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Let’s cross the (dentate) line and talk hemorrhoids

That pain in the rear comes in different varieties. Hemorrhoids are classified relative to their relationship to the dentate line, a line that divides the upper and lower anal canal.

Hemorrhoids can be:

Internal hemorrhoids. The engorged vein and tissue bundle are positioned above the dentate line. Internal hemorrhoids are less sensitive to pain and irritation. They are further subgrouped into four grades based on the degree of prolapse from the anal canal.

External hemorrhoids. The engorged vein and tissue bundle are positioned below the dentate line. External hemorrhoids are more likely to be painful.

Mixed hemorrhoids. The engorged vein and tissue bundle straddle the dentate line.

Why, oh why?

The exact cause of hemorrhoids is unknown, but it’s observed that any condition that puts pressure on the rectal veins can cause the vascular bundles to bulge. 

Common conditions associated with hemorrhoids are:

  • Chronic constipation or diarrhea

  • Straining during bowel movement

  • Prolonged sitting on the toilet

  • Aging

  • Pregnancy

Common complaints

Hemorrhoids can be great comedic fodder but the distress they cause are no joke:

  • Itch and irritation

  • Bleeding hemorrhoids

  • Thrombosed hemorrhoids

  • Prolapsed internal hemorrhoids

Getting rid of that pain in the butt

Mild symptoms can usually be relieved with simple home and over-the-counter remedies. With self care and medical treatment, the pain and swelling can usually decrease in two to seven days.

In addition to over-the-counter hemorrhoid creams, home remedies include:

  • Eating a high-fiber diet and taking over-the-counter fiber supplements (25-35 grams of fiber/day) to make stools soft, formed and bulky.

  • Avoiding excessive straining to reduce the pressure on hemorrhoids and help prevent protrusion.

  • Drinking more water to help prevent hard stools and aid in healing.

  • Taking warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day to help the healing process.

Persistent symptoms, prolapsed hemorrhoids, or severe pain from clotted hemorrhoids may require surgical treatment. Some of these procedures, such as rubber band ligation, cut off blood supply to shrink or cut off the hemorrhoids. For severe hemorrhoids that fail treatment with minimally invasive procedures, the definitive fix is surgical removal of the extra tissue that causes bleeding and protrusion.


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