What are hemorrhoids?
Hemorrhoids are swollen veins that are present in the lower part of your rectum or anal canal. It is commonly known as Piles. There are two types of hemorrhoids, classified according to their location. If the hemorrhoids are located outside the anus, they are called External Hemorrhoids. If they are located within the anal canal or within the rectum, they are called Internal Hemorrhoids. They are one of the most common causes of per rectal bleeding worldwide.
How common is this condition?
If you take the population of the whole world this condition is present in 4.4% of the people worldwide. In any given population it is said that, 50% of the people over the age of 50 are at risk of developing hemorrhoids during their lifetime.
What causes the condition?
Some people are at higher risk of developing hemorrhoids if there have been family members such as their parents who have a history of hemorrhoids, giving us an idea that there is a genetic predisposition to developing the disease.
Increased pressure in the lower part of your bowel will reduce the flow of blood within the veins in this region and cause them to swell up. Anything that leads to increased pressure in the rectum will therefore add to the risk of developing hemorrhoids, such as
- Long term straining during bowel movements
- A history of lifting heavy objects which requires you strain continuously
- Even sitting or standing for long periods of time is known to increase the risk
- Increased pressure inside the abdomen such as when coughing or sneezing can also push out the hemorrhoids.
Signs and Symptoms:
Some people who have Internal Hemorrhoids carry on with their normal routine without ever knowing that the problem exists. But some others will end up having symptoms such as:
- Itching around the anus as well as pain and discomfort around the anus, especially when you sit for long periods of time.
- You might fell a soft and painful lump around the anus specially after passing stools (defecation).
- Fresh bleeding into the toilet pan, immediately after passing stools (you get what you call a splash in the pan) or you might see blood on the toilet paper.
- Sometimes you might find the task of going to the toilet a very painful experience when you have external hemorrhoids.
Diagnosis:
If the hemorrhoids are external, then a visual inspection of your anus is enough to reach a diagnosis. But if the hemorrhoids are internal and they come out only during defecation, then your doctor might have to do an examination called the Digital Rectal Examination. During this test your doctor will insert a gloved finger which has been lubricated with gel into your rectum, and they will feel around the inside to detect any abnormalities. They might ask you to strain down or cough while doing the examination.
During the Digital Rectal Examination if the doctor does feel anything abnormal then they might order another test called the Sigmoidoscopy. The Sigmoidoscopy is a test that involves inserting a small, thin tube at the end of which there is a tiny fiber optic camera fitted onto it. This tube is inserted into you rectum and the images from the camera can be visualized by your doctor on a screen. This gives your doctor a very good picture of the inside of your rectum so that they can have a good look at your hemorrhoids up close.
Treating the condition:
There are variety of treatment options available for the management of hemorrhoids, depending on their severity and the level of discomfort for the patient. There are both non-surgical as well as surgical methods that can be applied. Some of the non-surgical methods include:
- Pain relief – since a lot of people mostly complain about the pain and the discomfort they experience, relieving this pain is almost all that is need for them. This can be done by soaking themselves in a warm water bath (sitz bath) for about 10-15 minutes every day and if they want they can also get used to sitting on a warm water bottle to relieve the pain from external hemorrhoids.
Pain relief can also be given through the insertion of suppositories, which are pain relief medication that can be inserted into your rectum. Although this method might cause a lot of pain to the patient initially during the insertion, it is an excellent method of pain relief.
- If you have the problem of being constipated then a diet rich in fiber will help alleviate this and improve the condition. Even over the counter stool softeners will be helpful to resolve this issue and reduce the discomfort that is present during defecation.
- Hydrocortisone creams or hemorrhoid creams which can be bought over the counter can also help alleviate the discomfort that is cause by hemorrhoids.
If the non-surgical methods don’t improve the condition then you might have to consider surgical methods which include:
- Rubber band ligation – where the doctor inserts a tube into your rectum and places a rubber band around the swollen hemorrhoids cutting off their blood supply and causing them to shrink.
- Sclerotherapy – where a chemical that will reduce the size of the hemorrhoid is directly injected into the blood vessel.
What you should watch out for?
Follow up of a patient with hemorrhoids should include:
- Looking for the presence of blood clots in the affected veins
- Signs of further bleeding
- Presence of anemia due to blood loss
- Recurrence of the hemorrhoids
Preventing the condition:
To avoid development or recurrence of hemorrhoids, you have to make sure you don’t strain during bowel movements. In order to do this you have to drink a lot of water, make sure you eat a diet rich in fiber such as brown rice, whole wheat and carrots. Also you must avoid sitting on hard surfaces for long periods of time.
Reference websites: