Hemorrhoids (Piles): Symptoms, Causes, Complications, Diagnosis, Treatment and Prevention

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man at the office with Hemorrhoids

1Overview

Hemorrhoids are inflamed and swollen veins that occur around the rectum or the anus. The rectum is a portion of the large intestine that leads to the anus. The anus is the opening on the other end of the digestive tract and is the outlet where the contents exit the body.

External hemorrhoids are found in the skin around the anus. Internal hemorrhoids, on the other hand, develop inside the lower rectum. These latter types of hemorrhoids may prolapse, or protrude, through the anus. However, most of the hemorrhoids that are prolapsed shrink on their own. Severely prolapsed hemorrhoids may become permanent or they may require treatment.

Hemorrhoids are made up of smooth muscle and blood vessels. They may aid in the process of having bowel movements. Almost everyone has hemorrhoids. However, the majority of people do not have symptoms. Treatment is only needed when symptoms occur.

When the smooth muscles inside the hemorrhoids break down, they can be exposed to the shear forces within the anus. This may result in bleeding, prolapse, or discomfort. In addition, this may also result in itching or pruritus. It is important to know that there may be other reasons for anorectal itching. These symptoms may persist even if the hemorrhoids have been removed. It is also important to know that the symptoms caused by hemorrhoids may be due to malignant or benign tumors.

2Symptoms

The symptoms of hemorrhoids are often shared with many other anorectal problems, such as fistulae, fissures, and pruritus. Hemorrhoids are not usually dangerous or life-threatening. Most of the symptoms go away in a few days.

Although many people have this condition, not everyone experiences symptoms. For internal hemorrhoids, the most prominent symptom is the presence of blood along with the passage of stool. This can be seen either on the tissue paper or in the toilet bowl. However, if the hemorrhoids prolapse to the outside of the body, it becomes painful and irritated. This is known as protruding hemorrhoid.

Symptoms of external hemorrhoids may include a lump around the anus as well as painful swelling. When this happens, hemorrhoid has become thrombosed and is known as a thrombosed external hemorrhoid. In addition to this, excessive cleaning, straining, and rubbing around the anus can cause irritation and bleed, as well as itching. This may produce a vicious cycle of symptoms. Aside from this, draining the muscle may also result in pruritus.

3Causes

Several causes have been identified as the cause of hemorrhoids. There are several theories as well. Some researchers believe that hemorrhoids are diseases of the varicose veins found in the esophagus. In this case, a functional and physical failure of the sphincters that coordinate the drainage and filling of the cushions around the anus may be the culprit. Another hypothesis is that the collagen around the anal canal has become weak. Thus, the collagen under the mucosal layer degenerates when the person defecates, strains, or during physical activity. Yet another theory is that there is an increase in blood supply to the vascular plexus, which is a group of veins that are found near the rectum and the anus. Finally, bowel habits and constipation are associated with hemorrhoids.

Although the exact causes of hemorrhoids are not yet clear, the definite pathophysiology, or disease process, behind it is the sliding of the mucosal tissues, as well as its stretching. The anal tissue has cushions and when these cushions weaken, they become displaced downwards, causing prolapse and even the dilatation of veins.

Symptomatic hemorrhoids have a different pathophysiology compared to asymptomatic hemorrhoids. First, there is a deterioration of the tissue anchoring the connective tissue. Then, there is a displacement of the tissue towards the anus. Abnormal widening or distention of a clump of blood vessels, known as anastomoses, within the cushions occur. Finally, there is an abnormal dilatation of the bins of the group of veins of internal hemorrhoid.

There have been a number of contributing factors identified that can lead to hemorrhoids, such as diet low in fiber, straining all the time, constipation, pregnancy, diarrhea, and a sedentary lifestyle. Apart from pregnancy, however, none of the other contributing factors have been supported by evidence. Others have posited the role of the dysfunction of the pelvic floor and how it relates to the pressure around the anal sphincter, which is a muscular band that surrounds the anus. However, it is also unclear whether these changes in pressure can result to hemorrhoids or not.

4Complications

In most cases, hemorrhoids have mild symptoms and do not need treatment. However, symptomatic hemorrhoids require treatment because of their complications. It is important to remember that hemorrhoids are not linked to an increased risk of bowel cancer, as previously thought. The complications of hemorrhoids may range from mild to excessive bleeding, often causing distress for the person.

Incontinence, or the loss of bowel control, is another problem. Fecal incontinence is rare, but it can be corrected by surgery. When this happens, the person may feel embarrassed because of the lack of ability to control when stools appear. The associated decreased quality of life due to this complication is readily apparent, especially when the person cannot leave the house anymore because he cannot control his bowel movements.

Sometimes, a small channel may develop between the inside of the anus and the skin’s surface. This is called an anal fistula and is one of the most pressing problems associated with hemorrhoids.

Another complication of hemorrhoids is a pain, especially during bowel movements and upon straining. The patient may also complain of itchiness around the anus, which can be relieved after the patient takes a salt bath.

Rarely, bleeding due to hemorrhoids may cause anemia, especially if the bleeding is severe. The person loses large amounts of red blood cells in the process, developing anemia.

Problems with hygiene can also be caused by hemorrhoid. Due to the blood and itching, it may be difficult to clean the area around the anus after defecation. This can cause

social and personal problems because of the lingering smell around the anus. The possibility of bacterial infection is also present because of the uncleaned contents of the large intestine that remain around the anus.

These infections can sometimes be severe, and poor hygiene is the primary cause. However, they are not usually fatal, unless the patient has other serious diseases that make him unable to fight infections. Such diseases are usually immune diseases, such as HIV/AIDS.

5Diagnosis

Patients with discomfort around the rectum are usually candidates for a diagnosis of hemorrhoids. Bleeding during defecation may also point to a diagnosis of hemorrhoids, although this is not the only diagnosis that is related to the symptoms. A rectal examination is usually performed by a physician, which is known as a digital rectal exam. The doctor will examine the rectum to check for swollen or reddish veins or lumps.

Other ways to diagnose hemorrhoids are to perform a colonoscopy, wherein the doctor probes the large intestine with an instrument that has a small camera. This allows the physician to check the inside of the color. Sometimes, a sigmoidoscopy may be warranted, as well as an anal probe.

Patients who complain of painful hemorrhoids may have another condition. In this case, other examinations may be necessary. These patients may have colon cancer or rectal or anal carcinoma.

6Treatment

The natural course of hemorrhoids is usually benign, but they tend to get worse over time. The best treatment is always to prevent the hemorrhoids from occurring in the first place. Non-operative treatments may also be necessary, especially when the patient experiences pain, discomfort, or bleeding. Sclerotherapy may be indicated, which is when the doctor injects phenol or salt solution at the base of hemorrhoid. This causes the sclerosis of the tissue, and shrinkage of the mucosa surrounding hemorrhoid.

Cryotherapy is the use of cold techniques to treat hemorrhoids. It is also a non-operative procedure but is associated with the foul-smelling discharge, prolonged pain, and a need for additional therapy.

Surgical treatments may be warranted. Surgical hemorrhoidectomy can be performed using either closed or open techniques. There are complications associated with this procedure, including urinary incontinence, bleeding, and infections. An alternative is stapled hemorrhoidectomy. .This uses a circular stapling device and is useful for rectal hemorrhoids.

7Prevention

Preventing hemorrhoids can be beneficial. One way to prevent hemorrhoids is to refrain from straining excessively during bowel movements. This can cause hemorrhoids to occur, although this has not yet been proven. A diet high in fiber will help cleanse the colon and prevent the person from straining too much. In addition, regular exercise will also prevent hemorrhoids. Other ways to prevent it include diets high in green, leafy vegetables and consuming less alcohol. In addition, monitoring during pregnancy is also recommended as pregnancy is a proven risk factor for hemorrhoids. Regular visits to a gastroenterologist are also recommended as a preventive measure against hemorrhoids.