestinal tract may also be helpful.

It is necessary to rule out other diseases associated with anal bleeding. These include Crohn’s disease, anal fissure, colitis and colorectal cancer.

Treatment of Internal Hemorrhoids

• Diet modifications: One must take sufficient fibre in diet as well as plenty amount of water to prevent constipation to relieve discomfort. Although there is no permanent cure for this but one must take necessary measures to lower the discomfort.

If the symptoms don’t subside, other measures may be taken by the doctor:

• Sclerotherapy or injection with a scar forming solution to close the hemorrhoid. It is used as an alternative to banding.
• Rubber band litigation in case of prolapsed hemorrhoids. This is done to lower down or remove the blood supply to the hemorrhoids.
• Cauterization and coagulation using laser beam or electric probe or infrared light.
• Surgery for the removal of grade three or grade four internal hemorrhoids.