Make an Appointment
Talk to DoctorOverview
Hemorrhoids, also known as piles, are swollen and enlarged veins that can occur inside or outside the anus and rectum. They are similar to varicose veins and can cause discomfort, pain, and rectal bleeding. The exact cause of hemorrhoids is often unknown, although there are several factors that can contribute to their development.
There are different types of hemorrhoids based on their location:
- External hemorrhoids: These develop underneath the skin around the anus. They can be itchy, painful, and may occasionally bleed. Blood clots can also form within these hemorrhoids, resulting in pain and swelling.
- Internal hemorrhoids: These form inside the rectum, the part of the digestive system that connects the colon to the anus. Internal hemorrhoids may bleed, but they are typically not painful.
- Prolapsed hemorrhoids: Both internal and external hemorrhoids can prolapse, meaning they stretch and bulge outside of the anus. Prolapsed hemorrhoids can cause bleeding and pain.
Fortunately, there are effective treatment options available for hemorrhoids. Many people find relief through home treatments and making lifestyle changes.
Symptoms
The signs and symptoms of hemorrhoids can vary depending on the type of hemorrhoid:
External hemorrhoids are located beneath the skin surrounding the anus. They can cause the following signs and symptoms:
- Itching or irritation: You may experience itching or discomfort in the anal region due to external hemorrhoids.
- Pain or discomfort: External hemorrhoids can be painful, causing discomfort or aching sensations.
- Swelling: The area around the anus may become swollen due to external hemorrhoids.
- Bleeding: External hemorrhoids can also lead to bleeding, typically observed as small amounts of bright red blood.
Internal hemorrhoids: These are located inside the rectum and are typically not visible or noticeable. They usually do not cause any discomfort, but they can become problematic if you strain during bowel movements, leading to the following symptoms:
- Bleeding: You may experience painless bleeding during bowel movements. This can be observed as small amounts of bright red blood on toilet tissue or in the toilet bowl.
- Prolapsed or protruding hemorrhoids: Straining can cause a hemorrhoid to protrude through the anal opening. This can result in pain and irritation.
Thrombosed hemorrhoids: Blood may build up in an external hemorrhoid and clot (thrombus), which can cause:
- Severe pain
- Swelling or inflammation
- Hard lump near the anus
It is important to seek medical attention under the following circumstances:
- If the patient experiences bleeding during bowel movements or if their hemorrhoids do not improve after a week of at-home care.
- If there is severe rectal bleeding or if the patient experiences symptoms such as lightheadedness, dizziness, or fainting.
- If their are changes in the bowel habits or in the color or consistency of the feces, patient shouldn’t automatically assume that rectal bleeding is the result of hemorrhoids. Other conditions, such as colorectal and anal cancer, can cause rectal bleeding.
Causes
Hemorrhoids occur when veins in the anus or rectum are strained and put under pressure. They can be likened to varicose veins affecting the lower region of your body.
Increased pressure on the abdomen or lower extremities, resulting from various forms of straining, can lead to swollen and inflamed anal and rectal veins, leading to the development of hemorrhoids. Factors that contribute to hemorrhoid formation include:
- Straining during bowel movements
- Prolonged sitting on the toilet
- Chronic diarrhea or constipation
- Obesity
- Pregnancy
- Engaging in anal intercourse
- Following a low-fiber diet
- Regularly lifting heavy objects
Risk factors
Hemorrhoid symptoms can potentially affect individuals of any age, including teenagers, although it is rare for children to develop hemorrhoids due to the time it takes for them to form. However, certain risk factors can increase the likelihood of developing hemorrhoids. The risk increase if the patient has any of the following:
- Age: The chance of developing hemorrhoids increases with age. This is due to the fact that the tissues in the rectum and anus that support the veins may weaken and stretch out.
- Pregnancy: Because of the strain the growing baby puts on the anal region, this is also possible during pregnancy.
- Bowel movement: People who consume low fiber diet may strain during bowel movement cause by constipation.
- Lifting: Lifting heavy weights regularly put strain at the anal region that may cause this condition.
Diagnosis
Hemorrhoids are diagnosed by healthcare providers through a combination of symptom assessment and physical examination. Additional procedures that may be used include:
- Digital examination: The doctor inserts a lubricated, gloved finger into the rectum to check for any abnormalities or growths.
- Visual inspection: Internal hemorrhoids, which are often too soft to be felt during a rectal exam, may be examined using an anoscope, proctoscope, or sigmoidoscope to view the lower part of the colon and rectum.
These tests can be slightly uncomfortable but are not typically painful. They are usually performed in a doctor’s office or outpatient center, and patients can go home the same day.
In some cases, a doctor may recommend a colonoscopy to examine the entire colon, particularly if:
- Symptoms suggest the possibility of another digestive system disorder.
- There are risk factors for colorectal cancer.
- The patient is middle-aged and has not had a recent colonoscopy.
A colonoscopy may be performed to confirm findings from other tests or to screen for signs of colon cancer. This procedure is done on an outpatient basis and requires anesthesia.
Treatment
In many cases, hemorrhoids tend to resolve on their own without the need for treatment. Symptoms such as discomfort and bleeding typically last around one week or slightly longer. However, if treatment is necessary, it may involve the following approaches:
- Home treatment: With home treatments, the patient can frequently reduce the minor pain, swelling, and inflammation of hemorrhoids.
- High-fiber foods: Eat more whole grains, fruits, and vegetables. By doing this, the stool will become softer, which will assist the patient avoid straining, which can exacerbate the symptoms of already-existing hemorrhoids. To avoid issues with gas, gradually add more fiber to the diet. Make an effort to consume 20 to 35 grams of fiber every day.
- Topical treatments: Apply a hydrocortisone-containing over-the-counter hemorrhoid cream or suppository or use pads with witch hazel or a numbing ingredient.
- Regular warm bath or sitz bath: two to three times a day, soak the anal area in plain, warm water for ten to fifteen minutes. The toilet may fit over a sitz bath.
Hemorrhoids symptoms typically go away with these remedies in a week. If the patient doesn’t see relief within a week, or sooner if they have extreme pain or bleeding, they should visit a healthcare provider.
- Medications: In cases of mild discomfort caused by hemorrhoids, healthcare providers may advise using over-the-counter creams, ointments, suppositories, or pads containing ingredients like witch hazel, hydrocortisone, or lidocaine to alleviate pain and itching temporarily. However, it is crucial to follow medical guidance and avoid prolonged use of over-the-counter steroid creams, as they can potentially thin the skin.
- Minimally invasive procedures: One of the various minimally invasive procedures might be suggested by the healthcare professional for hemorrhoids that are bothersome or that continue to bleed. These procedures can be carried out in a healthcare provider’s office or other outpatient location without the need for general anesthesia.
- External hemorrhoid thrombectomy: A healthcare provider can remove the external hemorrhage if a painful blood clot (thrombosis) has developed inside of it, which can bring relief right away. The best results are obtained when this local anesthetic technique is carried out within 72 hours of the clot forming.
- Rubber band ligation: Involves placing small rubber bands around the base of an internal hemorrhoid to restrict blood flow and facilitate its eventual removal. While the process generally leads to the withering and shedding of the hemorrhoid within a week, it can be accompanied by discomfort and mild bleeding, typically occurring between two to four days after the procedure. Severe bleeding is rare but possible, and there is a slight risk of experiencing more serious complications.
- Sclerotherapy injection: In order to shrink the hemorrhoid tissue, healthcare provider will inject it with a chemical solution. Although the injection is not painful, it might not be as effective as rubber band ligation.
- Infared coagulation (laser or bipolar): Coagulation methods utilize heat, infrared light, or lasers. They make internal hemorrhoids that are tiny and bleeding stiffen and shrivel. Coagulation often produces little discomfort and has few negative side effects.
- Surgical procedures: The majority of people with hemorrhoids do not need surgery. But if previous methods haven’t worked or the patient have huge hemorrhoids, the healthcare provider can suggest one of the following:
- Hemorrhoidectomy: Large external hemorrhoids or prolapsed internal ones are removed surgically. The surgeon cuts away extra tissue that leads to bleeding using one of several ways. General anesthesia, spinal anesthesia, or local anesthesia mixed with sedation can all be used during the procedure.
The most thorough and effective method of treating severe or recurrent hemorrhoids is hemorrhoidectomy. After the procedure, the majority of patients experience some pain, which medications can alleviate. A warm bath may also be beneficial.
- Hemorrhoid stapling: An internal hemorrhoid is removed with a stapling tool. Alternately, it holds a prolapsed internal hemorrhage inside the anus. Stapled hemorrhoidopexy is a technique that stops blood flow to hemorrhoidal tissue.
Hemorrhoidectomy typically causes more discomfort than stapling, which enables a sooner return to normal activities. However, stapling has been linked to a higher incidence of recurrence and rectal prolapse, in which a portion of the rectum protrudes from the anus, compared to hemorrhoidectomy.
