What Are Hemorrhoids?
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 for the patient. Some people may have both types of hemorrhoids at the same time. The treatment of hemorrhoids depends on the type.
They are also called piles. Hemorrhoids are very common. Often, though, the cause is unknown. They may be a result of straining during bowel movements. They might also occur during pregnancy due to increased pressure on the veins. Sometimes, hemorrhoids are asymptomatic, but other times, they may cause itching, discomfort, and bleeding. Occasionally, a clot may form, which can be extremely painful. Sometimes, these clots need to be drained or lanced. With the help of home treatments and lifestyle changes, many people can get relief from hemorrhoids.
Causes
Hemorrhoids are generally caused by increased pressure that makes the veins become engorged and widened. These veins, along with the overlying tissues, form swellings called hemorrhoids. The most common cause of hemorrhoid formation is strain during bowel movements.
Other causes include:
- Diarrhea, especially chronic diarrhea
- Constipation, especially chronic constipation, which causes strain that 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; also, not following a 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, the condition is very common, since the uterus enlarges. 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 labor.
- Aging; it is common in adults aged 46–65. However, younger people and children might also get it.
- Genetics (some people may inherit it)
Symptoms
Both internal and external hemorrhoids have similar symptoms, such as:
- Itching in the anal area
- Bleeding during bowel movements, which may be painless or painful. On the toilet paper or in the toilet bowl, bright red streaks can be seen.
- 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 tissue paper after bowel movements with internal piles. External hemorrhoids often form a hard, painful lump near the anus.
Depending on the location, hemorrhoid symptoms may vary.
- Internal hemorrhoids: These are present inside the rectum, so they can’t be seen or felt. Rarely do they cause discomfort. While passing stools, if it is strained or irritated, it may cause the surface of the 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 a 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 muscle spasms, which can be painful. At the anal verge, a lump may be felt. Internal hemorrhoids may develop into thrombose, which can lead to severe pain. If the hemorrhoid is inflamed, it can leak mucus that further causes inflammation of the skin around the anus, which results in burning and itching. This is known as pruritus ani.
- External hemorrhoids: These lie under the skin around the anus and thus 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, it results in thrombosed external hemorrhoids, which cause 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 movements, 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.
The most common sign of a hemorrhoid is bleeding during bowel movements. The doctor will first do a physical examination, as well as perform other tests to rule out other diseases or serious conditions. Colorectal cancer and anal cancer may also cause rectal bleeding, so do not assume hemorrhoids are the culprit if you experience rectal bleeding. If there are larger amounts of rectal bleeding, lightheadedness, dizziness, or faintness, consult your doctor.
Diagnosis
If a person experiences any of the above symptoms, they should contact a doctor.
Piles are usually diagnosed through a physical examination by a doctor. The doctor may also perform other tests to confirm hemorrhoids. These tests include a digital rectal exam or a manual exam, using a gloved, lubricated fiber.
Complications of Hemorrhoids
These are rare, but complications include:
- Anemia: If there is chronic blood loss from the hemorrhoids, it may result in anemia. With 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. This can be extremely painful.
- Blood clots: Sometimes, a thrombus may form due to an accumulation of blood, which can be painful. It may cause swelling and inflammation in that area as well.
Treatment
Simple changes in lifestyle and remedies can reduce both internal and external hemorrhoids. These include:
- Having more fiber in the diet
- Drinking plenty of water
- Over-the-counter medications to control itching
- Taking stool softeners
If the above methods do not offer 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 relieved by:
- Topical creams and ointments: Over-the-counter creams and suppositories that contain hydrocortisone are available. Also, topical numbing agents or pads that contain witch hazel can be used.
- Ice packs and cold compresses: These help reduce swelling.
- Sitz bath using warm water: This is placed over the toilet. It helps relieve burning and itching.
- Moist towelettes: Pain can become 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, consult a doctor.
Non-surgical treatment options include:
- Rubber band ligation: This is the most common non-surgical technique to remove a hemorrhoid. It is used for internal hemorrhoids. An elastic band is placed on the base of the hemorrhoid to cut off the blood supply. The hemorrhoid will then shrink or fall off.
- Sclerotherapy: A solution is injected into an internal hemorrhoid. It then produces a scar that cuts off the blood supply to the hemorrhoid.
- Photocoagulation
- Electrocoagulation
Surgical options to treat hemorrhoids may involve:
- Hemorrhoidectomy: Wherein the hemorrhoid is completely removed
- Stapling: Wherein a prolapsed hemorrhoid is tacked back into place.
Both of these procedures are performed under anesthesia, and the patient is discharged on the 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 their bulk. This helps avoid straining during bowel movements. In order to avoid gas problems, slowly incorporate fiber into your diet. Doing regular exercise and drinking plenty of water also help make bowel movements easier, with less pressure on the anal wall.
- Fiber supplements: The recommended daily amount of fiber in the diet is 25 grams for women and 38 grams for men. Over-the-counter fiber supplements are available, such as Metamucil and Citrucel, which can improve overall symptoms and bleeding caused by hemorrhoids. They also soften the stool and make it regular. Fiber supplements can cause constipation if there is not enough fluid intake, so have at least 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 the urge, go have a bowel movement; if you wait, the urge may go away, which may make the stool dry and harder to pass later.
- Exercise: Doing regular exercise and keeping yourself active will help prevent constipation and reduce pressure on the veins. It also helps to lose weight, which is another factor that contributes to hemorrhoids.
- Avoid prolonged sitting: This can increase the pressure on the veins in the anus.
What Does a Hemorrhoid Look Like?
Normal hemorrhoids are not visible. For symptoms to occur, first the hemorrhoids would 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 appears as a lump. A non-thrombosed hemorrhoid is seen as a rubbery lump.
