Hemorrhoids: Causes, Symptoms and Treatment

Hemorrhoids are blood vessels that are located in the muscles of the walls of the rectum and anus. They are located at the junction where small arteries merge into veins. 

Now, hemorrhoids become an issue when they begin to swell, cause itching, pain and/or bleeding. This condition is referred to as hemorrhoidal crises or hemorrhoidal disease (commonly called pile).

Causes of Hemorrhoidal Disease

It usually develops due to increased pressure in the lower rectum and this can be due to: 

1. Straining while stooling.
2. Sitting for too long 
3. Chronic diarrhea or constipation
4. Obesity
5. Pregnancy
6. Anal sex
7. Regular heavy lifting
8. Colon cancer 
9. Previous kidney surgery
10. Alcohol, fat or spicy foods

Risk factors

1. Age – The older one gets, the more predisposed they are because of weakening of the tissues supporting the veins in the rectum and anus.
2. Family history – When a family member had the condition.

There are different types of hemorrhoids and they are classified based on their location to the pectinate line(this is the dividing point between the upper 2/3 and lower 1/3 of the anus).

They include: 

1. Internal hemorrhoids: These are located above the pectinate line and are covered with same cells as those that line the intestine. There are different grades of internal hemorrhoids, based on the degree of position change below the pectinate line into the anal canal.

Grade 1: Here the hemorrhoid bulges into the anal canal but it doesn’t fall completely. This may bleed.

Grade 2: It becomes visible outside the anus during straining but spontaneously returns to its original internal position once the straining is stopped.

Grade 3: The hemorrhoid protrudes past the anus without any straining.

Grade 4: Here the hemorrhoid becomes too painful to be pushed back in.

2. External hemorrhoids: These are located below the pectinate line and are covered with cells that resemble the skin.

Symptoms

1. External hemorrhoids: These can form blood clot and lead to: 

• Acute and throbbing pain (most common)
• Excess skin tags that cause difficulty with cleaning after stooling and can cause secondary skin infections
• Dark and clotted bleeding

2. Internal hemorrhoids: These can prolapse (move from original position) and/or form blood clots    causing:

• Bleeding that is usually painless (most common) 
• Mucus discharge which leads to irritation (burning and itching) of the skin around the anus
• Moderate fecal incontinence (inability of the bowel to hold feces)
• Pain (rarely) 

Diagnosis

1. Physical examination
2. Anoscopy, sigmoidoscopy or colonoscopy (All examinations carried out to examine changes around the bowel and anus).

Treatment Options

• Medications

This includes pain killers like diclofenac, stool softeners, anti-diarrheal agents, other medications including suppositories to shrink the hemorrhoid. its important to be very weary of herbal medicines peddled as been effective

• Surgery

Widely used for those who medications prove ineffective

• Lifestyle measures (These are quite effective for prevention as well)

1. Increase in fiber intake and fluids
2. Avoiding prolonged sitting/defecating position and straining
3. Avoiding anal intercourse
4. Regular exercise

In conclusion it is important to get treated at early stages for better results if any symptoms are experienced. Seeing a physician is really important. Self medication is not the way to go.

Pharm Blessing Maduelosi (B.Pharm UPH)