Hemorrhoids: Causes, Symptoms and Treatment
Hemorrhoids are lumps in the anus which occur when the veins in the wall of the anus and rectum become swollen and stretched. They are very common both in men and women as half of all people over the age of 50 have hemorrhoids, although some may not exhibit any symptoms. Paradoxically, many people who believe to have hemorrhoids actually have none at all. This is because certain anal and rectal problems, such as abscesses, fistulae or fissures, have similar symptoms and can be easily confused with hemorrhoids. Common symptoms associated with hemorrhoids include bleeding with bowel movements, which is sometimes accompanied by pain and a feeling that there is stool in the rectum.
There are two types of hemorrhoids (please note that most sufferers have both forms at the same time):
Internal hemorrhoids occur in the rectum. They cannot usually be seen but may droop down outside the anus.
External hemorrhoids form in the anus. They often appear as a small lump under the skin.
Risk Factors and Causes of Hemorrhoids
Age and family history of hemorrhoids are two major factors increasing the risk of developing this condition. Hemorrhoids are a result of increased pressure in the veins around the anus and rectum which causes these veins to swell and enlarge. This increased pressure can be due to the following factors:
- Straining during bowel movements, which frequently occurs in patients with chronic constipation
- Spending long periods of time sitting on the toilet
- Frequently lifting heavy objects
- Sitting down or standing for extended periods of time
- Pregnancy and childbirth
- Chronic cough
- Chronic diarrhea
- Overuse of laxatives or enemas
- Liver disease
Symptoms of Hemorrhoids
The most common sign of hemorrhoids is the appearance of streaks of bright red blood on the toilet paper or stool after a bowel movement. Sometimes, blood may even drip into the toilet water. Although bleeding is a common symptom of hemorrhoids, it can also be due to other digestive problems, including anal and colorectal cancers. Hemorrhoids are sometimes also associated with rectal discharge of mucus, which may result in a feeling that there is still stool left in the rectum after a bowel movement.
Internal hemorrhoids are usually not painful. However, those that protrude out of the anus may become painful if they are rubbed. In rare cases, internal hemorrhoids may cause severe pain when strangled by a reduced blood supply.
Besides blood and a feeling of fullness due to rectal discharge of mucus, further symptoms of external hemorrhoids include itching and pain around the anus and the appearance of small bulges near the anal area. Skin tags around the anus may develop in patients with external hemorrhoids after a hemorrhoid with a blood clot has healed.
After examining the patient’s medical history, the patient is asked about their bowel habits and symptoms such as bleeding, itching or pain. The physical examination typically involves a visual examination of the anus and rectum followed by a digital rectal exam, in which the doctor inserts a gloved, lubricated finger into the rectum to check for abnormalities. To see into the anus and rectum, the doctor may use a variety of tools, including anoscope, proctoscope or sigmoidoscope. Colonoscopy is used if a more extensive examination of the entire colon is required. Sometimes, blood tests and fecal tests are ordered to rule out other possible causes of the symptoms.
Treatment of Hemorrhoids
Hemorrhoids that do not cause any symptoms and problems do not require treatment. Even when symptoms do occur, they usually go away on their own in just a few days, especially when the cause is temporary, such as pregnancy.
Hemorrhoids can often be treated with diet and lifestyle changes. It is recommended to increase the intake of dietary fiber and to drink plenty of fluids, which help to eliminate constipation and thus reduce straining during bowel movements. Spicy foods should be avoided. Exercise may help relieve pressure and ease the symptoms of hemorrhoids. Patients with hemorroids should not sit down for extended periods of time.
People with hemorrhoids should not force a bowel movement and they should locate a toilet as soon as possible if they feel the urge to have a bowel movement. Irritating the hemorrhoids and the anal area should be avoided. When hemorrhoids protrude beyond the anus, they typically return inside the anus on their own, though sometimes, they may need to be gently pushed back in with a finger.
Over-the-counter medicated creams, ointments and suppositories containing numbing agents or witch hazel can help relieve symptoms such as pain and itching. Common pain relievers like acetaminophen (paracetamol), aspirin or ibuprofen may also help to alleviate any discomfort.
Although surgical removal of hemorrhoids is rarely needed, it may be recommended to relieve excessive bleeding or pain caused by large hemorrhoids or hemorrhoids that fail to respond to non-surgical treatment methods. Procedures available to remove hemorrhoids include:
Clot removal. When pain due to a blood clot in an external hemorrhoid is severe, the surgeon can make a small incision in the vein to remove the clot.
Rubber band ligation. Tiny rubber bands placed around the base of the hemorrhoid cut off its circulation causing the hemorrhoid to wither and fall off.
Sclerotherapy. A chemical is injected into the hemorrhoid to make it shrink.
Stapled hemorrhoidopexy. This procedure, which is also known as circular stapling, involves inhibiting the flow of blood to tissue through use of staples. However, stapled hemorrhoidopexy poses a greater risk of recurrence and prolapse than traditional surgical removal.
Photocoagulation uses a burst of infrared light, heat or a laser to destroy hemorrhoids.
Hemorrhoidectomy is the surgical removal of a hemorrhoid performed under local or general anesthesia. Unlike the other aforementioned procedures, hemorrhoidectomy may require a one or two day hospital stay.