Overview
A general introduction on hemorrhoids
What are hemorrhoids?
Hemorrhoids, also referred to as piles, are swollen, enlarged veins which form inside and outside of the rectum and anus. They can be painful, uncomfortable and cause per rectal bleeding. Every person is born with hemorrhoids but they do not cause us any trouble until they become swollen and enlarged, producing irritating symptoms.
Actually, every person has hemorrhoids. These are the pillow-like clusters of veins that are located just under the mucous membranes that line the lowest part of the rectum and anus.
Hemorrhoids become a medical condition when these veins become swollen and distended (like varicose veins in the lower limbs).
Usually, hemorrhoids are caused by pressure increase due to:
- Pregnancy
- Weight-bearing
- Straining during bowel movements.
Hemorrhoids are rarely dangerous, but they can be recurrent and painful.
Key Facts & Statistics
- 1 out of 20 American nationals has symptomatic hemorrhoids.
- People of all ages, sexes and from all races and ethnicities can affected by hemorrhoids.
- Hemorrhoids are more common in people aged 50 years old and above. They affect more than half of the people in this population.
Risk Factors
What are the risk factors for hemorrhoids?
- Any individual can develop symptomatic hemorrhoids, the young and the old, women and men.
- Several factors can increase the risk or chances if developing symptomatic hemorrhoids. Some of these are:
- Consuming diets that are low in fiber.
- Obesity (being overweight).
- Pregnancy.
- Chronic constipation or diarrhea.
- Spending much time sitting on toilets or using toilet seats(those that do not allow a person to squat while defecating. Rather, they sit).
- Straining while having bowel movements.
Causes
What are the causes of hemorrhoids?
- Straining puts pressure on veins in the anus and the rectum which then leads to development of hemorrhoids.
- Hemorrhoids can develop as a result of:
- Straining to lift very heavy objects eg during weightlifting.
- Pushing bowel hard during constipation.
- Pelvic pressure due to gaining weight. For example, during pregnancy.
- Aging. Older ages of 45-65 years are associated with development of hemorrhoids (hemorrhoids are most common in that age group). However, young individuals can also develop this condition.
- Homosexuality and anal intercourse. These can cause new ((fresh) hemorrhoids or worsen the existing hemorrhoids.
- Diarrhea. Hemorrhoids can develop after chronic diarrhea.
Signs & Symptoms
What are the signs and symptoms of hemorrhoids?
Signs of external hemorrhoids include:
- Rectal bleeding.
- Pain in the anus, especially on sitting down.
- Hard lumps near the anus. These lumps feel sore and tender.
- Swelling in the anal region.
- Itchy anus.
Types
What are the most common types of hemorrhoids?
As stated earlier, hemorrhoids can occur inside or outside of the rectum.
Classifying hemorrhoids is based upon the location (where) the swollen vein develops.
Types of hemorrhoids
The following are the classes of hemorrhoids:
- External hemorrhoids.
- Internal hemorrhoids.
- Prolapsed hemorrhoids.
External hemorrhoids
Swollen veins form below the skin around the anus. They can cause itching and are also painful. They also occassionally bleed.
Internal hemorrhoids
Swollen veins form inside the rectum.
These are graded into 4; grades 1, 2, 3 and 4.
- Grade 1. Hemorrhoids remain in the rectum without prolapsing.
- Grade 2. Hemorrhoids prolapse on passing of stool. They return inside on their own.
- Grade 3. Hemorrhoids are prolapsed and need to be pushed back in.
- Grade 4. Hemorrhoids are prolapsed and will not go back inside.
Prolapsed hemorrhoids
Both internal and external hemorrhoids can prolapse (stretch and bulge outwards of the the anus). These prolapsed hemorrhoids can be painful and there might also be bleeding.
Diagnostic Procedures & Tests
How are hemorrhoids diagnosed?
Based on patient history, presenting symptoms and a physical/ clinical examination, hemorrhoids can be diagnosed.
Other procedures are:
- Digital rectal exam.
- Anoscopy.
- Sigmoidoscopy.
Digital rectal exam
A gloved and lubricated finger is inserted into the rectum to feel for swollen veins.
Anoscopy
An anoscope is used to view the lining of the anus and rectum. An anoscope is a lighted tube.
Sigmoidoscopy
A sigmoidoscope, which is a lighted tube with a camera, is used to view the sigmoidal part of the large intestine (colon) and the rectum
Treatment and Management
How are hemorrhoids treated?
Often, hemorrhoids go away on their own without requiring treatment.
Simple at-home treatment procedures:
At home, the following are steps that can be taken to ease symptoms :
- Application of over-the-counter medications that contain lidocaine or hydrocortisone over the affected area.
- Swallow non-steroidal anti-inflammatory drugs (NSAIDs) to ease pain and inflammation.
- Use laxatives to soften stool.
- Increase intake of fiber through diet.
- Hydration. Drink more water.
- Use tissue paper with lotion or flushable wet pipes when you visit the toilet.
Non-surgical treatment options.
How do qualified healthcare specialists treat hemorrhoids?
Methods that are used by healthcare providers (HCPs) to treat hemorrhoids are:
- Rubber band ligation.
- Electrocoagulation.
- Infrared coagulation.
- Sclerotherapy.
Rubber band ligation
A small rubber band is placed around the base of a hemorrhoid. It works by cutting off blood supply to the vein.
Electrocoagulation
An electric current is used to stop blood flow to a hemorrhoid. It is done by sending a low electric current into a hemorrhoid, which creates scarring. The scar tissue cuts off blood supply, and the hemorrhoid shrinks.
Infrared coagulation
It is also known as infrared photocoagulation. A small probe is placed into the rectum to transmit heat that gets rid of the hemorrhoid.
Sclerotherapy
A chemical is injected into the swollen vein and it destroys the hemorrhoid tissue.
Surgical treatments.
- Hemorrhoidectomy.
- Hemorrhoid stapling.
Hemorrhoidectomy
A surgical procedure is carried out to remove large external hemorrhoids or prolapsed internal hemorrhoids.
Hemorrhoid stapling
A stapling instrument is utilized to remove an internal hemorrhoid. Sometimes, it can be used to pull a prolapsed internal hemorrhoid back inside the anus and hold it there.
Differential diagnosis
What other conditions can cause hemorrhoid-like symptoms?
- Several gastrointestinal disorders can cause rectal bleeding and other symptoms that are similar to those of hemorrhoids.
- Bowel disease which can cause bleeding are:
- Colon cancer.
- Crohn’s disease.
- Ulcerative coliyis.
Complications
What are the complications associated with hemorrhoids?
People suffering from hemorrhoids may also develop:
- Anemia.
- Skin tags (flap of tissue which hangs off skin).
- Strangulated hemorrhoids.
- Blood clots (external hemorrhoids).
- Infection.
Prevention
How do we prevent hemorrhoids?
- Hemorrhoids commonly occur as people get older.
- Preventing formation of hard stools and constipation can help in prevention of hemorrhoids.
- Steps that can help prevent hard stools and constipation are:
- Avoid toilet seats. If you have to use them, spend less time on the toilet seat.
- Utilise latrines, which allow squating.
- Hydrate regularly.
- Consume fibre-rich foods.
- Stay physically active.
- Maintain moderate body weight.