An Overview of Hemorrhoids

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Hemorrhoids are a common but aggravating condition involving swollen and inflamed veins in the rectum or anus. Depending on their location, they often result in unrelenting discomfort, pain, itchiness, and bleeding.

While sometimes caused by straining during bowel movements, hemorrhoids are also associated with obesity, pregnancy, and other conditions. A high-fiber diet and over-the-counter (OTC) stool softeners can help alleviate related constipation, and topical creams might also be recommended by your doctor. In some cases, however, a procedure such as sclerotherapy or hemorrhoidectomy may be recommended, although the latter is rare these days.

Symptoms

The symptoms of hemorrhoids can range in severity from mild to debilitating. The types of symptoms experienced are largely related to whether the hemorrhoid is external (on the skin around the anus) or internal (inside the rectum).

External hemorrhoids can often be identified by a lump on the surface of the anus. These tend to be the most uncomfortable because there are nerve endings in the area. Anal pain, itchiness, tenderness when wiping, among other signs and symptoms, can occur. The pain can become especially severe if the hemorrhoid clots.

Internal hemorrhoids are typically painless and remain undetected with no visible signs. Pain can occur, however, if the hemorrhoid begins to slip (prolapse) out of the anal canal, though this is not common. If the hemorrhoid becomes fixed outside of the anal canal, the pain can often be excruciating, especially if thrombosed. On rare occasion, such hemorrhoids will require emergency care.

Causes

Hemorrhoids primarily affect adults ages 45 to 65 and are most commonly associated with bowel movement problems, including chronic constipation or diarrhea, straining during bowel movement, and sitting for a long time on the toilet.

Each of these things can exert stress on veins that drain blood from the colon and rectum, which are located within the anal canal in a structure known as the hemorrhoid cushion. The ensuing rise in blood pressure in these veins can cause them to slip from muscles and connective tissues meant to hold them in place, leading to the formation of hemorrhoid.

Certain individuals are at greater risk for hemorrhoids, including those who eat a low-fiber diet, obese or pregnant people, those with inflammatory bowel disease (IBD), and those with constipation/hard stools. Genetics can also play a role.

Diagnosis

Because the symptoms of hemorrhoids are similar to other medical conditions (including anal fissures, IBD, and colorectal cancer), it is important that they are examined by a doctor. This is especially true if there is bleeding, extreme pain, or the worsening of symptoms despite treatment.

Hemorrhoids can usually be diagnosed with a visual examination of the anal and rectal (anorectal) area. Sometimes, a gloved rectal exam, internal examination with a scope, or lab or imaging tests may be necessary.

Treatment

Most cases of mild to moderate external hemorrhoids will benefit from conservative treatment options, such as over-the-counter (OTC) or prescription stool softeners and sitz baths. OTC topical ointments (Preparation-H, Rectogesic) may be helpful, but some have corticosteroid and should only be used when recommended by your doctor. If symptoms are severe and fail to respond to these approaches, other, more invasive interventions may be explored. 

Non-surgical options to collapse the hemorrhoid or cut its blood supply include rubber band ligation, sclerotherapy, and infrared coagulation. 

Surgery to remove, reposition, and/or suture the hemorrhoid (or its blood supply) is reserved for severe cases in which the pain is unremitting and interfering with the quality of life. Excisional hemorrhoidectomy (rare), stapled hemorrhoidopexy, and Doppler-guided hemorrhoid artery ligation may all be considered.

Coping

Even a relatively mild case of hemorrhoids can complicate your life by causing you pain during bowel movements, while sitting at work, or when trying to sleep at night. This is especially true if you suffer recurrent bouts.

To better cope, you need to find the strategies beyond medications that can aid in your speedy recovery. Some particularly helpful ones include staying hydrated, avoiding irritating soaps, staying active, lubricating stools, and not spending an overly long time sitting on the toilet.

A Word From Verywell

While the majority of hemorrhoid cases are uncomplicated and readily treated at home, medical care should be sought if the rectal blood is a deep red or purplish color, if stools are tarry, or if there is severe abdominal pain or weight loss. These may be signs colorectal cancer of which hemorrhoids may only be a symptom.

The same rules apply if your hemorrhoids worsen or fail to improve despite treatment. See your doctor and ask for a referral to a proctologist or gastroenterologist if you think that it's time to step up treatment. There is no need to suffer in silence. 

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Article Sources
  • American Society of Colon & Rectal Surgeons. Hemorrhoids. FASCRS.org. 2015.
  • Bharucha AE. Hemorrhoids. National Digestive Diseases Information Clearinghouse Nov 2010.
  • FamilyDoctor.org. Hemorrhoids. American Academy of Family Physicians. March 2014.