HEMORRHOID OVERVIEW

Hemorrhoids are swollen and inflamed veins around the anus or inside the lower rectum. Hemorrhoids may also be referred to as piles. The veins in the rectal area have no valves and may become weakened and enlarged with increased congestion of blood flow in the region. Hemorrhoids may occur inside the anus (internal) or under the skin around the anus (external). Hemorrhoids are usually not a serious condition and commonly resolve within a few days.

Three Types of Hemorrhoids Hemorrhoids are classified according to location, severity, and the amount of pain they cause. There are three types of hemorrhoids, including:  1. External hemorrhoids. They develop under the skin around the anus below the anorectal line. The anorectal line is where the skin lining changes to mucous membrane in the anal canal.  This type of hemorrhoid can be painful if inflammation occurs. Painful swelling or a hard lump may develop around the anus from a blood clot (thrombotic hemorrhoid). 2. Internal hemorrhoids. They develop inside the anus above the anorectal line. This type of hemorrhoid is usually painless. Bleeding may occur before, during, or after defecation. First degree internal hemorrhoids enlarge but don’t protrude outside the anus. 3. Prolapsed hemorrhoids. They occur when an internal hemorrhoid protrudes outside the anus. This type of hemorrhoid is usually accompanied with heavy mucous discharge and bleeding. Second degree hemorrhoids bleed and prolapse with bowel movements, but spontaneously return inside the anus. Third degree hemorrhoids prolapse with defecation and exertion, and can be returned with manual manipulation. Fourth degree hemorrhoids prolapse and don’t go back inside the anus, with pain and profuse bleeding. If prolapse isn’t treated, hemorrhoids may become chronic. Painful swelling or a hard lump may develop within the anus from a blood clot (thrombotic hemorrhoid). Are Hemorrhoids Common? Hemorrhoids are a very common condition in men and women. The National Institute of Health estimates about half of all people have hemorrhoids by age 50. Hemorrhoids are also common among pregnant women. Hemorrhoids caused by pregnancy are usually a temporary problem.

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HEMORRHOIDS CAUSES AND SYMPTOMS

Hemorrhoids Causes

The most common cause of hemorrhoids is a low-fiber Western diet. A diet low in fiber and high in refined foods can cause constipation from insufficient fecal bulk. This may cause straining during bowel movements, since the smaller and harder stools are more difficult to pass.   Straining increases intra-abdominal pressure and can weaken and enlarge the veins, causing hemorrhoid formation. Other factors that may cause hemorrhoids include diarrhea, long periods of standing or sitting, improper lifting, obesity, aging, anal intercourse, food allergies, liver disease, or a sedentary lifestyle. Hormonal changes, intra-abdominal pressure from the growing fetus, and childbirth can also result in hemorrhoid formation in pregnant women.

Hemorrhoids Symptoms

Hemorrhoid symptoms commonly occur following constipation. Straining or excessive friction around the anus may cause irritation with bleeding or itching. Mucus discharge from the anus may also cause itching. Most hemorrhoidal symptoms resolve within a few days. Hemorrhoid symptoms may vary according to the location and severity.

External Hemorrhoids Symptoms

• Tender, blue swelling around the anus
• Pain and tenderness, particularly during a bowel movement
• Itching
• Hard lump around the anus from a blood clot (thrombus).

Internal Hemorrhoids Symptoms

• Bright red blood on toilet paper or coating stool after a bowel movement
• Discomfort around the anus
• Draining mucus from the anus with or without itching
• Soft tissue that protrudes from the anus with bowel movements, but then retracts (prolapsing hemorrhoid)
• Severe cases may include pain, bleeding and protruding tissue that will not go back
• Bleeding from the anus may indicate colorectal cancer and requires immediate medical care.

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HEMORRHOIDS EXAMS AND TESTS

A doctor can diagnose hemorrhoids based on a medical history and physical exam. The doctor will examine the anus and rectum for swollen and inflamed hemorrhoidal veins. A digital rectal exam is performed with a gloved, lubricated finger to feel for abnormalities. The rectum may also be examined for internal hemorrhoids with a proctoscope or an anoscope (a short, lighted tube). If hemorrhoids are found, the doctor will prescribe treatment based on their location, size and degree of severity. 

Additional tests may be necessary to rule out other causes of gastrointestinal bleeding or if there are risk factors for colorectal cancer. The following tests are not routinely used to diagnose hemorrhoids.

Flexible Sigmoidoscopy

A lighted, flexible tube (sigmoidoscope) is inserted through the rectum to visualize the rectum and lower third of the colon (sigmoid) for causes of bleeding, abnormalities and disease. This test is commonly used to screen for colon cancer. Biopsies (tissue samples) and small growth removals can be performed.

Barium Enema

A barium enema is an X-ray exam of the large intestine (colon and rectum). In order to visualize the intestine on an X-ray, the colon must contain barium-containing contrast material. The barium contrast material is applied through a tube that is inserted through the rectum. This allows the colon to be clearly visualized by X-ray picture. 

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