Hemorrhoids/Piles

Types of Hemorrhoids

1. Internal Hemorrhoids:
   • These occur inside the rectum.
   • They are usually painless but can cause bleeding during bowel movements.
   • They can prolapse (fall outside the anus) and may become painful and irritated.
2. External Hemorrhoids:
   • These occur under the skin around the anus.
   • They can cause itching, pain, and swelling.
   • If a blood clot forms inside an external hemorrhoid, it may become a thrombosed hemorrhoid, which can be particularly painful.

Causes and Risk Factors

Hemorrhoids develop when there is increased pressure on the veins in the rectum or anus. This pressure can result from:

• Straining during bowel movements (often due to constipation or diarrhea)
• Chronic constipation or diarrhea
• Pregnancy, due to the pressure of the growing uterus
• Obesity
• Aging, which weakens the tissues around the anus
• Sitting for long periods (especially on the toilet)
• Heavy lifting
• Genetics, as some people may inherit a tendency to develop hemorrhoids

Symptoms

• Bleeding: Bright red blood on toilet paper, in the toilet bowl, or on the stool itself.
• Itching: Around the anus, often caused by irritation.
• Pain or discomfort: Especially during or after bowel movements, particularly with external hemorrhoids or prolapsed internal hemorrhoids.
• Swelling or a lump: Near the anus, which may be sensitive or painful.
• Mucus discharge: In cases of prolapsed internal hemorrhoids.

Diagnosis

A healthcare provider typically diagnoses hemorrhoids based on symptoms and a physical exam. In some cases, further tests may be necessary:

• Digital rectal exam: The doctor may feel for abnormalities in the anal area.
• Anoscopy: A small tube is used to look inside the rectum.
• Sigmoidoscopy or colonoscopy: If the bleeding is significant or persistent, these procedures can help rule out other causes, such as colorectal cancer.

Treatment Options

1. Conservative Measures:
   • Dietary changes: Increasing fiber intake (fruits, vegetables, whole grains) to avoid constipation.
   • Staying hydrated: Drinking plenty of water can help prevent constipation.
   • Topical treatments: Over-the-counter creams, ointments, or suppositories to reduce pain, itching, and inflammation.
   • Warm baths (sitz baths): Sitting in warm water for 10–15 minutes can provide relief from discomfort.
   • Stool softeners: These can make bowel movements easier and reduce straining.
2. Minimally Invasive Treatments:
   • Rubber band ligation: A rubber band is placed around the base of an internal hemorrhoid to cut off its blood supply, causing it to shrink and fall off.
   • Sclerotherapy: A chemical solution is injected into the hemorrhoid to shrink it.
   • Infrared coagulation: Uses infrared light to scar the hemorrhoid and stop blood flow.
3. Surgical Treatment:
   • Hemorrhoidectomy: In severe cases, surgical removal of hemorrhoids may be necessary, especially if other treatments fail.
   • Stapled hemorrhoidopexy: A technique that staples the hemorrhoid back into place and removes the excess tissue.

Prevention

To prevent hemorrhoids or reduce symptoms, consider the following:

• Eat a high-fiber diet to prevent constipation and avoid straining.
• Exercise regularly to improve digestion and bowel function.
• Avoid sitting for long periods, especially on the toilet.
• Respond to the urge to have a bowel movement promptly, as delaying it can lead to constipation.

When to See a Doctor

• If you experience heavy bleeding, especially if it’s persistent or severe.
• If you have pain or swelling around your anus that doesn’t go away.
• If you notice any changes in bowel habits, such as a change in stool consistency or shape.
• If you’re unsure whether your symptoms are due to hemorrhoids or another condition.

Hemorrhoids are a common and often manageable condition, but if you’re experiencing significant discomfort or complications, seeking medical advice is important to determine the best treatment approach.