Definition and Overview

Hemorrhoids refer to a painful condition that arises when some of the veins in the anal canal become swollen. Although not serious, this condition can cause a lot of pain and discomfort. This is a very common condition, with many people experiencing it at one point in life.

Types of Hemorrhoids

There are two main types of hemorrhoids, with the main difference being the position of the swollen veins. If the veins inside the anal canal are affected, it is called internal hemorrhoids. If the veins near the anal opening are swollen, it is a case of external hemorrhoids.

Internal hemorrhoids also occur in different degrees.

  • First-degree hemorrhoid tends to bulge out mildly during bowel movements.

  • Second-degree hemorrhoid bulges out during bowel movement then moves back inside on its own.

  • Third-degree hemorrhoid bulges out and needs to be pushed back inside using a finger.

  • Fourth-degree hemorrhoid bulges out of the anus at all times.

The specific type of hemorrhoid will determine the best form of treatment to take. A person, however, can suffer from both types simultaneously.

Causes

Hemorrhoids arise when the veins in the rectal and pelvic area experience intense pressure, which can be brought on by different possible causes, such as:

  • Constipation – Constipation may cause a person to strain harder than usual in order to move stool and this may cause increased pressure in the anus.

  • Pregnancy - Hemorrhoids are very common during the last few months of pregnancy due to the increased pressure the fetus places on the pelvic region.

  • Labor – Pushing the baby out can cause or worsen hemorrhoids.

  • Obesity – Weighing a lot more than the pelvic region normally cause hemorrhoids.

  • Family history – The tendency to develop hemorrhoids may also be inherited.

Key symptoms


There are similar symptoms experienced by those who suffer from internal and external hemorrhoids. These include:

Internal hemorrhoids can also cause visibly sagging veins that bulge out from the anus. This occurs when the swelling is severe. On the other hand, external hemorrhoids may lead to the formation of hard, tender lumps under the skin.

The pain that accompanies hemorrhoids arises when the anal muscles squeeze the swollen veins during bowel movement.

Who to See

A general physician can help diagnose hemorrhoids using a physical exam and by considering a person’s medical history. There are not many tests required to diagnose this condition, especially if it occurs at a young age. An examination of the rectum, either with a gloved hand or with the help of a lighted scope, as well as an anoscopy is usually sufficient.

However, doctors may ask for further examinations if other potential health risks are suspected. This is because rectal bleeding can also signal other more serious problems such as rectal/anal cancer or colon cancer. To rule these out, doctors require other tests including colonoscopy, sigmoidoscopy, and Barium enema.

Types of Treatments Available

Internal and external hemorrhoids are handled differently when it comes to treatment. External hemorrhoids are the less serious of the two and will require simple home treatment, which will include:

  • Consuming more fiber to loosen the stool and avoid further straining the swollen veins
  • Increasing water intake
  • Applying ointments to relieve itching
  • Applying ice to the painful area for 10 minutes several times a day
  • Taking a sitz bath for 15 minutes several times a day
  • Using stool softeners, if increased water and fiber intake does not help
  • Resting/taking a complete bed rest for a day or two during the days the veins are most inflamed
  • Sleeping on the stomach with a pillow under the pelvic area
  • Sitting on a pillow
  • Lying on your side (for pregnant women)

Patients should also avoid activities that may worsen the hemorrhoids, such as:

  • Sitting or standing for prolonged periods
  • Lifting heavy objects
  • Rubbing the affected area
  • Using perfumed soaps
  • Wearing constricting underwear
  • Wearing clothing that is tight around the anal area

For the pain and itching, patients may take over-the-counter pain relievers such as acetaminophen. Non-steroidal anti-inflammatory drugs, however, are more recommended as they can also alleviate the swelling.

All these home care tips will also help patients with internal hemorrhoids, but they will also require special treatment, especially in more severe cases. Doctors often tie the hemorrhoids with a rubber band or deliberately cause tissue scarring around the affected veins in order to cut off their blood supply. Doing so causes the swelling to stop and the hemorrhoids to shrink and eventually disappear.

If these treatments do not work, patients suffering from severe hemorrhoids may also have them surgically removed.

When to Seek Surgery for Hemorrhoids

Hemorrhoidectomy refers to surgery that removes hemorrhoids. This surgery becomes necessary when the following occurs:

  • Uncontrolled bleeding
  • Anal fissure
  • Blood clot
  • Blood and pus at the anus
  • Severe rectal pain

Surgery may also be considered if the hemorrhoids inhibit a person from living normally or if the symptoms have become too bothersome.

References:

  • Dozois EJ, Pemberton JH (2006). “Hemorrhoids and other anorectal disorders.” Therapy of Digestive Disorders.
  • Marcello PW (2010). “Diseases of the Anorectum. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease.
  • British Medical Journal: “Managing Haemorrhoids.”
  • The New England Journal of Medicine: “Hemorrhoids.”
  • International Journal of Pharmacy and Pharmaceutical Sciences: “Hemorrhoids – A Common Ailment among Adults, Causes & Treatments: A Review”
  • Madoff RD (2012). “Diseases of the Rectum and Anus.” Goldman’s Cecil Medicine.
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