Hemorrhoids

Hemorrhoids are swollen veins found in the anus and rectum. There are two types of hemorrhoids: internal hemorrhoids and external hemorrhoids. Internal hemorrhoids form in the lower rectum whereas external hemorrhoids form under the skin around the anus.  While internal hemorrhoids are relatively painless, external hemorrhoids may cause more pain due to the higher number of nerve endings outside the anus.

Last Updated: February 25, 2024

Hemorrhoids occur as a result of pressure being applied towards the veins in the anus and rectum. The buildup of pressure can affect the blood flow, thus causing the swelling of veins. Hemorrhoids may develop due to the following:

 

  • Straining during bowel movements
  • Chronic constipation
  • Sitting on the toilet for long periods of time
  • Obesity
  • Straining when lifting heavy objects
  • Eating a low-fiber diet
  • Pregnancy 
    • Hemorrhoids are particularly common during pregnancy because the enlarged uterus can press on the rectal veins, resulting in its swelling. 

Signs and symptoms for hemorrhoids may vary depending on whether it occurs internally or externally. Internal hemorrhoids are generally painless and may cause mild bleeding during bowel movements. However, internal hemorrhoids can become uncomfortable if it protrudes beyond the anus, causing pain and itching. 

 

External hemorrhoids, on the other hand, are much more uncomfortable than internal hemorrhoids. Some of the usual symptoms are pain, bleeding (especially during bowel movements), swelling around the anus, and itching. Blood clots may also form inside external hemorrhoids and become thrombosed hemorrhoids. Common signs and symptoms of this are severe pain and a hard lump near the anus. 

A physical exam is needed to diagnose a patient with hemorrhoids. A doctor can diagnose external hemorrhoids by inspecting around the anus.  For internal hemorrhoids, a digital rectal examination can be performed to check for unusual growths in the rectum. In addition, doctors may also decide to do an anoscopy. This procedure involves the use of an anoscope which is a short, plastic tube that is inserted in the anus to view  the rectum and the anal canal. If these examinations find proof of bleeding, other tests may be performed to rule out other conditions such as anal cancer, anal fissure, and colorectal cancer.

 

There are various conservative treatments that can help in managing hemorrhoids.  One way is to use topical hemorrhoid creams to relieve pain and itching. A sitz bath or a warm water bath for the buttocks may also aid in reducing irritation. Also, oral pain relievers may be taken if experiencing mild pain.  However, if hemorrhoids are causing severe pain, invasive treatments may be considered. Some common procedures include: 

  • Rubber band ligation
    • Small rubber bands are placed around the hemorrhoid to cut off the blood supply. Cutting of the circulation shrinks the hemorrhoid until it eventually subsides. 
  • Hemorrhoidectomy
    • A surgical technique which targets and removes excess hemorrhoidal tissue that causes pain and bleeding
  • Hemorrhoid stapling
    • A stapling device is inserted in the anus to remove a ring of hemorrhoidal tissue

 

Less common procedures include: 

  • Laser or infrared coagulation
  • Sclerotherapy

Hemorrhoids can be prevented with these simple lifestyle changes:

  • Eat foods rich in fiber 
    • High-fiber foods such as fruits and vegetables can soften stool, thus, preventing straining during bowel movements 
  • Drink a lot of fluids
    • Drinking fluids can soften stool and prevent straining during bowel movements
  • Exercise
    • Moderate exercise can improve bowel function and help avoid constipation
  • Avoid straining when passing stool



REFERENCES:

Harvard Health Publishing. (2021). Hemorrhoids and what to do about them. Retrieved August 3, 2022, from https://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them 

Mayo Foundation for Medical Education and Research. (2021). Hemorrhoids. Mayo Clinic. Retrieved August 3, 2022, from https://www.mayoclinic.org/diseases-conditions/hemorrhoids/diagnosis-treatment/drc-20360280 

Mayo Foundation for Medical Education and Research. (2021). Hemorrhoids. Mayo Clinic. Retrieved August 3, 2022, from https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268#:~:text=Hemorrhoids%20are%20swollen%20veins%20in,rectum%2C%20similar%20to%20varicose%20veins. 

MediLexicon International. (n.d.). External hemorrhoids: Treatment, pictures, symptoms, and causes. Medical News Today. Retrieved August 3, 2022, from https://www.medicalnewstoday.com/articles/322732#causes-and-risk-factors 

Last Updated: February 25, 2024