Hemorrhoids

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• What is Hemorrhoids?
• Symptoms
• Causes
• Risk factors
• Diagnosis
• Treatment

Hemorrhoids

When you have hemorrhoids or piles, veins in your anus and lower rectum become swollen, like varicose veins. There are 2 types of hemorrhoids comprising internal hemorrhoids which develop inside your rectum and external hemorrhoids which develop under the skin of the anus.

Around 3 out of 4 adults experience hemorrhoid symptoms at some point in their life. There are various causes of hemorrhoids but most of the time they cannot be identified.

However, treatments for hemorrhoids are usually effective. Home remedies and lifestyle modification may relieve symptoms.

Symptoms

Signs and symptoms of hemorrhoids vary by type of hemorrhoid.

• External hemorrhoids occur beneath the skin surrounding the anus. You may experience:
  • Bleeding
  • Swelling of the anal area
  • Discomfort and pain
  • Irritation or itching around the anus
• Internal hemorrhoids develop inside your rectum. You cannot see them and rarely feel the pain. However, when you strain to pass stool, you may experience:
  • Rectal bleeding with no pain. You may see some drips of bright red blood in the toilet or on toilet tissue.
  • Prolapsed hemorrhoid is a hemorrhoid that bulges outward from the anus, it can be quite painful.
• Thrombosed hemorrhoids occur when blood clots form in the dilated veins of external hemorrhoids. You may experience:
  • Swelling
  • Severe pain
  • Inflammation
  • A hard lump around your anus

When to see a doctor

You should see your doctor if you experience rectal bleeding or your condition is not better after one week of home treatment.

If there are changes in your bowel habit or stool color or consistency, hemorrhoids may not be the cause. Other diseases such as colorectal cancer or anal cancer can also cause rectal bleeding.

If you feel dizzy, and lightheaded, and experience severe rectal bleeding, please seek immediate medical attention.

Causes

When veins around your anus encounter increased rectal pressure, your veins would become congested and stretch, swell, or bulge, leading to hemorrhoids. The pressure in the lower rectum increases when:

• You strain to pass stools.
• You sit on a toilet for a long time.
• You suffer from constipation or chronic diarrhea.
• You suffer from obesity.
• You are pregnant.
• You have anal intercourse.
• You do not eat a high-fiber diet.
• You lift and carry heavy objects regularly.

Risk factors

When you get older, the tissues around your rectal and anal veins become weaker and stretch out, increasing the risk of hemorrhoids. In pregnant women, the extra weight of the fetus pressing on the rectum and anus leads to a higher risk of hemorrhoids as well.

Complications

There rarely are any complications but possible ones are:

• Anemia. When bleeding from hemorrhoids is frequent and excessive, it can lead to anemia. This is when your body does not have enough healthy red blood cells to transfer oxygen to cells throughout your body, but it is infrequently seen.
• Strangulated hemorrhoid. This can cause extreme pain due to inadequate blood supply of internal hemorrhoids.
• Blood clot. A thrombosed hemorrhoid occurs when a blood clot is formed. The condition can cause severe pain. Lancing and clot evacuation may be required.

Prevention

Hemorrhoids can be prevented by keeping stools soft.

Below is what you can do to prevent and minimize hemorrhoid symptoms.

• Increase your fiber intake to soften stools and increase bulk so you do not have to strain to pass stool. However, try to increase fiber intake from fruits, vegetables, and whole grains little by little to avoid gas problems.
• Drinking 6-8 glasses of water or liquids (except alcohol) daily to help soften your stools
• The recommended daily intake of fiber is 20-30 grams, but most people do not eat enough. Try fiber supplements to improve rectal bleeding and other symptoms of hemorrhoids. Drink a minimum of 8 glasses of water when you take fiber supplements to avoid constipation.
• Do not strain or hold your breath when defecating to avoid engorging your lower rectal veins.
• Do not hold up your bowel movements, otherwise, your stool can become dry and hard.
• Exercise helps increase your bowel motility, reducing constipation and pressure on veins.
• Limit the time you sit on a toilet to avoid congesting anal veins for too long.

Diagnosis

External hemorrhoids can be examined visually; however, internal hemorrhoids need to be examined through your anal canal and rectum.

• Digital rectal exam
  Your doctor will put on a glove, lubricate his/her gloved finger, and insert it into the rectum to feel if there are any unusual rectal lumps.
• Visual inspection
  An inspection with a proctoscope, anoscope, or sigmoidoscope is to check the lower part of your colon for internal hemorrhoids and masses that are hard to feel during a digital rectal exam.

A colonoscopy may be prescribed to examine your entire colon if:

• Your doctor suspects that you may suffer from other digestive problems.
• There are risk factors related to colorectal cancer.
• You are in the middle-aged group and have not undergone a colonoscopy recently.

Treatment

Preparing for your appointment

See your doctor if you suffer from hemorrhoids. You may be referred to a gastroenterologist or colon and rectal surgeon for further diagnosis and treatment.

What you can do
Prior to your doctor's appointment, check if there is anything you need to do and take note of the following:

• Your symptoms and their duration.
• Your usual bowel habits and daily diet including fiber intake.
• Medications and dietary supplements as well as the dose.
• Questions you would like to ask

Sample of questions you can ask your doctor:

• What causes hemorrhoids?
• Are hemorrhoids temporary or permanent?
• Are there any hemorrhoid complications?
• What is the best treatment method?
• If that treatment is not effective, what else we can do?
• Do I need surgery?
• What I can do at home to relieve the symptoms?
• What is the best way to cope with my current medical issue along with hemorrhoids?

Ask any other questions you may have.

What to expect from your doctor
Samples of questions your doctor may ask:

• Do your symptoms cause pain?
• What are your daily bowel habits?
• How many high-fiber foods do you eat daily?
• What have you tried to relieve the symptoms?
• What have you tried which makes your symptoms worse?
• Is there a family record of colon or rectum or anus cancer or hemorrhoids?
• Have your bowel habits changed recently?
• Is there any blood in your stools or any blood drips into the toilet or on tissue paper?
• What is the usual amount of bleeding and the color of the blood?

What you can do in the meantime

Prior to your appointment, you can try to relieve symptoms by eating more fruits, vegetables, and whole grains and drinking at least 6-8 glasses of water daily.