What are Hemorrhoids?
Hemorrhoids or piles are swollen, painful, and inflamed veins in and around the anus and lower rectum. It is a common condition in both men and women, usually occurring due to straining when passing stool which is common in chronic constipation. Women are prone to develop hemorrhoids, especially during pregnancy and childbirth. The most common symptom is the passage of bright red blood while passing stool or when wiping after a bowel movement.
Causes and Risk Factors of Hemorrhoids
Increased pressure in the veins of the rectum and around the anaus results in swelling of the veins. This causes pain, especially on straining during bowel movements or while sitting. Rupture of the swollen veins may result in bleeding. Straining while passing stool is the most important cause associated with development of piles. This usually results due to constipation. Since constipation is a common symptom during pregnancy, hemorrhoids may develop or get aggravated during this time, especially during the third trimester.
Pressure of the growing uterus on the pelvic veins and inferior vena cava during pregnancy causes a slowing of venous return from lower part of the body, resulting in stagnation of blood in the veins and their subsequent dilation. Increased progesterone levels during pregnancy also contribute to piles formation by causing swelling of the veins due to relaxation of the venous walls. Progesterone also causes slowing down of the intestinal tract, leading to constipation.
Sitting for long periods of time is another common cause of hemorrhoids. Women who have had hemorrhoids before pregnancy are more likely to suffer from them again during pregnancy. Hemorrhoids may be caused during childbirth due to the bearing down efforts or pushing during the second stage of labor. Following childbirth, piles is a common complaint.
Types of Hemorrhoids
Hemorrhoids are of two types. Those situated inside the anus and lower rectum are known as internal hemorrhoids, while those situated under the skin around the anus are known as external hemorrhoids. In some cases, the enlarged internal hemorrhoids pull down the rectal lining and may protrude from the anus. These are known as prolapsing internal hemorrhoids.
Internal hemorrhoids may be graded according to their severity into the following groups
- First degree hemorrhoids have symptoms of bleeding but they do not prolapse.
- Second degree hemorrhoids are those that prolapse and retract on their own. Bleeding may or may not be present.
- Third degree hemorrhoids are those that prolapse but do not retract on their own. They may be pushed back in by a finger.
- Fourth degree hemorrhoids are those that prolapse but cannot be pushed back in. These include thrombosed piles or prolapsed piles.
Symptoms of Hemorrhoids
The passage of varying quantities of bright red blood during or after a bowel movement is the most common symptom of hemorrhoids. This is sometimes accompanied by pain which is also likely while sitting. Anal itching is a common symptom. Hard, painful lumps may be felt near the anus.
Diagnosis of Hemorrhoids
Diagnosis is usually made from the history, followed by a rectal examination. Other tests that may be done are stool guaiac, sigmoidoscopy, and anoscopy.
Treatment of Hemorrhoids
Treatment usually consists of a Sitz bath (sitting in a warm bath for 10 to 15 minutes) and application of corticosteroid creams to reduce pain and swelling or hemorrhoid creams with lidocaine to relieve pain. A high-fiber diet and lifestyle changes can help. Avoiding constipation and use of stool softeners is advisable. Infrared coagulation (heat treatment) or sclerotherapy (injection of a chemical solution within the vein) may help to shrink the piles. When all else fails to control bleeding or pain, surgery may be advised. This includes rubber band ligation or hemorrhoidectomy (surgical removal of hemorrhoids). Stapled hemorrhoidectomy blocks blood flow to the hemorrhoidal tissue.