Michael Margolin, MD, FACP, FACG  
     
     
HEMORRHOIDS AND ANAL FISSURES
 
  HEMORRHOIDS are enlarged cushion-like networks of blood vessels at the anus. There are two types: external and internal, referring to their location. External hemorrhoids develop near the rim of the anal canal and are covered by very sensitive skin. If a blood clot develops, (a thrombosed hemorrhoid), painful swelling may occur. To the finger's touch the external hemorrhoid is a hard, sensitive lump.  Internal hemorrhoids develop inside the anus, beneath the rectal lining. Painless bleeding and protrusions during bowel movements are the most common symptoms. However an internal hemorrhoid can cause severe pain if it protrudes from the anal canal and cannot be pushed back inside.   Many factors contribute to hemorrhoids, including the erect posture of the human race. Chronic constipation or diarrhea, aging and pregnancy also contribute.  

An ANAL FISSURE is a tear in the anal opening. Fissures are usually painful and may bleed.  

TREATMENT  Bowel movements must be kept soft, and all straining avoided. Diet should be high in fiber (roughage), including salads, vegetables, whole wheat (rather than white bread) and fruit. An apple or more a day (or applesauce) may indeed help keep the doctor away. Avoid spicy foods. Mitrolan, Fiber Con, Fiberall and Equalactin are fiber-supplements that absorb water if your bowels tend to be too loose.  Avoid lingering on the toilet. Cleanse the area gently. Flushable wipes are helpful for this. Tucks pads are gentle and may also feel soothing. Bed rest may help by shifting the forces of gravity. An ice cube held against the hemorrhoid may ease the pain.  Soaking in 4 - 6 inches of warm water with 1 tablespoon of boric acid in the bath tub 2 - 4 times daily may help. Lie on your back with your cheeks spread. Swish the water around occasionally.  A&D ointment is as good as anything for applying on the outside. Anusol is fine too. Preparation H may cause more inflammation in some people. Calmol 4 suppositories after each bowel movement may be useful for internal hemorrhoids.  The pain and swelling should reduce over 2 - 7 days. The firm lump of a swollen external hemorrhoid should completely recede within 1 1/2 months.