Hemorrhoids, also known as piles, are structures in and around the anal canal, which are used by the body as a mechanism to control stool passing through the anal sphincter. While the Hemorrhoidal veins are typically used as an aid by the body, any damage or irritation caused by passing stool can quickly lead to severe swelling, and depending on the size, and the positioning of the hemorrhoids, the symptoms and complications that they bring can be extremely painful.
At least 50 percent of people will suffer from hemorrhoids at least once in their lifetime, and people who suffer from them once are more susceptible to further complications in the future.
What Are The Different Kinds Of Hemorrhoids?
Diagnosing Hemorrhoids is generally a straightforward procedure, but there are two different categories in which this disorder is classified into: Internal and External. When self diagnosing oneself with Hemorrhoids, people will generally assume that any pain or discomfort around the anal-rectal area is just “hemorrhoids”, however both types of hemmorhoids come equipped with their own unique symptoms, and treatments which must be recognised in order to treat them properly.
Internal hemorrhoids are typically found inside the rectum, deep enough to be out of sight. Thanks to the lack of pain-sensing nerves in this part of the body, internal hemorrhoids are generally free from pain, and the only obvious symptom is the presence of blood when passing stool. The amount of anal bleeding can range from a few spots on the toilet paper, to an excessive amount dripping into the toilet bowl. On some occasions, internal hemorrhoids may prolapse, which simply means that they enlarge enough to protrude outside of the anal sphincter, making them visible, and touchable. Prolapsed internal hemorrhoids are easy to spot, thanks to their distinctive pink coloring, which makes them stand out from the rest of the tissue around that area. While internal hemorrhoids are typically painless, if they happen to protrude, the increased pressure and the increased irritation from clothes, and movement may cause some discomfort. Protruded hemorrhoids will generally recede back into the rectum on their own accord, but in the event that they don’t, they can be encouraged by gently pushing them back into place.
External hemorrhoids are inflamed veins which are typically a lot more painful than those which lie internally, and if symptoms fail to subside within a week or so, then surgical intervention may be a requirement. External hemorrhoids often lie within the anus, but prolapsing to the outside is common, and is usually caused by a passing stool. Thrombosis is an unfortunate condition in which blood clots form within the prolapsed external hemorrhoid, making them extremely swollen, and painful. Thrombosed hemorrhoids can be identified by their often blue or purple coloring, which is usually a result of broken blood vessels and blood clots which form within them. The lifespan of an external hemorrhoid can range from a couple of days, to a couple of weeks, but the main symptoms generally dissipate within a week, depending on the treatment.
What Are The Signs & Symptoms Of Hemorrhoids?
The signs and symptoms of hemorrhoids will depend on the type the patient is suffering with, and the symptoms are not exclusively caused by hemorrhoids. Anal bleeding is the most common symptom that is apparent in both internal, and external hemorrhoids, however, the sign of blood from the anal region is not certain to be caused by hemorrhoids. Bleeding the anal region should be a major cause for concern, and medical advice should be sought after as soon as possible. While the most common cause of anal bleeding is hemorrhoids, any blood in your stool could indicate more life-threatening diseases such as anal, and colorectal cancer.
The most common symptoms of hemorrhoids, can include:
- Bleeding from the anus. The amount can differ, but anything from spots of blood on tissue paper, to streams of blood evacuating your bowels during a stool movement can provide evidence of hemorrhoids.
- Anal itching, and general discomfort around the anal region. The itchiness is more prominent in external hemorrhoids, but this symptom is generally experienced with both types. The presence of an unusual mucus typically adds to the itchiness in, and around the anus.
- Swollen lumps close to the anus may indicate prolapsed internal hemorrhoids, or external hemorrhoids. The lumps are usually painful to touch.
- Discolored lumps protruding from underneath the anus. These typically indicate a thrombosed hemorrhoid, which can be extremely painful and debilitating.
- The need to pass stool, immediately after a normal bowel movement. This requirement is caused by the enlarged hemorrhoid in the anal canal, causing a feeling of discomfort similar to that of constipation. The larger the hemorrhoids, the more uncomfortable this feeling generally is.
The majority of symptoms are generally associated with external hemorrhoids, since the protrusion of the swollen vein is more prominent, and an easier target. Internal hemmorhoids usually have little, to no symptoms besides bleeding when passing stool. However, the strain placed on the anus during a bowel movement is often enough to cause an internal hemorrhoid to prolapse, making it a lot more painful, and uncomfortable.
When Should I Seek Medical Advice?
It is always recommended to seek medical advice at the first sign on rectal bleeding, if you have never been diagnosed with hemorrhoids in the past. Failure to do so could lead to further complications down the road, including life-threatening illnesses such as cancer, and more inconvenient conditions such as an anal fissure, colitis and Crohn’s disease.
A medical professional can carry out a physical examination, which will help determine whether you are are suffering from hemorrhoids or not. The process is usually quick, and painless. Firstly, the medical professional will look at the exterior of the anal area, and if nothing is obviously apparent, then a further examination into the anal cavity will be required, and this is typically executed with a lubricated finger, an anoscope, or a proctoscope.
If further examinations are required, then a sigmoidoscopy may be used, or a colonoscopy will be used to get a detailed view of the entire colon. In both circumstances, a lighted, flexible tube will be inserted into the rectum.
What Causes Hemorrhoids?
Whilst the symptoms and treatments are very well documented, the exact cause of hemorrhoids is still relatively unknown. Several factors come into consideration when determining the root cause of hemorrhoids, but in general, it is overweight, pregnant, and elderly people who are at a higher risk of developing them.
Some of the most documented factors which are believed to play a role in the cause of hemorrhoids, include extreme abdominal pressure, obesity, sitting or standing for a prolonged amount of time, intense coughing and sneezing, vomiting, straining while passing stool, and failure to exert breath during physical labour.
Another factor which needs to be taken into consideration is your diet. Eating habits can come in to play when looking at the cause of hemorrhoids, and proper knowledge can help with the prevention of them likewise. Diets which are high in processed foods, and low in natural fiber, are more likely to cause hemorrhoids, so eating plenty of fiber can go a long way in preventing the condition. Constipation, being the side effect of a low-fiber diet can contribute to the development of hemorrhoids in two ways. Firstly, the excess straining when trying to pass stool can aggravate the hemorrhoids, and also, the stools produced will tend to be bigger, and firmer, which can further irritate the swollen veins.
Genetics can also play a part in the development of hemorrhoids, since the weak structure of veins in some people can be passed down through the genes. If hemorrhoids is common in your family, then chances are, you are more vulnerable to the condition, although their is little evidence to support this association.
For women who are suffering from hemorrhoids during pregnancy, an explanation can be found in the fact that an increased pressure from the fetus on the abdomen, as well as the changes in hormones, can apply additional pressure to the hemorrhoidal blood vessels, causing them to swell and enlarge. Symptoms can increase during the delivery of the baby, but surgical treatment is rarely needed, and the hemorrhoids will usually subside and retract back into the anus within a few days.
To summarise the possible causes of hemorrhoids, the most commonly known ones are:
- Obesity (or being overweight in general)
- Heavy lifting on a regular basis
- Sitting for extended periods of time
- Repeated coughing and, or vomiting
- Age (elderly people have an increased risk due to the weakening of supporting tissues)
- Family history of hemorrhoids
- Lack of dietary fiber
- Prolonged constipation or diarrhoea
What Are The Complications With Hemorrhoids?
Complications from hemorrhoids may differ, depending on whether they are internal, or external. However, the majority of people will suffer from the both simultaneously at some point. For internal hemorrhoids, the most obvious complications are the uncomfortable itchiness they cause, and the bleeding from the rectum. Itchiness is apparent in both internal, and external hemorrhoids, and it is typically caused by the secretion of mucus, which is released by your body to help deal with the situation. The mucus causes an uncomfortable itch, both inside, and outside of the anal sphincter.
The amount of blood lost during a bowel movement should not be a major concern, as the amount can range anywhere from a few spots on the toilet paper, to a small pool in the toilet bowl. However, the first sign of blood when passing stool should be an indication that it’s time to seek medical advice.
The major complications from hemorrhoids are most common in the ones which prolapse, and are visible externally. The increased irritation from clothing, and moving around can lead to further itchiness, bleeding, and pain. In the worst case scenario, a hemorrhoid can begin to fill with blood, which usually clots and hardens, causing thrombosis. Thrombosis can make the hemorrhoid swell to a substantial size, and the pain can be extremely uncomfortable, and debilitating. However, the pain will generally subside within a few days, and the chance of requiring surgery is very rare. A skin tag may remain when the healing process is finished, but this will generally cause no complications.
With external hemorrhoids, because of the increased size of the swollen vein, it is common to feel the need to pass stool, even though your body has no need to. The feeling can be compared to that of constipation, so the constant need to want to go to the toilet can be uncomfortable for some.
How Can I Treat Hemorrhoids?
There are a wide range of treatments available for hemorrhoids, depending on the severity, and the type you are dealing with. The majority of hemorrhoids can be treated at home, with the help of a cream, or an ointment which is either purchased over the counter, or prescribed by your general practitioner. Hemorrhoids will generally heal themselves within a week or two, and the addition of an external treatment is usually to help minimize the symptoms, and to make the healing process a lot more comfortable.
The first, and most common method to treating hemorrhoids, is through medication. This mode of treatment is usually the quickest, and most accessible, as the majority are available over the counter. Swelling and inflammation, being the most common complications of hemorrhoids can be relieved with a range of creams, ointments and suppositories. In more severe cases, your doctor may prescribe you with corticosteroid cream, which is used to help alleviate the more severe inflammation.
External medications such as creams and ointments should only be used for a short period of time, as a prolonged exposure to the sensitive tissues can lead to further complications in the future. While this advice is only a rule of thumb, it is recommended to never exceed 7 days of treatment using external medications.
Each treatment has it;s advantages and disadvantages, and neither of them work better, or worse than any other. For more information, speak to your doctor before applying any creams or ointments to the affected areas.
To help relive the pain associated with hemorrhoids, common painkillers such as paracetamol are commonly used. However, to prevent any additional constipation, it is recommended that you avoid codeine based painkillers. In severe cases, your GP may prescribe a product which contains a local anaesthetic, but again, these products should not be taken for a prolonged period of time, as they can make the entire area around your anus more sensitive to further complications.
Laxatives are another medication which are typically prescribed to people suffering from hemorrhoids. Constipation can increase the amount of swelling in the hemorrhoidal veins, potentially making the situation a lot worse.
For a non-medicating treatment, try soothing the affected area in a warm bath. Making sure the water is not too hot, simply soaking the back passage in a small amount of water, a few times per day is a traditional therapy for hemorrhoids, without the need for external medications. Do not use soap, as the additional chemicals can make the affected area worse. On the opposite side of the spectrum, an ice pack or cold compresses may be used to help alleviate some of the swelling, and discomfort.
The most promising way to cure hemorroids permanently the natural way is a clinically proven home treatment system like “Hemorrhoid No More” by Jessica Wright, which is based on recommendations by the Stanford School of Medicine and the American Public Health Association.
How Can I Prevent Hemorrhoids?
There are a number of preventative measures that are recommended to help decrease the chances of developing hemorrhoids. The majority of them are simple lifestyle, and dietary changes, and can be put into effect immediately.
Increasing the amount of soluble fiber in your diet is one way to help prevent the development of hemorrhoids. This can be achieved by increasing the amount of fiber-rich foods in your diet, or by supplementing with a fiber supplement. A healthy, well balanced diet should consist of at least 5 servings of fruits and vegetables, nuts, and whole grains. It is recommended that you keep your consumption of processed foods and meats, to a small level.
To help keep your bowel movements consistent, it is recommended that you increase the amount of fluid you drink on a daily basis. These two small dietary changes can go a long way in preventing any potential outbreaks.
Another preventative measure is to exercise more, and to prevent sitting for hours at a time. It can be difficult to execute the latter, but taking a break from sitting every 30 minutes will help tremendously with preventing hemorrhoids.
When sitting on the toilet, it can be difficult to not strain, or hold your breath when trying to pass stool, especially if you are suffering from constipation. However, doing so can increase the amount of pressure in the hemorrhoidal veins, causing them to swell and enlarge even further. Practice relaxing, and allowing the stool to pass naturally. You should never force yourself to go to the toilet. Only take a seat when you are sure you are ready to pass something. Waiting for longer will help create drier stools, which will pass easier, and with less irritation. If you require any assistance, then applying as small amount of petroleum jelly to the anal sphincter can help make the process a lot smoother.
If you apply the dietary changes properly, you may see an increased loss of weight, which is more than welcomed, since an increase in bodyweight can increase the risk of you developing hemorrhoids in the first place. Healthy eating and regular exercise should be a main priority.
When Will I Require Surgery?
If the external hemorrhoids become too inflamed and swollen, and the symptoms are failing to alleviate with traditional medications, then surgery may be required. While this is a rare occurrence, it is sometimes the best, and only option. In most cases, a more severe case of hemorrhoids can be treated on the same day, and without the need for traditional surgery. There are three main methods which are most commonly used. These are:
During this procedure, the blood vessels around your anus are injected with a chemical solution which helps to numb the nerve endings, ultimately decreasing the amount of pain. The chemical formula also helps harden the tissue, so a scar is formed in it;s place. The healing process can take anywhere from 4 to 6 weeks, and the end result will be a shrivelled up hemorrhoid which causes no further complications.
A simple, but effective treatment for clearing up painful hemorrhoids, is banding. The procedure simply involves placing a tight, elastic band at the base of the hemorrhoid, essentially cutting off it’s blood supply. The hemorrhoids should dissipate and fall off within a week of this treatment.
While there may be some slight discomfort for a couple of days after this treatment method, it’s biggest advantage is the fact that it can be done on the same day, and without anaesthetic. Painkillers are generally prescribed to help with the pain during the healing process.
3. Infrared Coagulation (Cauterisation)
The last, but not the least effective treatment for hemorrhoids, is coagulation. A device simply emits a small infrared light, which is used to burn the end of the hemorrhoid, essentially cutting of it’s blood supply. While an infrared light is the most common procedure used, another option which is sometimes used is an electric current. This method of treatment would generally be called electrotherapy.
When Is Traditional Surgery Used?
Although the majority of hemorrhoids can be treated successfully using one of the three aforementioned treatment methods, around 10 percent people who suffer from severe hemorrhoids will eventually need traditional surgery. For surgery to become an option, the hemorrhoid must cause extreme pain, which makes it impossible to live with.
The procedure is also known as hemorrhoidectomy, and generally occurs when the hemorrhoid has developed below the dentate line. Anaesthesia is required for a surgical procedure, and the end result is similar to the non-traditional forms of treatment, with the hemorrhoid either being removed completely, or it’s blood flow cut off, allowing it to die, and dispose of itself naturally.
Understanding Hemorrhoids, Diagnosis and Treatment on Web MD
Majo Clinic on home remedies and the influence of lifestlye
External Hemorrhoids Overview on Healthline
NHS Choices from the UK on Hemorrhoids
In-depth information on Colorectal Surgery published by the University of California
Hemorrhoids No More home remedy cure by Jessica Wright
Harvard University on treatment and surgical procedures