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A Real Pain In The Butt

I recently received an email from a DRUM! reader in Italy who wasn’t able to sit on his drum throne because of hemorrhoids. As a novice drummer, I originally thought it seemed strange that drummers would ever be sidelined by such a problem. But after asking around the drum community I learned that this was a much more common problem than I thought.

Hemorrhoids are a condition in which the veins around the anus and/or lower rectum become swollen and inflamed. These can result from straining to move your bowels and can also be associated with aging, chronic constipation or diarrhea, pregnancy, or anal intercourse. Other anorectal problems such as irritation and itching (pruritus ani), anal fissures, and fistulae or abscesses, have similar symptoms and are incorrectly referred to as hemorrhoids.

Although many people have hemorrhoids, not all experience symptoms. Hemorrhoids usually are not dangerous or life threatening. In most cases, symptoms go away within a few days. The most common symptom of internal hemorrhoids is bright red blood in the stool, on toilet paper, or in the toilet bowl. Internal hemorrhoids may protrude through the anus (protruding hemorrhoid), becoming irritated and painful.

Symptoms of external hemorrhoids include painful swelling or a hard lump around the anus that results when a blood clot forms known as a thrombosed external hemorrhoid. Excessive straining, rubbing, or cleaning around the anus may lead to irritation with bleeding and/or itching, which can result in further symptoms.

An evaluation by a physician is important any time blood in the stool or bleeding from the rectum occurs. Swollen blood vessels that indicate hemorrhoids can be detected by a simple digital rectal exam. Closer evaluation of the rectum for hemorrhoids requires an internal exam. Other causes of gastrointestinal bleeding can be determined with sigmoidoscopy or colonoscopy.

The goal of initial treatment of hemorrhoids is to relieve symptoms. These include warm water tub baths several times a day for about ten minutes and the application of hemorroidal creams and/or suppositories to the affected area.

Preventing the recurrence of hemorrhoids requires relieving the pressure and straining of constipation. Eating a diet rich in fiber and drinking six to eight glasses of fluid per day results in softer, bulkier stools, which makes it easier to empty the bowels, lessening the pressure on hemorrhoids caused by straining. Eliminating straining also helps prevent the hemorrhoids from protruding. Your physician may also recommend a stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).

In severe cases, hemorrhoids must be treated endoscopically or surgically to shrink and destroy the hemorrhoidal tissue. There are a number of techniques utilized including rubber band ligation, sclerotherapy, infrared coagulation, and hemorrhoidectomy.

The best way to prevent hemorrhoids is to keep your stools soft, decreasing pressure and straining during bowel movements, and to empty bowels as soon as possible after the urge occurs. Exercise and increased fiber in the diet help reduce constipation and straining by producing stools that are softer and easier to pass.

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