Hemorrhoid

[Pbar]

After I have a bowel movement, I get a cutting pain and itching
in my anus. it can be very intense. I have tried all the creams and pads. The only thing I have found that works is soaking in a hot bath for 10 or 15 minutes. is this a Hemorrhoid?
I have been Dx with IBD and take Asacol every day.

thanks
pbar.

[Kevin Pho, MD]

Hello - thanks for asking your question.  

Benign anorectal diseases, including fissures, abscesses, fistulas, and hemorrhoids, are common. The prevalence of specific disorders is difficult to estimate since almost any anorectal discomfort is often attributed to symptomatic hemorrhoids.

I'll discuss the treatment of hemorrhoids.  I would strongly suggest follow up with your personal physician, because other causes such as those listed above can also cause anorectal discomfort.

Hemorrhoids are normal components of the human body. They arise from a network or "cushion" of widened (dilated) veins called the hemorrhoidal plexus that in turn arise from certain rectal veins, the superior and inferior hemorrhoidal veins. As commonly used, the term "hemorrhoids" refers to conditions in which the hemorrhoids become enlarged or inflamed or otherwise irritated or when a blood clot forms within them.

Conservative measures are successful in alleviating symptoms for most patients with hemorrhoidal disease:

Bleeding:
Clinical trials have demonstrated that adding fiber to the diet through supplementation with psyllium or appropriate commercially available fiber preparations may significantly reduce bleeding episodes associated with hemorrhoidal disease. Psyllium as well as methylcellulose add bulk to stools (ie, they are "bulking agents"), making them softer and easier to pass. Several fiber supplements are commercially available that contain either of these components. Those who take fiber supplementation should increase their fluid intake to help avoid constipation.

Irritation and itching (pruritus):
Irritation and pruritus associated with hemorrhoids may be treated by various measures including the following:

Warm sitz baths - During sitz baths, the rectal area is immersed in warm water for approximately 10 to 15 minutes two to three times daily. Sitz baths are available in most drugstores; in addition, portable bowls are commercially available that allow for their use in the workplace. The effectiveness of warm sitz baths may be due in part to relaxation of the internal anal sphincter.

Fiber supplementation may help to alleviate itching potentially related to fecal soilage, since their bulking effect may reduce leakage of rectal contents.

Application of various pain-relieving (analgesic) creams -
Administration of hydrocortisone rectal suppositories
Creams and suppositories, particularly hydrocortisone, should not be used for longer than one week unless directed by your doctor, since they may result in certain side effects, such as skin rash and inflammation (contact dermatitis) with pain-relieving creams or skin wasting (atrophy) with steroid creams.

Patients who continue to have symptoms despite the conservative measures described above may be candidates for one of various techniques developed to treat symptomatic hemorrhoids.

This can include rubber band ligation, sclerotherapy, cryotherapy, laser coagulation or surgery.

I would strongly suggest that you follow this up with your personal physician or gastroenterologist.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Links:
Medline Plus - Hemorrhoids
http://www.nlm.nih.gov/medlineplus/hemorrhoids.html

[surgeon]

It does not sound like a hemorrhoid; it sounds like a fissure, which is a tear in the surface over the control muscle at the anus. Hemorrhoids don't cause the kind of pain you describe, but fissures do. They can be treated in various ways, but need to be diagnosed correctly by having an exam. Often a cream to relax the muscle (nitroglycerin cream is one type) works fine. In cases that don't get better that way, a pretty simple operation does the trick. You need to be examined. (A nickle says it's a fissure; but don't guess or treat yourself-- get a definite diagnosis)

[perry22]

A related discussion, hemorrhoid and fissure was started.

[perry22]

A related discussion, further inquiry was started.