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Hemorrhoids – Causes, symptoms and treatment of internal vs external hemorrhoids

Hemorrhoids, also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids have a number of causes, although often the cause is unknown. They may result from straining during bowel movements or from the increased pressure on these veins during pregnancy. 

Internal and External Hemorrhoids

Internal hemorrhoids are far enough inside the rectum. They don't generally hurt because you have few pain-sensing nerves there. Bleeding may be the only sign of them.

External hemorrhoids are under the skin around the anus, where there are many more pain-sensing nerves, so they tend to hurt as well as bleed.

Thrombosed hemorrhoids - Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus) that can result in severe pain, swelling, inflammation and a hard lump near your anus.

Symptoms

Signs and symptoms of hemorrhoids may include:

·         Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet;

·         Itching or irritation in your anal region;

·         Pain or discomfort;

·         Swelling around your anus;

·         A lump near your anus, which may be sensitive or painful (may be a thrombosed hemorrhoid).

Hemorrhoid symptoms usually depend on the location.

Causes

The veins around your anus tend to stretch under pressure and may bulge or swell. Swollen veins (hemorrhoids) can develop from increased pressure in the lower rectum due to:

·         Straining during bowel movements

·         Sitting for long periods of time on the toilet

·         Chronic diarrhea or constipation

·         Obesity

·         Pregnancy

·         Anal intercourse

·         Low-fiber diet

Hemorrhoids are more likely with aging because the tissues that support the veins in your rectum and anus can weaken and stretch.

Risk factors

As you get older, you're at greater risk of hemorrhoids. That's because the tissues that support the veins in your rectum and anus can weaken and stretch. This can also happen when you're pregnant, because the baby's weight puts pressure on the anal region.

Complications

Complications of hemorrhoids are very rare but include:

·         Anemia. Rarely, chronic blood loss from hemorrhoids may cause anemia, in which you don't have enough healthy red blood cells to carry oxygen to your cells.

·         Strangulated hemorrhoid. If the blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be "strangulated," another cause of extreme pain.

Prevention

The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:

·         Eat high-fiber foods. Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can cause hemorrhoids. Add fiber to your diet slowly to avoid problems with gas.

·         Drink plenty of fluids. Drink six to eight glasses of water and other liquids (not alcohol) each day to help keep stools soft.

·         Consider fiber supplements. Most people don't get enough of the recommended amount of fiber — 25 grams a day for women and 38 grams a day for men — in their diet. Studies have shown that over-the-counter fiber supplements, such as Metamucil and Citrucel, improve overall symptoms and bleeding from hemorrhoids. These products help keep stools soft and regular.

If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause constipation or make constipation worse.

·         Don't strain. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.

·         Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.

·         Exercise. Stay active to help prevent constipation and to reduce pressure on veins, which can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that may be contributing to your hemorrhoids.

·         Avoid long periods of sitting. Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.

Treatment

→Home remedies

You can often relieve the mild pain, swelling and inflammation of hemorrhoids with home treatments. Often these are the only treatments needed.

·         Eat high-fiber foods. Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can worsen symptoms from existing hemorrhoids. Add fiber to your diet slowly to avoid problems with gas.

·         Use topical treatments. Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a numbing agent.

·         Soak regularly in a warm bath or sitz bath. Soak your anal area in plain warm water 10 to 15 minutes two to three times a day. A sitz bath fits over the toilet.

·         Keep the anal area clean. Bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Avoid alcohol-based or perfumed wipes. Gently pat the area dry or use a hair dryer.

·         Don't use dry toilet paper. To help keep the anal area clean after a bowel movement, use moist towelettes or wet toilet paper that doesn't contain perfume or alcohol.

·         Apply cold. Apply ice packs or cold compresses on your anus to relieve swelling.

·         Take oral pain relievers. You can use acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin IB, others) temporarily to help relieve your discomfort.

With these treatments, hemorrhoid symptoms often go away within a week. See your doctor if you don't get relief in a week, or sooner if you have severe pain or bleeding.

→Medications

If your hemorrhoids produce only mild discomfort, your doctor may suggest over-the-counter creams, ointments, suppositories or pads. These products contain ingredients, such as witch hazel, or hydrocortisone and lidocaine, that can relieve pain and itching, at least temporarily.

Don't use an over-the-counter steroid cream for more than a week unless directed by your doctor because it may cause your skin to thin.

External hemorrhoid thrombectomy

If a painful blood clot (thrombosis) has formed within an external hemorrhoid, your doctor can remove the clot with a simple incision and drainage, which may provide prompt relief. This procedure is most effective if done within 72 hours of developing a clot.

Other alternatives in case the medical treatment doesn’t work: Minimally invasive procedures (Rubber band ligation, Injection (sclerotherapy), Coagulation (infrared, laser or bipolar)) and Surgical procedures (Hemorrhoid removal and Hemorrhoid stapling)

(Mayoclinic Website)

 

 

May 2019

Sara Silva