Hemorrhoid

Last updated date: 04-Oct-2023

Originally Written in English

Hemorrhoid

Hemorrhoid, also known as plies, refers to the swollen and enlarged veins around the lower rectum and anus. They are much similar to the varicose veins and comprise two categories. They include those which develop within the rectum, internal hemorrhoids, and those that occur beneath the skin on the anus, external hemorrhoids. 

Hemorrhoids are common and affect one out of four individuals from time to time. They are generally painful and cause extreme discomfort. However, they are treatable and easily manageable. Since hemorrhoids tend to worsen with time, medical providers recommend seeking immediate treatment as soon as they occur. Apart from avoiding aggravation, this also helps prevent additional complications and other health problems.

 

Types of Hemorrhoids 

Hemorrhoids can occur in or on the rectum. These are the most common types of hemorrhoids based on the location of the swollen veins; 

External hemorrhoids: This refers to the enlarged, swollen veins that develop under the skin. The canal in the anus allows the feces to exit. External hemorrhoids tend to be painful and itchy and sometimes bleed. They can occasionally clot if they fill up with blood. Although this is not harmful, it can cause severe pain and swelling. 

Internal hemorrhoids: This is where the swollen veins occur in the rectum. The rectum is a section of the digestive tract that links the colon or large intestine and the anus. Such internal hemorrhoids can sometimes bleed, but they are usually painless. 

Prolapsed hemorrhoids: Hemorrhoids can prolapse both internally and externally. This means that they can stretch or bulge outside of the anus. Furthermore, these prolapsed hemorrhoids can bleed and cause discomfort. 

Thrombosed hemorrhoid: A condition in which a blood clot (thrombosis) forms inside the hemorrhoid tissue is called a thrombosed hemorrhoid. They can develop on the anus as swelling or lumps. Thrombosed hemorrhoids are typically a type of hemorrhoid complication where a blood clot develops. However, blood clots can also occur in internal and external hemorrhoids. 

 

Causes of Hemorrhoids 

The major cause of hemorrhoids involves too much pressure that can cause the veins within the anus to stretch and even swell or bulge. Some of the factors that contribute to the increase of pressure around the lower rectum include; 

  • Sitting on the toilet for extended periods 
  • Obesity (overweight)
  • Straining during the bowel movements 
  • Severe constipation or diarrhea 
  • Pregnancy 
  • Engaging in anal intercourse 
  • Frequently lifting heavy things 
  • Consuming a low fiber diet 

 

Signs and Symptoms of Hemorrhoids 

The common signs and symptoms of hemorrhoids can include the following; 

  • Hemorrhoid pain and irritation around the anal area 
  • Severe itching on the anus 
  • Painful or an itchy lump and swelling around the anus 
  • Painful bowel movements and discomfort 
  • Leakage of the fecal matter 

Hemorrhoids cause pain and discomfort. However, they are not fatal, and they usually disappear even without any treatment. On the other hand, you should consult a physician if you notice any bleeding or experience black bowel movements. Bleeding can be a result of a different issue other than hemorrhoids. It can be ulcerative colitis, colon cancer, or Crohn’s disease. Due to this, it's important to have it checked out. 

 

Risk Factors of Hemorrhoids 

Hemorrhoid is a genetic condition that can be passed down through generations. If one of your parents or both have the disorder, you have increased chances of developing them. Also, hemorrhoids are more likely to develop if you do a lot of heavy lifting, are obese, or put your body under a lot of stress. 

Hemorrhoids can form due to straining when having or attempting to have a bowel movement. This could be because you are suffering from diarrhea or hemorrhoid constipation or if you spend too much time on the toilet. Hemorrhoids may as well be irritated by anal intercourse.

If you are pregnant, then you are at risk of getting hemorrhoids. As the uterus expands, it puts too much pressure on the colon vein, making it bulge or stretch. 

 

Hemorrhoids Diagnosis 

The doctor often diagnoses hemorrhoids depending on the symptoms and signs as well as the physical test. If necessary, you might also have to undergo the following; 

Digital rectal examination: This involves inserting a lubricated and gloved finger inside the rectum to check for anything unusual, including growths. 

Anoscopy: During this procedure, the doctor uses an illuminated tube known as an anoscope to check the lining of the rectum and anus for any abnormality. 

Sigmoidoscopy: This involves the use of an illuminated tube attached to a camera at the tip (sigmoidoscope). It enables the doctor to check the inside of the lower region of the rectum and colon. Rigid sigmoidoscopy and flexible sigmoidoscopy are examples of the procedures. 

Although these tests can cause discomfort, they are usually painless. They are often performed without anesthesia in a physician’s office or an outpatient clinic. It’s relatively a short procedure; hence you will return home on that same day. 

At times, the doctor can conduct a colonoscopy to verify the results of other tests or to look for symptoms of colon cancer. Anesthesia is necessary for this outpatient procedure. 

 

Hemorrhoids Treatment 

In most cases, hemorrhoids usually resolve on their own without any treatment form. However, symptoms such as bleeding and pain may persist for a week or a bit longer. 

Medical providers categorize and treat hemorrhoids depending on the extent of prolapse, which is divided into the following grades; 

  • Grade 1 hemorrhoid. These are the ones that bleed but don’t prolapse
  • Grade 2 hemorrhoids prolapsed on the outer part of the anal canal but diminish spontaneously. 
  • Grade 3 hemorrhoids protrude on the outer part of the anal canal and must be manually reduced.
  • Grade 4 hemorrhoids are usually irreducible and continuously prolapse. Grade 4 hemorrhoids include those that are acutely thrombosed and those that include rectal mucosal prolapse.

 

In the meantime, medical providers can recommend the following to manage the symptoms; 

Medications:

The doctor can recommend over-the-counter ointments, creams, pads, or hemorrhoid suppositories if the condition is causing minor discomfort. Such hemorrhoid medication consists of ingredients like witch hazel, hydrocortisone, and lidocaine. They work by alleviating discomfort and itching for a short while. 

You should, however, avoid using the over-the-counter steroid cream for one or more weeks unless your doctor says so. This is because they might thin the skin. 

Minimally invasive approaches:

The doctor can prescribe one of the minimally invasive techniques for recurrent bleeding and painful hemorrhoids. These procedures may normally be performed without anesthesia in the physician's office or an outpatient center. 

  • Rubber band ligation

This procedure involves placing one or two small rubber bands on the internal hemorrhoid base to stop the bleeding. After a week, hemorrhoids will wither and eventually fall off. 

Hemorrhoid banding is, however, uncomfortable and can result in bleeding. This can start two to four days following the operation, although it is not usually serious. More severe complications may occur on rare occasions.

  • Injectables (sclerotherapy)

To shrink the hemorrhoid tissue, the doctor can inject it with chemical content. Although the injection is painless, it may be less efficient, unlike the rubber band ligation. 

  • Coagulation (laser, infrared, or bipolar)

This technique utilizes infrared light or laser or sometimes heat. They shrivel and harden the tiny, bleeding internal hemorrhoids. It, however, has some side effects and normally triggers some discomfort. 

Surgeries:

If the condition is more intense, then a surgical procedure might be necessary. Doctors can also recommend hemorrhoid surgery if other forms of treatment are not effective or if the patient has big hemorrhoids. 

The surgical procedure to address hemorrhoids can thus include the following; 

  • Hemorrhoidectomy (removal of hemorrhoid)

This involves the removal of excess tissue that might be triggering bleeding. The surgeon can perform this operation under a combination of local anesthesia and sedation or general anesthesia and spinal anesthesia. 

A hemorrhoid removal procedure is the most efficient and comprehensive treatment for serious and recurring hemorrhoids. Urinary tract infections may result from complications such as temporary problems of emptying the bladder. Such a complication is usually common following spinal anesthesia. 

Most individuals experience some discomfort after the operation. In such situations, doctors often prescribe some drugs to help ease the problem. A warm bath might also be beneficial. 

  • Hemorrhoid stapling 

Stapled hemorrhoidopexy is a procedure to stop blood from flowing to hemorrhoidal tissue. It's usually designed to treat only internal hemorrhoids. 

Stapling is less painful, unlike hemorrhoidectomy, and enables a quicker return to normal day-to-day activity. Stapling, in comparison to hemorrhoidectomy, has been linked to a higher possibility of recurrence as well as rectal prolapse. Rectal prolapsed is where a portion of the rectum protrudes through the anus. 

Urinary retention, bleeding, and discomfort, as well as sepsis (a rare fatal blood infection), are all possible complications. It’s thus essential to consult the doctor on a suitable alternative for you. 

Home remedies:

These hemorrhoid home remedies can help you ease the minor pain, inflammation, and swelling associated with the disorder while at home; 

Consuming high fiber foods: Vegetables, fruits, and whole grains are examples of fiber-rich foods. Including this in your regular diet helps soften the stool, hence increasing the bulk. This will eventually prevent straining during bowel movements as this can aggravate the existing hemorrhoid symptoms. Medical experts recommend adding fiber to the diet gradually to prevent gas problems. 

Frequently soaking in a warm bath: Soaking the anal region with plain warm water is essential. Doctors recommend doing this for about 10 to 15 minutes at least 2 or 3 times each day. Alternatively, you can use a sitz bath that fits over your toilet. 

Using topical treatments: Applying the over-the-counter hemorrhoid suppository or cream that contains hydrocortisone is helpful. You can also use a pad with numbing content or witch hazel.

Taking oral pain killers: Aspirin, acetaminophen such as Tylenol, and ibuprofen such as Motrin IB and Advil can temporarily help ease pain and discomfort. 

Applying these home remedies can help relieve and cure hemorrhoid symptoms in a week. However, you should see a physician if you don’t see any changes or improvement after a week or if the bleeding and pain become severe. 

 

Preventing Hemorrhoid

Hemorrhoid is typically a preventable condition. Keeping the stool softer is the best way of preventing hemorrhoids. This is because they can easily pass through; hence you don’t have to strain. The following tips will also help you prevent the disorder and minimize the symptoms; 

Drinking plenty of fluids: Drinking at least 6 to 8 glasses of water or any other liquid every day makes the stool softer. You should however, note that alcohol doesn’t play a role. 

Avoid straining: Too much straining or holding breath while attempting to pass the stool leads to increased pressure within the vein around the lower rectum. 

Avoid sitting in the toilet for long: Prolonged sitting in the toilet can result in increased pressure of the veins within the anus. 

Relieve your bowels immediately you feel the urge: It’s essential to pass the bowel movement as soon as you feel the urge. Any delay can make the urge to disappear, and this causes the stool to dry out; hence it becomes hard to pass. 

Regular exercise: Staying active can help avoid constipation and minimize pressure within the anal veins. Such pressure usually occurs due to prolonged sitting or standing. On the other hand, exercising regularly is essential in cutting excess weight that could be causing hemorrhoids. 

Fiber supplements: The majority of people do not consume the recommended amount of fiber in their diet, which is 20 to 30 grams per day. Over-the-counter fiber supplements, including psyllium (Metamucil) and methylcellulose (Citrucel), have proven to enhance overall hemorrhoid symptoms and bleeding. 

Always ensure that you drink at least eight glasses of water or other fluids a day if you are taking fiber supplements. This is because these supplements can trigger or aggravate constipation. 

 

Complications of Hemorrhoid 

Although rare, hemorrhoid can be associated with a few complications, such as; 

Anemia: This occasionally occurs when the hemorrhoid is associated with severe loss of blood. Anemia is a condition whereby there are insufficient healthy red blood cells in the body to transport oxygen to the cells. 

Blood clotting: In rare cases, a blood clot can occur in the thrombosed hemorrhoid. While this is usually harmless, it might cause severe pain. 

Strangulated hemorrhoid: Hemorrhoid can be strangulated if the flow of blood towards the internal hemorrhoid is cut off. This usually causes a lot of pain. 

Prolapse: Prolapsed hemorrhoid can result in discomfort and pain when passing a bowel movement or sitting. 

Infection: Sometimes, bacteria can come into contact with bleeding hemorrhoids, hence infecting the tissue. If the infection is left untreated, it could lead to severe complications, including the death of the tissue, fever, and abscesses. 

 

Hemorrhoid Foods 

Hemorrhoid Foods 

Medical providers always recommend eating more fiber and staying hydrated to prevent hemorrhoids and reduce the symptoms. But what are the most appropriate foods to eat? The following are some of the foods that might help with the pain and itchiness. 

  • Fiber

Typically, there are two categories of fiber; soluble fiber and insoluble fiber. Soluble fiber normally softens and dissolves with water, forming gel-like goo. This makes the stool softer, well-formed, and simple to pass. What’s more, it doesn’t cause constipation and involves little to no irritation. 

On the other hand, insoluble fiber does not dissolve and can also be referred to as roughage. It’s helpful in keeping the content flowing through and out of the system as well as balancing the chemistry within the intestines. 

  • Grains:

To get more insoluble fiber, you can consider pasta, swap white bread and crackers for ones made with buckwheat, whole-grain flours, stone-ground cornmeal, or rye. Soluble fiber is also present in barley and cooked oats. 

For breakfast, you can try a packet of instant oatmeal rather than a plain white bagel. It contains twice the amount of fiber for less compared to half of the calories. If you have the munchies, opt for the no-butter popcorn. Salads and soups can be topped with oat bran or wheat germ. 

  • Nuts, beans, and lentils:

When it comes to the legume family, you will have plenty of bang for your meal. A half-cup of beans, including navy, kidney, lima, and black beans, will provide approximately a third of the daily requirement. Depending on the variety you want, it will have about 7 to 10 grams of fiber, including soluble and insoluble. 

  • Fruits and vegetables:

Plant foods are always a good option. After thinning the skins of apples, plums, pears, or potatoes, you should consider keeping them. They contain vital insoluble fiber and flavonoids compounds which help manage and reduce hemorrhoid bleeding. 

Flavonoids are abundant in brightly colored produce such as grapes, berries, tomatoes, kale, and dark, leafy greens. The fresher they are, the better. When you are ready to consume them, you can try to keep them whole and avoid damaging the leaves or skin. Cooking them till their color change is not recommended. 

 

Foods to avoid

While fiber is highly essential, consuming foods containing a little amount of fiber can trigger or worsen constipation, and eventually, hemorrhoids. Therefore, it would be helpful if you limit eating such foods. They include; 

  • Meat 
  • Cheese, milk, and other dairies 
  • Bagels and white bread
  • Processed foods, including fast foods and frozen foods

 

Hemorrhoid and Anal Fissures 

Itching, discomfort, and bleeding are all the common signs of hemorrhoids and anal fissures. Hemorrhoids are caused by swollen veins, while an anal fissure occurs due to a tear in the anus lining. Since these two conditions are similar, the doctor will conduct a physical examination and may request tests to determine the cause of the symptoms.

 

Hemorrhoid and Pregnancy 

Hemorrhoids may be an additional irritation during pregnancy since the body is undergoing a lot of physical changes. But fortunately, they are typically harmless to both your health and that of the baby's. Besides, they are just a temporary issue. Hemorrhoids can sometimes worsen during labor when pushing, but they usually go away after the baby is born. 

Other women develop hemorrhoids during their first pregnancy. On the other hand, you have a high chance of recurrence if you have had them before when pregnant. 

A woman’s uterus becomes larger and presses against the pelvis as the fetus grows. 

As a result, it puts too much pressure on the veins around the rectum and anus. Eventually, they tend to swell and become painful.

The hormone progesterone, which rises during pregnancy, may also lead to the occurrence of hemorrhoids. When it relaxes the walls of the veins, it makes them more vulnerable to swelling. Hemorrhoids can also develop due to an increase in blood flow during pregnancy, which causes veins to swell.

Other additional factors that can contribute to the developments of hemorrhoid while pregnant can include the following; 

  • Straining due to carrying too much pregnancy weight 
  • Straining when trying to pass bowel movements 
  • Standing or sitting for a more extended period 

 

Hemorrhoids vs. Hernia 

Swollen veins around the rectum and anus are known as hemorrhoids. They can be found near the anal opening on the inside or outside of the anal canal. A hemorrhoid could be present for several years, but it often goes unnoticeable until it begins to bleeds. 

When a section of the body organ or tissue pokes or protrudes out of holes within muscle walls that usually keep the body parts in place, it is called a hernia. A femoral or inguinal hernia is a type of hernia that occurs most frequently in the lower abdominal wall region. In case a hernia does not repair on its own, a surgical procedure might be necessary. 

 

Bottom Line 

Hemorrhoids are swollen veins that normally occur in the rectum or anus. They can cause pain and discomfort, although you won’t always experience any visible symptoms. Internal and external hemorrhoid, which does not thrombose or prolapse, usually resolves independently without triggering any symptoms.

With the right hemorrhoid treatment, the condition is likely to improve. Also, adhering to the physician’s instructions and keeping a regimen such as avoiding standing and sitting for long and regular exercise can help improve hemorrhoids.