Hemorrhoids are clumps of dilated (enlarged) blood vessels in the anus and lower rectum. The rectum is the last area of the large intestine before it exits to the anus. The anus is the end of the digestive tract where feces leaves the body.
Sometimes hemorrhoids swell when the veins enlarge and their walls become stretched, thin, and irritated by passing stool. Hemorrhoids are classified into two general categories:
- internal, originating in the rectum, and
- external, originating in the anus
Enlarged Hemorrhoid Symptoms
Enlarged hemorrhoids are associated with symptoms such as
- mucus discharge,
- burning at the anus,
- severe pain,
- a sensation that the bowel is not really empty, and
- bleeding without pain.
In this article, our medical experts will explain where hemorrhoid pain comes from, what hemorrhoids feel like, and how they are diagnosed. Then you will discover the various treatments for hemorrhoids both at home and at the hospital, along with the positive attributes and drawbacks of each hemorrhoid treatment.
Internal hemorrhoids sit in the inside lining of the rectum and are not obvious unless they are substantially enlarged, in which case they can be felt. Internal hemorrhoids are usually painless and become apparent because they cause bleeding with a bowel movement.
Sometimes internal hemorrhoids prolapse or protrude outside the anus. If so, you may be able to see or feel them as moist pads of skin that are pinker than the surrounding area. Prolapsed hemorrhoids may hurt because the anus is dense with pain-sensing nerves. Prolapsed hemorrhoids usually recede into the rectum on their own.
External hemorrhoids are located underneath the skin that surrounds the anus and is lower than internal hemorrhoids. They can be felt when they swell and may cause
- pain, or
- bleeding with a bowel movement.
If an external hemorrhoid prolapses to the outside (usually in the course of passing a stool), you can see and feel it.
Blood clots sometimes form within prolapsed external hemorrhoids, which can cause an extremely painful condition called a thrombosis. If external hemorrhoid becomes thrombosed, it can look rather frightening, turn purple or blue, and could possibly bleed.
Despite their appearance, thrombosed hemorrhoids usually are not serious, though they can be very painful. They will resolve on their own in a couple of weeks. If the pain is unbearable, your doctor can remove the blood clot from the thrombosed hemorrhoid, which stops the pain.
What causes hemorrhoids?
While the presence of hemorrhoids is a reflection of the normal anatomy, most people and care professionals refer to hemorrhoids as an abnormal finding because they only present when they swell and cause problems.
Hemorrhoid swelling occurs when there is an increase in the pressure in the small vessels that make up hemorrhoid causing them to swell and engorge with blood. This causes them to increase in size leading to symptoms. Increased pressure may be caused by a variety of factors:
- Low fiber diet and smaller caliber stool cause a person to strain when having a bowel movement, increasing the pressure within the blood vessels.
- Prolonged sitting on the toilet may increase pressure within the hemorrhoid blood vessels
- Diarrhea, both acute and chronic
How is internal hemorrhoidal disease treated?
Various treatments are available for the internal hemorrhoidal disease. Not all people will require an office procedure or surgery.
For milder or occasional symptoms, the following treatments can help:
- Keep stool soft and regular by increasing the amount of fiber in your diet to 30 grams/day and, if needed, by starting a fiber supplement.
- Develop good toilet habits, such as not straining or sitting on the toilet for a long period of time.
- Take a warm tub or sitz bath to relieve more severe pain from bowel movements.
For more severe or chronic symptoms, other options are available. The best procedure for you depends on the size of the internal hemorrhoids and how severe your symptoms are.
Techniques for treating internal hemorrhoidal disease include:
- Rubber band ligation: Usually performed in the office without sedation, rubber band ligation involves placing rubber bands at the base of internal hemorrhoid to cut off its blood supply, allowing it to fall off.
- Doppler-guided hemorrhoidal artery ligation: This surgical procedure, done in the operating room under general anesthesia, uses a special anal probe equipped with a Doppler device. Blood vessels leading to the internal hemorrhoids are identified and then tied off (ligated), causing them to shrink. The internal hemorrhoids can also be fixed in place with stitches.
- Stapled hemorrhoidopexy, or Procedure for Prolapse and Hemorrhoids (PPH): Also done in the operating room, a special stapling device removes a donut of the rectal lining, which then pulls the bulging internal hemorrhoids back into the anus.
In most cases, a thrombosed external hemorrhoid does not need surgery. As the blood clot dissolves, the thrombosed external hemorrhoid shrinks.
How can I prevent internal hemorrhoidal disease?
Here are some ways to prevent internal hemorrhoidal disease:
- Try to keep your stool soft and regular. Make sure you get enough fiber in your diet, about 30 grams/day, by eating fruits, vegetables, and whole grains. A fiber supplement may help you reach your fiber goal. Your doctor may suggest a stool softener or laxative.
- Exercise regularly to help prevent constipation.
- Maintain good toilet habits. Don’t strain or sit too long on the toilet.
- Do not delay bowel movements. Go to the toilet when you feel the urge.
Everyone Has Hemorrhoids
Although most people think hemorrhoids are abnormal, everyone has them. Hemorrhoids help control bowel movements. Also, hemorrhoids cause problems and can be considered abnormal or a disease only when the hemorrhoidal clumps of vessels enlarge.
Hemorrhoids occur in everyone, and an estimated 75% of people will experience enlarged hemorrhoids at some point. However, only about 4% will go to a doctor because of hemorrhoid problems.
Article and Image Sources: