What Are Hemorrhoids?
Hemorrhoids are very common in both women and men, affecting about 1 in 20 individuals. It is estimated that approximately 75 percent of adults will experience hemorrhoids at any point in their lives. The onset of hemorrhoids usually ranges between 45 to 65, and they are even more common in pregnant women. About half of the patients can encounter symptoms of hemorrhoid by age 50, such as bleeding, itching, and even rectal pain.
Hemorrhoids are overinflated veins (swollen and enlarged) in the lower rectum or around the anus. The rectum is the appendage of the bowel leading to the anus, while anus is an opening at the end of the rectum where fecal content leaves the body. One of the most common causes of rectal bleeding is hemorrhoids. In most cases, they tend to resolve in a couple of weeks and are rarely dangerous. However, you should visit your physician to ensure it is not a severe condition. The doctor may remove hemorrhoids that are very painful or won’t go away with treatment.
Hemorrhoids Types
There are three types of hemorrhoids:
1. Internal Hemorrhoids
You cannot normally feel or see Internal hemorrhoids as they are deep inside the rectum. They rarely cause discomfort and do not usually cause pain because you have a small number of pain-sensing nerve fibers in this area. Bleeding can be the only sign of internal hemorrhoids because irritation or straining during defecation can affect the surface of hemorrhoids and lead to bleeding.
Sometimes straining can force internal hemorrhoids into the anal opening. This can cause pain or irritation and is known as a prolapsed and protruded hemorrhoids.
2. External Hemorrhoids
External hemorrhoids appear as a lump around the anus, where they tend to hurt as well as bleed due to the presence of many more pain-sensing nerve fibers. They are more uncomfortable as they cause tenderness and itching while passing stools. They may become more painful when the bleeding turns into clot.
External hemorrhoids sometimes get bigger, descend or bulge outside of the anal opening. After that, you may be capable of seeing them as nasty pale reddish bumps when compared to the neighboring area. They most probably hurt, usually when you defecate.
Plunged hemorrhoids are the type of external hemorrhoids that generally return back inside by themselves or can be easily pushed back into their original location if they don’t.
3. Thrombosed Hemorrhoids
Sometimes blood may accumulate within external hemorrhoids and form a thrombus (clot) resulting in severe pain, inflammation, swelling and a hard mass around your anus. This blood clot can turn the surrounding area blue or purple. It could bleed and itch or hurt a lot. You may still have a segment of skin left over, which could get irritated even when the clot is dissolved.
The most common signs and symptoms of both internal and external hemorrhoids include the following:
Hemorrhoids Symptoms
The types of signs or symptoms are largely based on the type of hemorrhoids i.e., internal, external or thrombosed and may range in acuteness from mild to severe.
- Painless bleeding is one of the most common signs of both internal and external hemorrhoids
- Swelling in the area around the anus
- Irritation or itching around your anus
- Mild to severe pain depending on the severity of the disease
- A sensitive thrombus around your anus, which may be painful
If you are experiencing these symptoms, avoid rubbing, excessive straining or wiping near the anus as it may lead to itching and irritation or can even cause bleeding. Additionally, try to keep that area dry rather than constantly washing.
What Causes Hemorrhoids?
Hemorrhoids mainly affect adults between ages 45 – 65 and are most usually accompanied with problems like an abnormal bowel movements, including diarrhea or severe constipation, pain and itching while passing stools. The causes of these symptoms can be constant straining, excessive pressure on veins due to pregnancy or tumors and sitting on a toilet for a very long time.
Each of these factors can exert pressure on the veins draining blood from the rectum and colon, that are present in the anal canal within a structure called hemorrhoid cushion. The increase in blood pressure can lead to slipping of these veins from surrounding connective tissues and other muscles meant to hold them in place, thus leading to the formation of hemorrhoids.
The veins near your anus may stretch under high pressure and can swell or bulge out. Varicose veins (hemorrhoids) can be formed due to an increase in pressure in the area around rectum due to the following reasons:
- Bruises during a bowel motion
- Sitting on the toilet for a long period
- Chronic constipation or severe diarrhea
- Obesity
- Low-fiber diet
- Pregnancy
- Tumors of the bowel (rectum) or adjacent organs
Diagnosis
A visual analysis of your anus can be adequate to diagnose external hemorrhoids. In order to confirm the diagnosis, the physician may perform various examinations to check out any abnormality or defect around the anus. This verification is done through a digital rectal exam. While performing this test, your physician inserts a well lubricated and gloved finger in your rectum. If a doctor feels something abnormal, he can ask for an additional test known as sigmoidoscopy.
A sigmoidoscopy is a method involving a tiny camera to view inside the rectum and verify internal hemorrhoids. The small camera known as sigmoidoscope is fitted within a narrow tube and then it is inserted within your rectum. Your doctor gets a visible and clear view of the inner part of your rectum by this test so that he can analyze hemorrhoids clearly.
Hemorrhoids Treatment
Depending on the severity of the disease, the treatment of hemorrhoids can be further divided into home remedies, medications, surgical procedures and others.
1) Home remedies
If you have just started experiencing signs and symptoms of hemorrhoids such as mild pain, swelling or inflammation, certain home remedies can be the best to relieve the symptoms. In milder cases, often these are the only treatments needed.
» Topical Applicants
An over-the-counter cream or suppository containing 1% hydrocortisone can relieve mild pain and inflammation. You can also use the pads of witch hazel or any numbing agent to soothe the symptoms.
» Eat high-fiber food
Eating foods rich in fiber such as fruits, green leafy vegetables, and whole grains can be beneficial for hemorrhoids patients. Fiber-rich foods can soften the stools, increases its bulk and stimulate digestion that helps you avoid straining and ease stool passing. Fiber has also the additional benefit of reducing gas and bloating.
» Warm Bath
Regularly rinse your area around the anus in lukewarm water for 10-15 minutes twice or thrice a day. A warm bath can soothe the anal area and provide relief from mild pain.
» Avoid dry toilet paper
In order to keep the area around anus clean at the end of a bowel movement, you should not use dry toilet paper as it can irritate the area and cause severe pain. Use wet toilet paper or moist towel instead, that in particular, does not have any alcohol or perfume.
» Apply cold compressions
Put on cold compresses or ice packs around your anus to overcome swelling and soothe irritation.
» Take Analgesics
You can use various over the counter painkillers like acetaminophen, ibuprofen or aspirin to help relieve your pain and discomfort temporarily.
In most cases, the symptoms of hemorrhoids often fade away within a week or two by following these home remedies. If you have constant bleeding or severe pain, visit your doctor for definitive treatment.
2) Medications
If hemorrhoids create only mild discomfort and pain, the doctor usually recommends ointments, pads suppositories or over-the-counter creams. These types of products have ingredients like lidocaine, witch hazel, or hydrocortisone meant to relieve itching and pain temporarily.
You should avoid the usage of over-the-counter steroid products more than a week except if recommended by your doctor, as it can cause damage to your skin and make it thinner.
» External hemorrhoid thrombectomy
If a painful thrombosis is found in external hemorrhoids, the doctor may take out the clot or thrombus with a slight incision and drainage, that can provide immediate relief. This process is most effective if performed within 72 hours of thrombus formation.
For painful hemorrhoids or continuous bleeding, the doctor can perform any other available procedures. These procedures can be performed within the physician’s office or anywhere else like outpatient setting and do not generally require any anesthesia.
» Rubber band tying
The doctor places some small rubber bands within the edge of internal hemorrhoid to avoid circulation around that area. The blockage of blood supply leads to the death of inflamed cells, resulting in falling off and fading of hemorrhoids in a week. This treatment is effective for many patients.
Rubber bands may cause discomfort and lead to bleeding within three to four days after this process, but it is not severe. Sometimes, serious complications may occur.
» Injection (Sclerotherapy)
Sclerotherapy involves the insertion of a chemical solution within the tissues of hemorrhoids in order to shrink it. This procedure is only effective for small-sized hemorrhoids. It causes less pain, but it is less advantageous than the rubber band ligation.
» Coagulation (laser, infrared or bipolar)
The procedure of coagulation uses heat, laser or infrared light to shrink the hemorrhoids.
While the coagulation process can cause little discomfort and may have some side effects, it is linked to the recurrence of hemorrhoids as they may return after some time. The rubber band treatment is more preferred than all coagulative procedures.
3) Surgical procedures
If you have large hemorrhoids, and if other treatments were not successful, the physician can suggest a surgery. Your surgical treatment may need a whole night stay or may be carried out as an outpatient.
» Hemorrhoidectomy
This procedure is known as hemorrhoid removal. In this process, your doctor takes off the hemorrhoidal tissue that leads to bleeding. Different techniques are used. The surgeon may perform the surgery with spinal anesthesia, local anesthesia along with sedation, or general anesthesia.
Hemorrhoid removal is the complete and most effective way to treat recurring or severe hemorrhoids. It may include some complications like urinary tract infections or temporary difficulty in emptying your bladder.
Many patients feel some pain after the surgery. You can control your pain by medications.
» Stapled Hemorrhoidectomy
This process, called stapled hemorrhoidopexy or stapled hemorrhoidectomy, blocks the flow of blood to hemorrhoidal tissue. It is generally used for the treatment of internal hemorrhoids.
Hemorrhoids stapling usually involves less irritation and pain than hemorrhoidectomy and allows rapid return to normal activities. Stapling has been related to a higher risk when it is compared with hemorrhoidectomy as it may cause rectal prolapse and recurrence. In this abnormality, a rectum’s part bulge from the anus. Its complications may include pain, bleeding, irritation, and urinary retention, moreover, sometimes a blood infection which can be life-threatening (sepsis). You must discuss with your physician about the best option for yourself.
Prevention
Prevention is better than cure. The best preventive measure is to adopt such habits that help you avoid straining and keep your stools soft so that they can pass easily and cause no pain. Follow these steps to prevent and reduce symptoms of hemorrhoids.
• Drink plenty of water
You should drink at least six to eight glasses of water or liquids (other than alcohol) every day to keep your stools soft.
• Use fiber supplements
Most people do not eat enough amount of fiber (standard fiber consumtion is 25 grams/day for women and 38 grams/day for men in their diet). Recent studies have revealed that the over-the-counter supplements of fiber, such as Citrucel and Metamucil, improve the bleeding, pain and other symptoms of hemorrhoids. While using fiber supplements, make sure that you drink six to eight glasses of water or other liquids per day. Otherwise, these fiber supplements can lead to constipation and make your symptoms worse.
• Do not strain
Holding your breath or straining while passing stools can generate greater pressure in the vessels within the lower rectum. Constant straining can lead to the formation of hemorrhoids.
• Avoid sitting too long
You should not sit for a long period, especially on the toilet seat as this can increase the venous pressure around the anus.
• Exercise
You must stay healthy and active to overcome pressure on veins and to prevent constipation, which may occur due to long periods of sitting or standing. You can lose excess weight by exercise, which can also prevent hemorrhoids.