What Are Hemorrhoids

Hemorrhoids are enlarged veins occurring in the walls of the anus and rectum, often causing pain and bleeding.

  • Increased pressure in the veins causes them to enlarge.
  • The enlarged veins get twisted and form lumps that result in bleeding and pain.
  • Physical examination of the anus and viewing the interiors of the rectum with a sigmoidoscope help diagnose hemorrhoids.
  • Symptoms of hemorrhoids appear and disappear on their own; fiber rich diet and use of stool softeners help relieve symptoms.
  • A procedure using rubber bands is used to treat hemorrhoids. Surgical repair also is done

The walls of the anus and rectum have a rich network of veins. When some of the veins become swollen, they form hemorrhoids. They can get twisted and lumps can form. They may become prolapsed and hang down from their original location. Sometimes they protrude out of the anus.  Hemorrhoids are classified according to the place of their origin. Internal hemorrhoids are those which originate above the anorectal junction and external hemorrhoids are those which originate in the area below the junction. Both types of hemorrhoids can protrude out of the anus when they are prolapsed.

Causes Of Hemorrhoids

When the pressure inside the veins of the anus and rectum is increased, they become swollen and result in hemorrhoids. Straining to pass stools due to constipation and strain during lifting heavy weights are the usual causes of increased pressure in the veins. Pressure during pregnancy and high blood pressure in the portal vein also may lead to hemorrhoids.

Symptoms

Pain and bleeding are the usual symptoms associated with hemorrhoids. When the hemorrhoids in the anus form lumps, blood clots develop inside them. They are called thrombosed external hemorrhoids and they cause pain and bleeding. Internal hemorrhoids also may bleed during a bowel movement, streaking the stool with blood and coloring the toilet bowl red. Anemia due to bleeding hemorrhoids is not very common as the blood loss is not usually heavy.

Itching in the anal area is not a direct symptom of hemorrhoids but cleaning of the anus becomes difficult if hemorrhoids protrude out of it, which in turn causes anal itching. Internal hemorrhoids and the mucus discharge from them may cause a feeling of fullness in the rectum even after emptying the bowel.

Complications: Formation of external thrombosed hemorrhoids and bleeding internal hemorrhoids are the usual complications that can develop.

Diagnosis

A physical examination of the anal region followed by viewing the inside of the anal canal with an anoscope helps the doctor in detecting external hemorrhoids. To detect internal hemorrhoids inside the rectum, a longer, flexible tube called sigmoidoscope is used. To rule out the presence of tumors, the lower part of the large intestine is also examined by colonoscopy.  These tests are necessary if there is bleeding from rectum.

Treatment

For hemorrhoids which do not cause any disturbing symptoms, doctors advice general measures to ease bowel movements. Diet rich in fiber, stool softeners and natural laxatives like psyllium husk help in easy motions and reduce the need of straining. Sitting in a bowl of warm water called a sitz bath helps in relieving minor symptoms. A thrombosed external hemorrhoid causing pain can be treated by pain killers such as NSAIDs or by local application of anesthetic ointments. Gradually, as the clot gets resolved in about a month or so, the pain also subsides. Removing the blood clot surgically or injecting anesthetics into the hemorrhoid are options in case of severe pain.

Injection sclerotherapy is a procedure to cut off a hemorrhoid from its place of origin by forming scar tissue. A certain substance is injected into the hemorrhoid to initiate the development of scar tissue.

A procedure called rubber band ligation is used to destroy internal hemorrhoids when sclerotherapy does not produce the desired effect. It is also used for internal hemorrhoids which are large. The rubber bands extended over the tip of a ligator are pushed on to the base of the hemorrhoid to cut off the blood supply to it. Eventually they drop off without causing any pain. The procedure is repeated at two-week intervals if several hemorrhoids have to be ligated. Other procedures used to destroy internal hemorrhoids include infrared photocoagulation and electrocoagulation. Laser destruction is another such technique that has become available now.

Several newer techniques are being developed in this field because surgical removal of a hemorrhoid involves many side effects such as retention of urine and severe pain. It may also cause constipation which would further complicate matters. The arterial blood supply to the hemorrhoid is identified with a Doppler and it is cut off to destroy the hemorrhoid in a procedure called Doppler-guided hemorrhoid artery ligation. Circumferential stapled hemorrhoidopexy is another new procedure. A surgical stapler circular in shape is used to cut off the hemorrhoid- suspending tissue, at the same pinning back the hemorrhoid in its original position.

Hemorrhoids Video Summary

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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2 Responses to What Are Hemorrhoids

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