Hemorrhoids or piles are vascular masses or swollen veins in the anus or lower rectum that has become loosened from the connective tissue as a result of congestion in the veins of the hemorrhoid plexus.  Hemorrhoids can be painful, uncomfortable and lead to rectal bleeding.

Types of Hemorrhoids

Hemorrhoids can occur inside or outside the rectum. The type of hemorrhoid depends on where the swollen vein develops. They include:

  1. External Hemorrhoids: This is when swollen veins form beneath the skin around the anus. Sometimes they fill with blood that can clot.
  2. Internal Hemorrhoids: This is when swollen veins form inside the rectum. The rectum is the part of the digestive system that connects the colon (large intestine) to the anus.

Causes or Risk Factors of Hemorrhoids

An individual can develop or is at risk of developing hemorrhoids if any of these factors are present:

  1. Pregnancy
  2. Obesity
  3. Old age
  4. Straining while pooing
  5. Prolonged sitting or standing
  6. Anal infection
  7. Rectal surgery
  8. Anal intercourse
  9. Chronic constipation or diarrhea
  10. Spending long time on toilet seat
  11. Increased abdominal pressure
  12. Hereditary factor

Signs and Symptoms of Hemorrhoids

They include:

  1. Visible palpable mass in cases of external hemorrhoids
  2. Sensation of incomplete fecal evacuation
  3. Anal itching
  4. Constipation
  5. Pain/ache in anus during defecation
  6. Bleeding during defecation
  7. Mucus discharge

Diagnosis of Hemorrhoids

Hemorrhoids can be diagnosed based on symptoms reported and physical examination. Diagnostic evaluations include:

  1. History and visualization by external examination and use of anoscope or protoscope: Here, an anoscope (lighted tube) is used to view the lining of the anus and rectum.
  2. Digital rectal exam: A gloved, lubricated finger is inserted into the rectum to feel for swollen veins.

Management of Hemorrhoids

Often times, hemorrhoids go away on their own without treatment. Symptoms may last a week or slightly longer. Below are steps that can be taken to relieve an individual of symptoms:

  1. Frequent warm sitz bath for about 10 to 20 minutes per day to ease pain.
  1. Ensure intake of enough water and regular exercise to avoid straining and constipation.
  2. Increase fiber intake through diet and supplements to avoid straining and constipation.
  3. Soften stool by taking laxatives such as Dioctyl.
  4. Analgesic ointment such as anusol cream can be applied to relieve pain.
  5. Take nonsteroidal anti-inflammatory drugs (NSAIDs) as prescribed for pain and inflammation.
  6. Use toilet paper with lotion or flushable wet wipes to gently clean anus after pooping. You can also use a tissue or washcloth moistened with water.

Return to the clinic if symptoms get worse or interfere with daily life or sleep. The medical professional may treat hemorrhoids with:

  1. Rubber band ligation: A small rubber band is placed around the base of a hemorrhoid to cut off blood supply to the vein.
  2. Electrocoagulation: Here, an electric current is used to stop blood flow to a hemorrhoid.
  3. Infrared coagulation: A small probe that transmits heat is inserted into the rectum to get rid of the hemorrhoid.
  4. Cryodestruction: This is freezing of hemorrhoids
  5. Sclerotherapy: A sclerosing solution e.g., phenol 5% is injected into the swollen vein to cause shrinkage and reduce prolapse.

Surgical management of hemorrhoids include:

  1. Hemorrhoidectomy: This is the excision of large external hemorrhoids or internal hemorrhoids and incision and removal of clot from thrombosed hemorrhoid.
  2. Hemorrhoid stapling: An internal hemorrhoid is removed by a stapling instrument or used to pull a prolapsed internal hemorrhoid back inside the anus and hold it there.

Prevention of Hemorrhoids

The following can help prevent hard stools and constipation that can lead to hemorrhoids:

  1. Avoid sitting too long or pushing too hard in the toilet
  2. Go the toilet as soon as the urge to defecate is felt. Do not hold back bowel movements
  3. Ensure adequate intake of water daily
  4. Ensure to eat high-fiber foods (fresh fruits, vegetables and whole grains) regularly
  5. Ensure regular physical exercises

Complications of Hemorrhoids

Hemorrhoids can be uncomfortable and painful, but they don’t often lead to serious problems. Rarely, people with hemorrhoids develop complications such as:

  1. Hemorrhage (bleeding)
  2. Anemia
  3. Infection
  4. Strangulated hemorrhoids (when muscles in the anus cut off blood flow to an internal hemorrhoid).
  5. Anal stricture (narrowing of the end of the anal canal that takes stool out of the body).

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