Hemorrhoids

Definition

Hemorrhoids, also called piles, are bunches of swollen veins located in the lower part of the rectum or the anus. Excessive pressure allows these veins to swell and protrude. They may or may not be painful. When the hemorrhoids are located inside the rectum or anus, they are called internal hemorrhoids. If the hemorrhoids hang outside the anus and are visible on the outside, they are called external hemorrhoids. Hemorrhoids are quite common in the general population, both in adults and children, and especially in pregnant women.

Symptoms

In many cases, hemorrhoids do not cause any significant symptoms. However, they start causing various symptoms when the blood inside these swollen veins starts clotting. The following are the more common symptoms of hemorrhoids:

  • There might be itching in the anal region.
  • Pain in the anus can occur while sitting or during bowel movements. This is usually caused by external hemorrhoids in which the blood has clotted.
  • Internal hemorrhoids may lead to a sense of incomplete bowel movements.
  • Fresh blood may be found in stools due to rupture of the hemorrhoids.
  • Tender lumps of tissue (formed by the swollen veins) can be seen hanging from the anal opening in case of external hemorrhoids. Such lumps can be felt inside the anus (upon examination) in case of internal hemorrhoids.
  • Painful external hemorrhoids that protrude from the anus make it difficult to clean the anal area.

Causes

Hemorrhoids result from increased pressure (due to straining while defecating) on the veins located in the rectum and anus. The pressure causes these veins to swell and form a lumpy mass. The following are some of the common causes of hemorrhoids:

  • Increased straining during bowel movements (during constipation)
  • Sitting for a long time to pass stools
  • Infections in the rectum and anus

Treatment

Treatment of hemorrhoids depends on the severity of the hemorrhoids and is usually done to treat the bothersome symptoms. The following are the treatment options:

  • Corticosteroid creams (available as over-the-counter medications) can be applied directly on the hemorrhoids to reduce pain and swelling.
  • For severe pain, hemorrhoid creams containing lidocaine (a local anesthetic) are also available.
  • Sitting in a bathtub of warm water (sitz baths) for 10 minutes or so after each bowel movement may soothe the pain.
  • Stool softeners (psyllium, docusate) can be used to prevent constipation and avoid straining that causes bleeding from the hemorrhoids.
  • In case the hemorrhoids do not heal with home treatments, infrared coagulation (a type to heat therapy) can be used to shrink the hemorrhoids.
  • For bleeding hemorrhoids, injection sclerotherapy (in which 5% phenol mixed with vegetable oil is injected into the hemorrhoid) is used to shrink the bulging veins and stop the bleeding.
  • In case of painful and bleeding hemorrhoids that do not heal with any of the above treatments, surgical removal of hemorrhoids is the last option.

Prevention

Preventive measures for hemorrhoids include the following:

  • High fiber diet (whole grains, vegetables, and fruits)
  • Adequate fluid intake (eight glasses of water a day)
  • Stress management
  • Using stool softeners in case of constipation

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