Hemorrhoids

Hemorrhoids are swollen and inflamed veins in or around the anus and rectum.

Hemorrhoids, also known as piles, are often caused by straining during bowel movements. They can cause discomfort and bleeding.

Most hemorrhoids can be treated with at home remedies and lifestyle changes, though some may require treatment by a health care professional.

There are two main types of hemorrhoids. Internal hemorrhoids develop inside the rectum. External hemorrhoids develop under the skin around the anus.

Learn more about hemorrhoids, including their definition, causes, symptoms, diagnosis, treatment, and potential risks and complications.

What are hemorrhoids?

Hemorrhoids are enlarged blood vessels in the lower rectum and anus, similar to varicose veins. They can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). Hemorrhoids are common and can affect people of all ages.

Causes of hemorrhoids

Increased pressure on rectal veins

• Straining during bowel movements: Straining increases pressure in the lower rectum, causing veins to swell.
• Chronic constipation or diarrhea: Both conditions can lead to prolonged straining and pressure on the rectal veins.

Pregnancy

• Increased pressure: The growing uterus exerts pressure on the veins in the pelvis.
• Hormonal changes: Hormones during pregnancy can relax vein walls, making them more prone to swelling.

Age and lifestyle factors

• Aging: Tissues supporting the veins in the rectum and anus can weaken and stretch with age.
• Prolonged sitting: Sitting for extended periods increases pressure on the rectal veins.
• Obesity: Excess weight puts additional pressure on the pelvic veins.
• Low-fiber diet: A diet low in fiber can lead to constipation and straining during bowel movements.

Symptoms of hemorrhoids

Internal hemorrhoids

• Painless bleeding: Bright red blood during or after bowel movements.
• Prolapse: Hemorrhoids that protrude outside the anus, especially during bowel movements, which may cause discomfort.

External hemorrhoids

• Itching and irritation: Around the anus.
• Pain and discomfort: Especially during sitting or bowel movements.
• Swelling: A lump around the anus, which may be tender or painful.
• Bleeding: Small amounts of bright red blood, usually on toilet paper.

Complications

• Thrombosed hemorrhoids: A clot forms in an external hemorrhoid, causing severe pain and swelling.
• Anemia: Chronic blood loss from hemorrhoids can lead to anemia, characterized by fatigue and weakness.

Learn more about blood clots>>

Diagnosis of hemorrhoids

Medical history and physical examination

• Symptom assessment: Detailed inquiry about the presence, duration, and severity of symptoms like bleeding, pain, and prolapse.
• Physical examination: Visual inspection and a digital rectal exam to assess for external and internal hemorrhoids.

Additional diagnostic tests

• Anoscopy: A small, lighted tube is inserted a short distance into the rectum to visualize internal hemorrhoids.
• Proctoscopy: A longer, lighted scope to examine the entire rectum.
• Sigmoidoscopy or colonoscopy: To rule out other causes of rectal bleeding, such as colorectal cancer or inflammatory bowel disease.

Treatment of hemorrhoids

Home remedies and lifestyle changes

• High-fiber diet: Increasing fiber intake through fruits, vegetables, and whole grains to soften stools and reduce straining.
• Hydration: Drinking plenty of fluids to help prevent constipation.
• Exercise: Regular physical activity to improve bowel function and reduce constipation.
• Sitz baths: Soaking the anal area in warm water for 10-15 minutes several times a day to reduce discomfort.
• Over-the-counter treatments: Creams, ointments, pads, and suppositories to relieve symptoms like itching and pain.

Medical treatments

• Prescription medications: Stronger topical treatments with steroids to reduce inflammation and pain.
• Minimally invasive procedures: Outpatient treatments for persistent or severe hemorrhoids.
  • Rubber band ligation: Placing a rubber band around the base of an internal hemorrhoid to cut off its blood supply, causing it to shrink and fall off.
  • Sclerotherapy: Injecting a chemical solution into the hemorrhoid to shrink it.
  • Infrared coagulation: Using infrared light to create scar tissue, cutting off blood supply to the hemorrhoid.
  • Laser therapy: Using laser energy to shrink or remove hemorrhoids.

Surgical treatments

• Hemorrhoidectomy: Surgical removal of hemorrhoids, typically for large, persistent, or thrombosed hemorrhoids.
  • Excisional hemorrhoidectomy: Traditional surgery to completely remove hemorrhoids.
  • Stapled hemorrhoidopexy: Using a stapling device to remove tissue and reposition hemorrhoids inside the anus, less painful and faster recovery compared to excisional hemorrhoidectomy.

Post-operative care

• Pain management: Use of prescribed pain medications to manage post-surgical pain.
• Wound care: Instructions on keeping the surgical area clean and allowing it to heal properly.
• Follow-up appointments: Regular check-ups with the surgeon to monitor healing and address any complications.

Potential risks and complications

Complications of untreated hemorrhoids

• Chronic pain: Prolonged discomfort and difficulty with bowel movements.
• Anemia: From chronic blood loss.
• Infection: Risk of infection if an external hemorrhoid becomes ulcerated.
• Strangulated hemorrhoid: Internal hemorrhoid that loses its blood supply due to prolapse and becomes infected or necrotic.

Surgical risks

• Bleeding: Risk of bleeding during and after surgery.
• Infection: Risk of surgical site infection.
• Anal stricture: Narrowing of the anal canal due to scar tissue formation.
• Incontinence: Rare risk of loss of bowel control post-surgery.

Long-term considerations

• Recurrence: Hemorrhoids can return if risk factors and lifestyle are not managed.
• Lifestyle changes: Maintaining a high-fiber diet, staying hydrated, exercising regularly, and avoiding prolonged sitting or straining to prevent recurrence.

Impact on quality of life

• Comfort and function: Addressing and managing hemorrhoids improves comfort during daily activities and bowel movements.
• Emotional and psychological impact: Support for managing embarrassment or anxiety related to hemorrhoids and their symptoms.

Hemorrhoids are a common condition that can cause significant discomfort but are manageable with proper diagnosis and treatment. Understanding the causes, symptoms, diagnostic methods, and treatment options is essential for effective care. If you experience symptoms of hemorrhoids, consulting with a health care provider will help develop a comprehensive treatment plan tailored to your specific needs and circumstances.