Caitlin Whyte (Host): This podcast is for informational purposes only and is not intended to be used as personalized medical advice. 

In today's episode, we are talking all about hemorrhoids with Dr. Rosalynn Nguyen, who practices General Surgery at Skagit Regional Health.

Welcome to Be Well, the podcast from Skagit Regional Health. I'm your host, Caitlin Whyte. Well, doctor, to start our episode off today, can you explain what are hemorrhoids and how do they develop in the body?

Rosalynn Nguyen, DO: So hemorrhoids, they are basically swollen blood vessels located in the rectal area. I imagine them like varicose veins of the anus and rectum. So, sometimes the veins in that area, they get engorged and inflamed and patients can notice that they become either painful or they cause discomfort and sometimes they bulge out of the anus and cause bleeding. 

Host: And what are some of the common causes or risk factors for developing hemorrhoids?

Rosalynn Nguyen, DO: Sure, the common risk factors that I see mostly in the clinic are when people have significant constipation where they're straining on the toilet or they're spending longer periods of time on the toilet. Also, weight gain can attribute to developing hemorrhoids. Pregnancy is a big one because there's a growing uterus and that puts pressure on the veins in that area. And also, due to a diet with low fiber and also aging just because of the natural breakdown of the tissues in that area can weaken over time and cause hemorrhoids.

Host: And are there any symptoms that people should be aware of, and how can those differentiate between hemorrhoids and other similar conditions?

Rosalynn Nguyen, DO: So the main symptoms of hemorrhoids patients will have some pain or discomfort in the rectal area. Sometimes it manifests as some itching or irritation, or you'll notice some swelling around the anus. You can definitely see some bleeding, especially with internal hemorrhoids, which are, you know, hemorrhoids that start to bleed and it's usually bright red blood that you'll see on the toilet paper, but isn't mixed in with the stool.

There are other issues that you can have in that area, like fissures, like cuts in the anus from constipation that can cause some bleeding that's similar, but it's a different entity. And of course, there's also other things that can cause bleeding and pain in the rectal area, so if you're not sure, it's always best to consult with a physician. 

Well, what are some preventative measures, like increasing fiber intake that people can do to reduce their risk of developing hemorrhoids? There's a lot you can do, actually. So, the main one that I recommend is increasing fiber intake. Most of us don't get enough fruits and veggies into our diet, so I recommend usually 25 to 35 grams of fiber a day, and then also making sure to stay hydrated throughout the day, something like eight glasses of water.

And exercising regularly is also helpful because physical activity helps prevent constipation. And then also to avoid straining, so trying not to rush when you're having a bowel movement, or trying to keep your bowel movements to less than two minutes when you're in the bathroom.

Host: Oh, wow. Okay. And what are some non-surgical treatments that are available for managing hemorrhoids?

Rosalynn Nguyen, DO: There's a bunch. So, non-surgical treatment is actually the mainstay that I try to recommend to my patients. There are topical creams like Preparation H or things that we can prescribe that help the hemorrhoids be a little bit more comfortable, something like a numbing cream, changing your diet is also helpful.

We often recommend what we call sitz baths, which are basically shallow, warm baths in the bathtub where you can just soak and sit down and soothe the area. Also using ice packs and stool softeners can help ease any pain in that area. 

Host: And after trying those, at what point should someone consider surgical intervention for hemorrhoids? 

Rosalynn Nguyen, DO: I usually recommend, you know, after three months of these non-surgical treatments, if they're not having any improvement, then I would start going down the road of surgical interventions. We have some options that can be done in the office that don't need any sedation. And then there are also options that are in the OR for more severe hemorrhoids. 

Host: Well, let's dive into those options a bit more here. What does the surgical treatment for hemorrhoids involve and what can patients expect in terms of recovery times?

Rosalynn Nguyen, DO: The less invasive procedures that we can do, the ones that are in the office without sedation are for internal hemorrhoids. Those are the ones that don't usually cause pain, but are usually bleeding. We can do injections with certain medications to kind of help those hemorrhoids shrivel up go away.

And then also we can use rubber banding where we use a little band and basically put it around the hemorrhoid and the hemorrhoid just shrivels up and it falls off on its own. They're not painful and we can do those in the office. For more severe hemorrhoids in the OR, we can do what's called a hemorrhoidectomy and there's multiple ways to do this but it usually involves removing the hemorrhoid with some type of cautery and can involve some suturing to close the wound.

And another option is called a stapled hemorrhoidopexy. And that's where we use a special stapling device to remove the hemorrhoids. And this is one we generally see used when people have multiple hemorrhoids going on at one time. 

So, in recovery after hemorrhoid surgery, I often explain to my patients that pain management is a big one, even though the surgery is pretty straightforward, patients often will have discomfort after surgery, so we do recommend that they take some either over the counter pain medications, or if they're okay with it, we can also prescribe some pain medications to ease their first couple of days after surgery.

Also, we recommend that we start stool softeners and staying hydrated to keep the stool soft, so recovery is less painful. And generally, we don't have to restrict the patients from any physical activities, so you're okay for any heavy lifting or working around the house. Some patients, depending on what their job is, they may opt to take a few days up to a week off from work just because of post op pain and just to recover.

And then, usually most patients will come and see me in the clinic two weeks afterwards, but we do see patients, you know, up to a month and just make sure that they're healing correctly. 

Host: And to close out our episode, doctor, are there any misconceptions about hemorrhoids that you'd like to clarify for our listeners?

Rosalynn Nguyen, DO: Absolutely. So one of the most common things that I see in the clinic is that, if you're having pain in the anal rectal area, that it must be hemorrhoids. This is not necessarily always the true thing going on. Again, there are also things like fissures that can be going on. Sometimes there's skin tags. There may be other things going on that a doctor needs to examine before we diagnose someone with hemorrhoids. Another part is that if you have hemorrhoids, that you have to have surgery. That is also not always true. Most of the times, when we see patients with hemorrhoids, they have relatively mild disease.

And so, we can treat them, like I said, with changing their diet or trying topical ointments and using sitz baths, increasing fiber, things like that can really help a patient with their hemorrhoids. So it's only really when we have more severe bleeding and really intractable pain that we start to go down the surgical road.

But it's definitely something that I encourage all my patients to talk to their doctors about and a big one is that, you know, hemorrhoids can turn into cancer and hemorrhoids themselves do not cause cancer, but it is important to be aware that the symptoms that you get with hemorrhoids like bleeding can cross over to something that we would worry about either rectal or colon cancer.

So, it is something to bring up to your doctor if you're worried that it's been going on for a long time.

Host: Well doctor, thank you so much for sharing. This has been such an informative episode. For more information, go to Skagitregionalhealth.org. And thanks for listening to Be Well, the podcast from Skagit Regional Health. If you found this conversation helpful, please be sure to tell a friend and subscribe, rate and review this podcast on your favorite podcast app. I'm Caitlin Whyte.