- Hemorrhoids is a condition characterized by the presence of swollen veins in the lining of the anus and lower rectum.
- Hemorrhoids are generally caused by an increased pressure that causes the veins to become engorged and wide.
Hemorrhoids, or piles, is a condition characterized by the presence of swollen veins in the lining of the anus and lower rectum. The swelling can be either internal or external. External hemorrhoids are formed by the swelling of the veins near the opening of the anus. This condition is not very serious, but may cause considerable pain and discomfort to the patient. Some people may have both the types of hemorrhoids at the same time. The treatment of the hemorrhoids depends on the type.
They are also called piles. Hemorrhoids are very common. Often the causes are unknown. They may result due to straining during bowel movements. They might also result during pregnancy due to increased pressure on the veins. Sometimes hemorrhoids are asymptomatic but sometimes they may cause itching, discomfort and bleeding. Occasionally a clot may form which can be extremely painful. Sometimes these clot need to be drained or lanced. With the help of home treatments and lifestyle changes many people can get relief fro m hemorrhoids.
Causes of hemorrhoids
Hemorrhoids are generally caused by an increased pressure that causes the veins to become engorged and wide. These veins, along with the overlying tissues, form swellings called hemorrhoids. The most common cause for the formation of hemorrhoids is the strain during bowel movements.
Some other causes include:
- Diarrhea- especially chronic diarrhea
- Constipation- especially chronic constipation causes strain which exerts pressure on the walls of the blood vessels.
- Sitting for long periods of time- particularly on the toilet
- Lifting heavy object repeatedly
- Being overweight- not following a high fiber rich diet may cause hemorrhoids.
- Anal infections and anal intercourse may either cause hemorrhoids or worsen the symptoms of existing ones.
- Certain medical conditions like liver cirrhosis
- Pregnancy may also result in the formation of hemorrhoids, especially during the last two trimesters. In pregnant women it is most common since the uterus enlarges. So it presses on the vein in the colon which causes it to bulge. Hemorrhoids can worsen by the strain to push the baby out during the labor.
- Aging- it is common in adults aged 46-65. However younger people and children might also get.
- Genetics- some people may inherit it.
Symptoms of hemorrhoids
Both internal and external hemorrhoids have similar symptoms:
- Itching in the anal area
- Bleeding during the bowel movements- it may be painless or painful one. On the toilet paper or in the toilet bowl bright red streaks can be observed.
- Pain in the anal area while sitting
- Pain during bowel movements
- Presence of hard or tender lumps near the anus
- Feces may leak out unintentionally
Internal hemorrhoids are usually small swollen veins in the anal wall. But in some cases, they develop into large swollen and sagging veins that project out of the anus. When squeezed by the anal muscles they develop into painful swellings. Bright red streaks of blood can be seen on the toilet bowl or the tissue paper after bowel movement with internal piles. External hemorrhoids often form a hard and painful lump near the anus.
Depending on the location hemorrhoids symptoms may vary
Internal hemorrhoids- they are present inside the rectum. They can’t be seen nor felt. Rarely do they cause discomfort. While passing stools if it is strained or irritated it may cause the surface of hemorrhoids to get damaged and bleeding may occur. Rectal bleeding is often the first sign of internal hemorrhoids. Straining can sometimes push it so that it protrudes through the anus. It is called prolapse hemorrhoid or protruding hemorrhoid.Inflammation of an internal hemorrhoid may cause swelling which is not painful since no pain fibers are attached to the veins above the pectinate line. But when a hard stool is passed it can scrape off the thinned lining of the hemorrhoid and cause painless bleeding. The swelling may cause spasm of the muscles which may cause pain. At the anal verge a lump may be felt. Internal hemorrhoid may result into thrombose which can lead to severe pain.
If the hemorrhoid is inflamed it can leak mucus which further causes inflammation of the skin around the anus which causes burning and itching. This is known as pruritis ani.
External hemorrhoids- they lie under the skin around the anus. They are visible. They can cause itching or bleeding when irritated. Usually they are very painful since many sensitive nerves are present in this body part. When an underlying vein within the hemorrhoid clots off it results into thrombosed external hemorrhoids which causes intense pain. At the anus a painful lump can be felt. External hemorrhoids can also cause excessive skin tags. These skin tags can be felt at the verge of the anus. They make cleaning difficult after bowel movement which can lead to secondary skin infections.
Thrombosed hemorrhoids- sometimes blood pools in an external hemorrhoid and forms a clot. This can result in swelling, inflammation, severe pain and a hard lump near the anus.
When to see a doctor
The most common sign of hemorrhoid is bleeding during bowel movements; doctor will first do a physical examination. Doctor will also perform other tests to rule out other disease or serious conditions. Colorectal cancer and anal cancer may also cause rectal bleeding hence do not assume hemorrhoids if you get rectal bleeding. If there are larger amounts of rectal bleeding, lightheadedness, dizziness or faintness then consult your doctor.
Diagnosis of hemorrhoids
If a person experiences any of the above symptoms, then he should contact a doctor.
Piles are usually diagnosed by a physical examination by a doctor. Doctor may also perform other tests to confirm hemorrhoids. These tests include digital rectal exam – by using a gloved, lubricated fiber the doctor performs manual examination.
Complications of hemorrhoids
These are rare but the complications include:
- Anemia- it is rare. From hemorrhoids if there is chronic blood loss then it may result in anemia. In this condition the body does not have enough blood cells to carry oxygen.
- Strangulated hemorrhoids- the hemorrhoids may become ‘strangulated’ if the blood supply to an internal hemorrhoid is cut off. It can be extremely painful.
- Blood clots- sometimes a thrombus may be formed due to accumulation of blood which can be painful. It may cause swelling and inflammation in that area.
Treatment of hemorrhoids
Simple changes in lifestyle and remedies can reduce both internal and external hemorrhoids:
- Having more fiber in the diet
- Drinking plenty of water
- Over-the-counter medications to control itching
- Taking stool softeners
If the above said methods do not give much relief, the doctor may tie off the swellings or scar the tissue that surrounds the hemorrhoids. This will cut off the blood supply to the swellings which gradually shrink in size. Surgery is another option if none of the other methods alleviate the symptoms.
Symptoms can be relived by:
- Topical creams and ointments- over –the- counter creams and suppositories are available. They contain hydrocortisone. Also topical numbing agent or pads which contain witch hazel are available.
- Ice packs and cold compresses- they help reduce swelling.
- Sitz bath using warm water –it is placed over the toilet. They help relive burning or itching
- Moist towelettes- pain can get aggravated by using dry toilet paper.
- Analgesics- painkillers may help alleviate the pain and discomfort. These include aspirin, Ibuprofen and acetaminophen (Tylenol)
Most of the medications including ointments, pads or suppositories are available over-the counter. If they are ineffective then consult a doctor.
Non surgical options
- Rubber band ligation- is the most common non surgical technique in removing hemorrhoid. It is for internal hemorrhoids. On the base of the hemorrhoid an elastic band is placed. This is to cut off blood supply. The hemorrhoid will shrink or fall off.
- Sclerotherapy- a solution is injected into an internal hemorrhoid. It produces a scar that cuts off blood supply to the hemorrhoid.
- Two other options are photocoagulation and electrocoagulation.
This may involve:
- Hemorrhoidectomy – the hemorrhoid is completely removed
- Stapling- a prolapsed hemorrhoid is tacked back into place. Both these procedures are performed under anesthesia and the patient gets discharged on the very same day of the surgery.
How to prevent hemorrhoids
Hemorrhoids can be prevented by inculcating healthy food habits like eating more fibrous foods including vegetables, fruits, and whole grains. Eating high-fiber foods softens the stools and increases it bulk. This helps avoid the straining during bowel movements. In order to avoid gas problems slowly incorporate fiber in your diet. Having regular exercise and drinking plenty of water also help in making the bowel movement easier with less pressure on the anal wall.
- Fiber supplements-the recommended amount of fiber in the diet is 25grams for women and 38 grams a day for men. Over – the -counter fiber supplements are available such as Metamucil and Citrucel which can improve overall symptoms and bleeding caused due to hemorrhoids. They also soften the stool and make it regular. Fiber supplements can cause constipation if enough amount of fluid intake is not there. Have atleast eight glasses of water or other fluids daily
- Don’t strain- greater pressure is exerted on the veins in the lower rectum due to straining. As soon as you feel to urge go to pass the bowel movement. If you wait the urge may go away which may make the stool dry and harder to pass.
- Exercise- doing exercise and keeping yourself active will help prevent constipation and reduce pressure on the veins. It also helps to lose weight which is also another factor that contributes to hemorrhoids.
- Avoid prolonged sitting-it can increase the pressure on the veins in the anus.
How does a hemorrhoid look like?
Normal hemorrhoids are not visible. For symptoms to occur first the hemorrhoids should swell and become inflamed or develop a clot. External hemorrhoids and prolapse hemorrhoids are visible outside the anus. A thrombose hemorrhoid is dark bluish in color and is seen as a lump. A non-thromobosed hemorrhoid is seen as a rubbery lump.