Hemorrhoids: Causes, Symptoms, Diagnosis & Treatment
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What are Hemorrhoids?
Many people have hemorrhoids but if they are the smallest of hemorrhoids and they present no symptoms, they can go undetected for an entire lifetime. If you asked many of these people “what are hemorrhoids?” or “what causes hemorrhoids?” they might not even know what you were talking about. However, others who have hemorrhoids endure a painful condition and may even go on to suffer from bleeding hemorrhoids which can be a frightening and embarrassing problem.
If you are suffering the pain and discomfort of hemorrhoids, you are not alone as it is thought that some 50% of adults in the US will have this condition in their lifetime.
Table of Contents:What do Hemorrhoids Look Like?
Causes & Symptoms
Treatment & Diagnosis
Hemorrhoids & Pregnancy
What Do Hemorrhoids Look Like?
This is a question that has been asked time and again because researchers are now saying that in fact, more than half of the world’s population suffers from these painful conditions. So when a doctor says that the person is suffering from hemorrhoids (this is the right spelling for the disease by the way), the person naturally becomes curious to know what they look like, since the symptoms are often not visible. Often hemorrhoids are internal and located in the anus, and it is obviously difficult to look into one’s own anus. So herein lies the question, what does a hemorrhoid look like?
Before going deeper into the subject it needs to be mentioned here that everyone has hemorrhoids, per say, it is just that it creates a problem in some (particularly in those in whom they become enlarged).
The question now is, why and how do they become enlarged? There are a lot of arteries and veins in the region and they pass on a lot of blood (this also helps while passing stool). Sometimes from excessive pressures in the area, over years, the veins in the region get strained and thus tend to stretch and swell. And this is what creates the problem.
Sometimes hemorrhoids tend to get protruded from the anus and when this happens it becomes relatively easier to see them. This condition is known as external hemorrhoids. In stark contrast to this are internal hemorrhoids. When someone suffers from internal hemorrhoids, it becomes very difficult to look at them, as there are hardly any visible symptoms. However sometimes relapsing internal hemorrhoids also look as if they are jutting out from the anus.
Causes and Symptoms of Hemorrhoids
It is still unclear as to the exact causes of hemorrhoids but there are many theories which attempt to explain this medical phenomenon.
We do know that pressure in the anal sphincter, which is the muscle that surrounds the anal canal, is more than likely the culprit. However, it is not clear if this pressure results in actually causing a hemorrhoid, or if it is the pressure which enlarges an already present hemorrhoid. If the latter is the case, then straining or forcing a bowel movement, would more than likely pull the hemorrhoids with the stool and the force of the stool, passing through a tighter sphincter, would in essence cause hemorrhoids by enlarging the vein itself.
Pressure in the Anal Area
It is pretty certain that with existing hemorrhoids, pressure in the anal area will simply make the condition worse and may enlarge the hemorrhoid until it may actually protrude from the anus. This is then known as a prolapsed hemorrhoid. Enlarging a hemorrhoid can also cause hemorrhoids to rupture or tear which in turn causes bleeding. Pressure may also cause anal fissures, which is a tear in the anal canal. This condition will also normally result in bleeding from the rectum.
Continuing on with the theory that pressure in the anus causes hemorrhoids to enlarge and presuming that this theory may also be the reason for hemorrhoids to occur in the first place, let's look at a number of lifestyle activities and possible causes for this pressure and the existence of hemorrhoids.
Internal vs. External Hemorrhoids
Hemorrhoids come as internal hemorrhoids (found inside the anus) or external (found under the skin surrounding the anus). It is the internal hemorrhoids that often show no signs and symptoms except where there is the presence of blood in the stool or an internal hemorrhoid may suddenly protrude through the anus outside the body. The blood may be the result of straining or irritation from a bowel movement which injures the delicate surface of the hemorrhoid. The protruding of the internal hemorrhoid may be caused by excessive straining.
External hemorrhoids will often cause a painful swelling or a noticeable hard lump surrounding the anus. Blood may also be apparent and sometimes forms into a clot adding to the irritation and discomfort.
Main Causes & Symptoms of Bleeding Hemorrhoids
When a hemorrhoid is formed, an excess of blood is trapped in the vein. Since hemorrhoids are actually in the anal cavity, they may bleed if a pregnant woman becomes constipated. When the stool rubs against the vein and is then pushed hard against it, the vein may burst. This may cause the vein in turn to actually start bleeding. Hemorrhoids like this should not cause too much pain unless it is an internal hemorrhoid and is blocking the anal cavity. The important thing is to drink lots of water together with a high fiber diet which in turn ensures a softer stool so that the bleeding hemorrhoids are not pressed so much against the anal wall.
Other causes of bleeding Hemorrhoids:
- Very weak rectal vein walls.
- Serious and ongoing constipation.
- Too much pressure on the rectal veins because of poor muscle tone or posture due to prolonged sitting and this includes sitting on the toilet itself.
- Hypertension in the portal vein
- The excessive consumption of alcohol and/or caffeine
- Pregnancy when many pregnant women suffer from hemorrhoids due to increased straining of bowel movements and hypertension
Treatment & Diagnosis of Hemorrhoids
When hemorrhoids are small and internal, the symptoms may be so mild that many people are unaware of their presence. However, there can be a lot of pain and discomfort associated with this condition especially from hemorrhoids that appear at the opening of the anal passage after straining to have a bowel movement. Fortunately, there are many treatment options and ways to reduce this distress while treating hemorrhoids.
- Change your diet to one that is high in bulk and fiber to ensure no constipation. Your daily intake of fiber should be between 25 and 35 grams.
- There are some fruits that are especially helpful for relieving hemorrhoids – pure fruit juice with no additives, cherries, blackberries, blueberries, cantaloupe melons, red and black currants, pomegranate juice, oranges, bananas and papayas.
- Drink at least 6-8 glasses of water every day to avoid constipation.
- Take a stool softener or bulk laxative while the change of diet starts to work.
- Take a mild pain reliever if necessary but ensure it does not contain codeine as this can actually cause any constipation.
- Just because you have pain and discomfort, don't put off having some exercise every day such as a 20 minute walk as this will help with constipation too.
- Soothe the hemorrhoid area by sitting in a basin of warm water several times per day.
- Don't delay going to the toilet if you need to have a bowel movement.
- Try to train yourself to have a set time each day for this bowel movement and never sit on the toilet for longer than a couple of minutes.
- Use pads containing witch hazel for cleansing and soothing the area. These can be bought from your local pharmacy or health store, or soak a cotton ball in witch hazel and leave it on the opening to the anal canal for about an hour several times per day.
- Instead of toilet paper, use fragrant-free baby wipes to clean the anus after each bowel movement. Never rub or scrub this sensitive area.
- Use ice packs or a cold compress to relieve any swelling or when you feel they will be helpful.
- Many people find a hemorrhoids pillow to be helpful. This is doughnut shaped that comes in different sizes. Others prefer to use an ordinary small pillow for extra cushioning.
- Avoid lifting heavy objects and if you must, then exhale as you lift the object but don't hold your breath.
- Treat coughing, diarrhea and of course constipation as soon as you notice any of these conditions.
- You may be tempted to scratch because of itchiness. Refrain from this because it will only make the hemorrhoid symptoms even worse.
Natural Treatment of Hemorrhoids
Many are embarrassed about the presence of hemorrhoids and even shy away from seeking medical advice for the treatment of this condition. Fortunately, the symptoms of hemorrhoids or hemorrhoids can be relieved by home remedies together with some important lifestyle changes.
Hemorrhoids are very common and are swellings that develop from the cushions of tissue that form part of the anal canal. These cushions are perfectly normal and act as a lining when the anus opens and closes in order to prevent any leakage. However, these cushions are rich in blood vessels and anything which increases the pressure on them can cause the blood vessels to swell.
Constipation, overweight and the later stages of pregnancy can all increase this pressure.
While hemorrhoids are small, they are not usually painful but can be extremely itchy. It is usually only when a hard lump starts to protrude from the anus, signaling thrombosis, that severe pain can be felt. If the hemorrhoids rupture, then bleeding can be a further symptom.
As we have said, lifestyle changes form an important part of the solution for hemorrhoids and if straining on the toilet or being constipated is causing your hemorrhoids, then such problems need to be addressed first.
Lifestyle changes should include:
- Ensuring you drink extra liquids (especially water) along with a healthy diet with plenty of fresh fruit, vegetables and fiber to prevent or address constipation.
- Avoiding sitting on the toilet for too long while trying to develop the habit of having a regular bowel movement at roughly the same time each day.
- Avoiding pushing or straining when having a bowel movement.
- As well as constipation, treating such conditions as a bad cough or diarrhea because these can also lead to hemorrhoids.
- Exercising is most important and hemorrhoids can benefit from all types of exercise except for those such as weight training which would add to the straining and aggravate any hemorrhoids. Not only will exercise help prevent the onset of hemorrhoids or the recurrence of hemorrhoids but you will feel healthier and more alert. But most importantly, good exercise means good muscle tone while lack of exercise means slack muscle tone. You need to promote good muscle tone to prevent hemorrhoids or to help get rid of them.
- Avoiding sitting or standing for long periods of time.
Home remedies include:
- Gently cleaning the affected area after a bowel movement with a fragrant-free baby wipe. Don't use dry toilet paper.
- Taking an oral mild pain reliever if necessary.
- Soaking the affected area in a bowl or bath of warm water several times a day to soothe and relax it. Soap isn't necessary and may aggravate the problem. Gently dry the area with a hair dryer after bathing.
- Applying ice packs or cold compresses to the anus to relieve swelling.
- Ordering H-Hemorrhoids with essential oils online for the relief of symptoms of hemorrhoids including pain, discomfort and itchiness.
- Or applying an over-the-counter hemorrhoid cream or suppository containing hydrocortisone. Alternatively, use pads containing witch hazel or a numbing agent.
With some time and effort, you can make some changes to your lifestyle and use home remedies to both successfully treat your hemorrhoids and prevent their recurrence in the future.
Hemorrhoids and Pregnancy
Hemorrhoids during pregnancy are essentially veins in the anal area which have become very swollen from the pressure of carrying the weight of an unborn baby. The veins fill up with too much blood, causing them to swell and eventually be known as a hemorrhoid. Bleeding Hemorrhoids are very common in pregnant women who are approaching their third trimester when the pressure on the fetus dilates the veins. Sometimes hemorrhoids will only surface during the onset of childbirth.
Hemorrhoids in general can be very painful and itchy and they are always found around the anal area. Doctors readily accept this condition as normal and will tell their patients not to be embarrassed.
Treatment of Hemorrhoids During Pregnancy
- Clean your anus after each bowel movement by patting gently with moist toilet paper or use gentle baby wipes.
- Use ice packs to relieve any swelling.
- Soak the affected area in a Sitz bath of warm water several times per day.
- Soak a cotton ball in witch hazel and leave it on the anus for an hour but do not insert it. Repeat twice a day.
- There is a home remedy you might like to try where you soak 2 garlic cloves in a pot with 2 cups of water which you boil until soft. Then place the pot with the steaming garlic below you and stay like that for about 15 minutes. The hemorrhoids should shrink and the pain disappear.
The important thing to remember when you have female hemorrhoids is to start treating them as soon as possible so that they do not develop into bleeding hemorrhoids. They may well be very itchy but resist the temptation to scratch as this can only make the problem worse.
Not all hemorrhoids will bleed but those that do cause blood to appear on the stool or toilet tissue used. It is important to remember that although bleeding hemorrhoids are not usually dangerous, there are instances when bleeding can harm a person and should be checked out by a health professional. Regular bowel movements and a high fiber diet are the best things for preventing hemorrhoids from bleeding during pregnancy. Bleeding hemorrhoids are often just another part of pregnancy and like morning sickness, they often go away in time. Hemorrhoids in general are nothing to be too concerned about and they should clear up after the pregnancy, bleeding however may indicate a more serious condition and it may be recommended to consult a health professional if bleeding is found.
While it is safer and more successful to treat hemorrhoids in their early stages, sometimes hemorrhoids become chronic or severe hemorrhoids - perhaps through neglect - and will then need extra careful treatment.
Hemorrhoids are common in both men and women with roughly 50% of the population suffering from hemorrhoids by age 50. However, sometimes when hemorrhoids are neglected or particularly stubborn, other solutions need to be investigated. One such solution could be hemorrhoidectomy surgery and this is the process where the hemorrhoid is removed surgically, usually as an outpatient procedure.
Surgery is also considered when symptoms become so bothersome that your lifestyle is affected or when hemorrhoids create a medical emergency, such as uncontrolled bleeding or the appearance of blood and pus at the anus along with severe rectal pain. The surgical procedure is not too lengthy and depending on the severity, a local anesthesia is all that is needed which should last 6 to 12 hours to provide pain relief after surgery. The patient can usually leave the medical facility within a matter of hours.
Types of Hemorrhoid Surgery & Alternative Therapy
Laser Hemorrhoid Surgery
There are quite a few options to get rid of painful hemorrhoids. Out of the surgical options laser hemorrhoid surgery is a popular choice amongst health professionals and patients. It is the preferred surgery for patients as it can be performed on an outpatient basis, the surgeon can pin point the tissue that needs to be treated and leave the surrounding area undisturbed, there is no bleeding as the laser seals off small blood vessels and nerves, and the procedure is not intrusive with minimal discomfort.
There is another procedure that uses a circular stapling device to remove hemorrhoidal tissue and close the wound. No incision is made. Called stapled hemorrhoidopexy, in this procedure the hemorrhoid is lifted and then "stapled" back into place in the anal canal. The advantage is often less pain after surgery than the traditional hemorrhoid surgery. But the stapled surgery is more expensive and the risk of recurrence is higher.
After surgery, it is important that the patient is able to urinate before leaving and that someone drives him or her home. Some people may find urinating difficult and there may be some pain too while doing so.
After care at home necessitates taking some pain relief if needed and eating a rather bland diet with plenty of liquids for a few days. Ice packs applied to the anal area will help to reduce swelling and pain while frequent soaking in a bath or bowl of warm water will soothe and relax anus. It is wise to take stool softeners for a short while to ensure smooth initial bowel movements during the few days recuperation period at home. Be careful not to strain during bowel movements as this can cause hemorrhoids to recur.
One of the methods of getting rid of stubborn hemorrhoids is by surgery but it does come with drawbacks such as pain and post-surgery complications. Super freezing hemorrhoids with a procedure called cryotherapy can be a less painful option.
Cryotherapy involves using super cooled gas or liquid to freeze the hemorrhoid and stop it from growing. In most cases, the hemorrhoid will shrink, shrivel and eventually die off. Most doctors use liquid nitrogen as the cryogenic agent in freezing hemorrhoids when doing cryotherapy for hemorrhoids. After the procedure has been completed, healthy tissue will eventually grow back. However, super freezing can only be used on external hemorrhoids.
Advantages of Cryotherapy over Traditional Surgical Procedures
- It is not necessary to stay in hospital as the method can be carried out in your doctor's rooms.
- It is significantly less painful with few complications.
- There is less likelihood of difficulty urinating because of pain.
- The recovery period can be quicker.
However, there can be side effects of nerve irritation, numbness or tingling, or redness and irritation of the skin.
Other guides on health conditions:
Definition & facts of hemorrhoids. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/symptoms-causes. Accessed January 25, 2021.
Hemorrhoids and what to do about them. Harvard Health Publishing. https://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them. Accessed January 25, 2021.
Mounsey AL, Halladay J, Sadiq TS. Hemorrhoids. Am Fam Physician. 2011;84(2):204–210.
Perrotti P, Antropoli C, Molino D, De Stefano G, Antropoli M. Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis Colon Rectum. 2001;44(3):405–409.
What are hemorrhoids? The American Society of Colon and Rectal Surgeons. https://www.fascrs.org/patients/disease-condition/hemorrhoids-expanded-version. Accessed January 25, 2021