Hemorrhoids are abnormally swollen veins in the rectum and anus. They are much like varicose veins you might see on a person's legs. When bulging hemorrhoidal veins are irritated, they cause surrounding membranes to swell, burn, itch, become very painful, and bleed. Hemorrhoids are caused by too much pressure in the rectum, forcing blood to stretch and bulge the walls of the veins, sometimes rupturing them.
In the US, about 4.4% of the general population has hemorrhoids which occurs more often in Caucasians from rural areas and in those with higher a socio-economic status. Prevalence of hemorrhoids increases with age. It peaks in people aged 45-65 years.
There are two kinds of this: internal and external.
Internal hemorrhoids usually don't hurt or itch; you can't feel them because they are deep inside the rectum. Internal hemorrhoids are pretty harmless. But since their bleeding could mask blood from a dangerous source like colorectal cancer, they should be treated.
External hemorrhoids cause most of the symptoms we commonly hear about --- pain, burning, and itching. If an external hemorrhoid becomes strangulated (cut off from blood supply), a clot can form in it and become an excruciatingly painful thrombosed hemoroid. Because of these unpleasant symptoms, external it get the most treatment attention
Another classification would be thrombosed hemorrhoids and prolapsed ones. When there is a blood clot in the anal area due to a rupture, the condition is known as thrombosed it. This happens only from external hemorrhoids and when the internal hemorrhoids extend to such an extent they jut out from the anus, then they are known as prolapsed it.
Once the rectal veins have been stretched out and it created, they are difficult to get rid of completely and tend to recur with less straining than it took to cause them in the first place. Fortunately, good habits and simple medical treatment usually control hemorrhoids well, and surgery is only recommended in unusually severe cases.
It form when increased pressure on the pelvic veins causes veins in the anal canal to swell and gradually stretch out of shape. Pressure increases can be caused by rushing to complete a bowel movement, persistent diarrhea or constipation, or other factors including being overweight or pregnant.
Persistent pressure also weakens tissues that support the veins in the anal canal. If those tissues become so weak that they can no longer hold the veins in place, the swollen veins and tissues bulge into the anal canal (internal this) or under the skin surrounding the anal opening (external hemorrhoids).
For some people, it may cause a little discomfort for a limited time. Other people have recurrent bouts of discomfort when hemorrhoids flare up. Some people struggle with hemorrhoid pain, discomfort, and itching much of their lives. The degree and duration of discomfort depend on where the hemorrhoids are.
It frequently develop during pregnancy because of extra pressure on veins (from the enlarged uterus). During labor, hemorrhoids may start or get worse because of the intense straining and pressure on the anal area while pushing to deliver the baby.
Most heal on their own in a week or two. It have a tendency to return unless something is done to prevent them. The most effective preventive measures are:
Eat between 25 and 30 grams of fiber a day.
- Drink at least 8 glasses of water a day.
- Increase your amount of daily physical activity.
- Add stool softeners or laxatives to diet. Consult with the doctor regarding the prolonged use of stool softeners and laxatives.
- Lose weight.
- Change bowel habits. Respond to the urge to defecate and stay relaxed to avoid straining.
- Exercise the buttocks muscles.
- Practice good personal hygiene. Keep the anal area clean and avoid using rough toilet paper.
If hemorrhoids are not effectively treated, you may develop infections as a result. You are at risk for an anorectal abscess or anal fissure. You may also lose the ability to control your bowel movements. If bleeding continues, a low red blood cell count, called anemia, can develop.
The common hemorrhoids symptoms are blood in stool, rectal bleeding, blood on toilet paper, anal itching, anal swelling, and pain during bowel movement. The complicated hemorrhoids symptoms are gastrointestinal bleeding, anemia, thrombosis, and strangulation.
The most common in internal hemorrhoids symptoms is bright red blood covering the stool, or on toilet paper. In the external hemorrhoids symptoms are sever paining and swelling, hard lump around the anus. Other hemorrhoids symptoms are itching, too much of straining, rubbing or cleaning around the anus may cause paining or irritation
, it leads to the bleeding.
In the complicated hemorrhoids symptoms, gastrointestinal bleeding is severe, it cause bleeding in stomach, blood while vomiting, blood in stool these are symptoms for gastrointestinal bleeding
. Anemic is also one of the complicated hemorrhoids symptoms it causes due to weakness.
Stomach ulcer is also hemorrhoids symptoms it is caused due to eating lots of spicy food, and not having the food in the correct time. In the thrombosis hemorrhoid symptoms it may lead to complicated heart attack, stroke and so on. Another hemorrhoids symptoms is strangulation, it means that blockage in the veins.
Other symptoms of internal hemorrhoids may include:
Itching. This is a frequent complaint, because internal hemorrhoids often seep mucus, which can irritate the anal skin and cause itching.
Causes and Risk factors:
- Skin irritation. Large hemorrhoids that bulge from the anus may secrete mucus, causing mild irritation.
- Discomfort. You may still feel the urge to pass stool right after having a bowel movement. This uncomfortable feeling is caused by the bulging of the hemorrhoid in the end portion of the large intestine (anal canal). In general, the larger the hemorrhoid, the greater the discomfort.
- Pain. Most internal hemorrhoids are not painful. But large hemorrhoids that bulge from the anus may become painful if they swell and are squeezed by the muscles that control the anus. Severe pain may be a sign that the blood supply to the hemorrhoid is being cut off (strangulated hemorrhoid). Emergency treatment is needed.
Hemorrhoids are usually caused by increased pressure on the veins in the pelvic and rectal area. As pressure increases, blood pools in veins and causes them to swell. Eventually, the swollen veins stretch the surrounding tissue, and hemorrhoids develop.
Bowel habits that can cause increased pressure and lead to the development of hemorrhoids include:
Rushing to complete a bowel movement. Hurrying can lead to excessive straining and increase pressure on rectal veins.
- Persistent diarrhea or constipation, which may cause straining and increase pressure on veins in the anal canal.
Other factors that can lead to the development of hemorrhoids include:
Being overweight. Excess weight, especially in the abdomen and pelvis, may increase pressure on pelvic veins.
- Pregnancy and labor. Hormonal changes during pregnancy increase blood flow to the pelvis and relax supportive tissues while the growing fetus causes increased pressure on blood vessels. During labor, hemorrhoids may develop because of the intense pressure on the anal area while pushing to deliver the baby.
- Medical conditions. For example, long-term heart and liver disease may cause blood to pool in the abdomen and pelvic area, enlarging the veins.
- Tumors in the pelvic area. These occur very rarely.
- Persistent constipation or diarrhea. These conditions may lead to straining with bowel movements.
- Being overweight.
- A family history of hemorrhoids. You may inherit the tendency to get them.
- Being age 50 or older. Half of people who are older than 50 seek treatment for hemorrhoids.
- Pregnancy and labor and delivery. As the fetus grows during the last 6 months of pregnancy, blood volume and pressure on pelvic blood vessels increase. The strain of labor also can cause hemorrhoids to start or get worse.
- Liver disease, heart disease, or both. These conditions may cause blood to back up in the pelvis and abdomen.
Factors that may make hemorrhoids worse:
- Prolonged sitting or standing. This may cause blood to pool in the anal area and increase pressure on the veins.
- Frequent heavy lifting or holding your breath when lifting heavy objects. This can cause a sudden increase of pressure in blood vessels.
The list of diagnostic tests mentioned in various sources as used in the diagnosis of hemorrhoids includes physical exam, digital rectal exam, anoscope exam, sigmoidoscopy, colonoscopy and proctoscopy.
In order to diagnosis the proper condition doctors will execute specific tests. External hemorrhoids are usually easier to diagnosis because they are outside of the anus and can easily be recognized. Internal hemorrhoids are much harder to diagnosis because they are inside of the anus. The doctor may execute a rectal examination with their gloved finger to discover the swollen hemorrhoid deep inside of the anus. Yet, to be more correct they might use an anoscope examination. Anoscopes is a tapering three inch long clear plastic or metal hollow tube that is one inch in diameter. The doctor will lube it before inserting it into the anus through the anal canal and into the rectum. When it is being withdrawn the doctor will be able to distinguish the internal it. If the patient is straining it will make them more visual. Indirect anoscopy may also be utilized to diagnose hemorrhoids. The doctor will use a special mirror to help see the patient's anus better while they are sitting down and straining while on the toilet. During this procedure the doctor will be able to see the effects that the straining is having on the patient's anus. This will also make it easier for them to see any lumps that could be identified as hemorrhoids.
Most individuals who have hemorrhoids discover them in one of several ways. They either feel the lump of an external hemorrhoid when they wipe themselves after a bowel movement, note drops of blood in the toilet bowl or on the toilet paper, or feel a prolapsing hemorrhoid (protruding from the anus) after bowel movements. Severe anal pain may occur when an external hemorrhoid thromboses, or a prolapsing internal hemorrhoid becomes gangrenous. Symptoms of anal discomfort and itching may occur, but anal conditions other than hemorrhoids are more likely to cause these symptoms than hemorrhoids. (Hemorrhoids often get a "bum rap" for such symptoms since both hemorrhoids and other anal conditions are common and may occur together. For example, up to 20% of individuals with this also have anal fissures)
Medical treatment of hemorrhoids is aimed initially at relieving symptoms. Measures to reduce symptoms include
Tub baths several times a day in plain, warm water for about 10 minutes.
- Application of a hemorrhoidal cream or suppository to the affected area for a limited time.
Preventing the recurrence of this will require relieving the pressure and straining of constipation. Doctors will often recommend increasing fiber and fluids in the diet. Eating the right amount of fiber and drinking six to eight glasses of fluid—not alcohol—result in softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on hemorrhoids caused by straining. Eliminating straining also helps prevent the hemorrhoids from protruding.
Good sources of fiber are fruits, vegetables, and whole grains. In addition, doctors may suggest a bulk stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).
In some cases, it must be treated endoscopically or surgically. These methods are used to shrink and destroy the hemorrhoidal tissue. The doctor will perform the procedure during an office or hospital visit.
A number of methods may be used to remove or reduce the size of internal hemorrhoids. These techniques include:
Rubber band ligation: A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within a few days.
- Sclerotherapy: A chemical solution is injected around the blood vessel to shrink the hemorrhoid.
- Infrared coagulation: A special device is used to burn hemorrhoidal tissue.
- Hemorrhoidectomy: Occasionally, extensive or severe internal or external hemorrhoids may require removal by surgery known as hemorrhoidectomy.
Many people who have hemorrhoids find relief from symptoms through home treatment. See the Home Treatment section of this topic for more information. If medical treatment is necessary, fixative procedures are the most widely used nonsurgical treatments. These procedures are most successful if you have small hemorrhoids.
Other Treatment Choices:
Fixative procedures include:
Rubber band ligation, a procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow so that the hemorrhoid shrinks and dies and, in about a week, falls off.
Coagulation with light (infrared photocoagulation), lasers, or electricity, which creates scar tissue, cutting off the blood supply to the hemorrhoid so that it shrinks and dies.
Medicine and medications:
Medicines can help relieve symptoms of it. You might try one or more of the following nonprescription remedies.
Ointments that protect the skin, such as zinc oxide or petroleum jelly, are the best nonprescription remedies for hemorrhoids. Ointments can prevent further injury and reduce itching by forming a barrier over it.
Use suppositories like those made by Preparation H or Tucks (formerly Anusol) for 7 to 10 days to relieve irritation and lubricate the anal canal during bowel movements. Some of these products contain substances that can harm anal tissues if they are used for too long.
Apply an ointment that contains 1% hydrocortisone, a type of steroid medicine that may relieve inflammation and itching. Your health professional may prescribe 2.5% hydrocortisone. But these products should not be used for more than 2 weeks because they can thin the skin.
Apply products that contain medicine to numb an area (local anesthetic). These products often have the suffix "-caine" in the name or the ingredients. Although these products help some people, especially those who have painful external hemorrhoids, some people become allergic to them. Ask your health professional before using these products.
Take nonprescription pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) and naproxen (Aleve) can help with pain and swelling.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.