Hemorrhoids, also called piles, are swollen and inflamed veins around the anus or in the lower rectum. This happens when there is extra pressure on these veins. Hemorrhoids can be either inside the anus (internal) or under the skin around the anus (external). Hemorrhoids are common in both men and women and affect about 1 in 20 Americans. About half of adults older than age 50 have hemorrhoids. Though not typical, children can also have hemorrhoids.
What happens in hemorrhoids?
Hemorrhoids develop when the supporting tissues the specially arranged blood vessels inside the lining of the anus, called the anal cushions disintegrate or deteriorate. They then begin to slide downwards, which will be associated with some inflammation. When the venous pressure within these blood vessels increases, the hemorrhoids swell and dilate as it is more difficult for blood to empty from them. These blood vessels become abnormally engorged, with some clots inside them (thrombosis). This downwards sliding causes them to protrude sometimes from the anus, especially when a person is passing stool. Engorgement of the internal vessels cause internal hemorrhoids while the external vessel engorgement causes external hemorrhoids which is usually noticed prolapsing from the anus. Both internal and external hemorrhoids can also occur in the same individual.
What causes Hemorrhoids?
Hemorrhoids can be caused by situations that increase the pressure within the abdominal cavity or cause congestion of these veins that make up the anal cushions. These factors are:
Increased Intra-abdominal pressure: This is such as occurs in constipation. This increases the pressure in the abdomen, and when combined with hard stool can cause congestion and protrusion of the veins in the anus, making the changes associated with hemorrhoids likely. Other conditions that increase the pressure inside the abdomen include pregnancy, and abdominal tumors.
Increased mucosal congestion. Conditions like frequent diarrhea and pregnancy can cause congestion and inflammation of the veins in the anal canal, making prolapse more likely.
Weak supporting tissue. Hemorrhoids can also occur in people who may genetically have a weak supportive network for the veins, making them more likely to slide down, or in people whose previously strong supporting tissues become weak with age.
What are the risk factors for hemorrhoids?
Hemorrhoids is more likely in the following situations.
- Chronic Constipation
- People who often strain during bowel movements
- Sitting on the toilet for long periods of time
- Frequent diarrhea
- Pregnancy
- Obesity
- Activities that cause straining like lifting heavy loads, weight lifting, and squats
- Family members with hemorrhoids
- Age older than 50 years
- Diet low in fiber
- Lack of exercise
- Colon cancer
- Liver disease
- Inflammatory bowel disease
- Anal intercourse
- Spinal cord injury
What are the symptoms of hemorrhoids?
These symptoms occur as a result of the protrusion caused by external hemorrhoids and most times resolve on their own after a short while. Others do not and can cause complications. They are:
- Swellings around the anus or anal skin tag
- Pain or discomfort around the anus
- Itching or irritation in the anal region
- Feeling of incomplete defecation causing straining
- Slimy mucus discharge usually noticed after wiping
- Protrusion from the anus (can be painful)
- Thrombosed hemorrhoids caused when blood pools in an external hemorrhoid and forms a clot (thrombus), it can result in: Severe pain, Swelling, Inflammation. This is often an emergency.
- An internal hemorrhoid is often painless and not noticeable but can cause bleeding, usually bright red after stooling
- Anemia can also result from the bleeding
How to get rid of hemorrhoids
Hemorrhoids can be discomforting and make life really uncomfortable. Some remedies and lifestyle changes can be effective to get rid of this. They are:
- High-fiber foods. Addition of fruits, vegetables and whole grains softens the stool and increases its bulk, which helps to avoid the straining that can worsen symptoms from existing hemorrhoids.
- Increase fluids. An increase in the fluid intake by drinking a lot of water also helps to soften the stool.
- Topical treatments. There are over-the-counter hemorrhoid creams or suppository containing hydrocortisone, and lidocaine which reduce pain, inflammation and swelling.
- Use of witch hazel pads. Natural witch hazel is an astringent, which is a substance that causes tissue to shrink. Research also reports that it also has antioxidant and anti-inflammatory properties, as well as bruise reduction. Pads infused with witch hazel are used topically to ease the pain and swelling associated with hemorrhoids.
- Warm bath or Sitz bath. Soaking the anal area in plain warm water for 10 to 15 minutes, two to three times a day is soothing and useful for hemorrhoids.
- Ice. Icing can be useful for short-term relief from particularly painful, swollen hemorrhoids. An ice pack or cold compress can be applied to the anus for about 10 minutes up to three times a day.
- Oral Analgesics. Pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDS like Ibuprofen and Aspirin) can help reduce pain and inflammation.
- Physical exercise. This can help with regular bowel movements and keep pressure off of the hemorrhoids. Exercises like a brisk walking, stretching, and yoga can be useful.
- Coconut oil. Coconut oil is a natural moisturizer, which may also help with hemorrhoid symptoms. Applying coconut oil may reduce the irritation and swelling, and it may also help reduce the urge to scratch.
- Aloe vera. This plant has an anti-inflammatory effect on the body and may help heal wounds. It may provide relief from the burning, itching, and swelling caused by hemorrhoids when applied to the anus
- Clot removal. The clot in a thrombosed hemorrhoid can be removed by a doctor with a relatively simple in-office procedure under local anesthetic.
- Rubber band ligation. This procedure is performed by a doctor who wraps a tiny rubber band around the base of the hemorrhoid, and with its circulation cut off, the hemorrhoid shrivels up, shrinks, and falls off, often within a week.
- Surgery. In severe cases, and recurrent painful thrombosis of the hemorrhoids, a hemorrhoidectomy can be done. This is an operation to remove hemorrhoids. It is usually a day procedure and is usually carried out under a general anesthetic. The procedure is generally safe, but it can be painful and cause bleeding. Recovery after the surgery can take a few weeks.