Hemorrhoids, Piles (Bulging Veins In Rectum)

Piles, hemorrhoids or ‘rhoids’ as it is known colloquially is a common problem that is estimated to affect almost 5% of the Amercian population. Yet only about one-third of these hemorrhoid sufferers seek medical treatment. It is believed that by the age of 50 years, about 50% of adults will suffer with symptoms that are characteristic of hemorrhoids. However, hemorrhoids is preventable and treatable.

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What are hemorrhoids?

Hemorrhoids is the term used to describe swollen and inflamed veins in the rectum and anus. However, these veins may also become prolapsed or thrombosed (blocked with a clot) to cause the symptoms typically referred to as hemorrhoids. It is not usually a serious condition but can cause considerable discomfort and severe cases may adversely affect a person’s life. Despite being a common problem, many people are embarrassed about the condition and do not seek medical treatment.

Some types of hemorrhoids may not present with any symptoms for long periods.  It is possible to prevent hemorrhoids in most cases but many people only make these lifestyle changes once hemorrhoids appear. There are various treatment options for hemorrhoids and sometimes surgery may be necessary. If left untreated, serious complications can arise in severe cases.

Meaning of Hemorrhoids

The term hemorrhoids actually refers to a normal anatomical structure. These hemorrhoidal cushions lie along the anal canal, just under the inner layer known as the mucosa. There are three such columns in the anal canal and it actually develops in fetal life. It is therefore present in every person unless surgery has been previously done to remove it. Most of us never experience any problem with these hemorrhoidal cushions.

Once these blood vessels become inflamed, swollen, prolapsed (protruding) or thrombosed (obstructed with a clot) then we experience symptoms that we refer to as hemorrhoids or piles. In fact the terms is often incorrectly used to describe any anal discomfort when it may not always be due to hemorrhoids. These symptoms include anal itching, burning anus, pain in the anus or rectal bleeding.

Causes of Hemorrhoids

There are a number of causes of hemorrhoids most of which involves an increase in pressure within the rectum and anus. The raised pressure may affect the veins in different ways, like slowing down the blood flow within the veins. This can cause the vein to become engorged and compromise the supportive tissue that holds it in place. It is also more likely to occur in older people because advancing age causes a natural weakening of this supportive tissue.

  • Prolonged sitting on the toilet.
  • Straining to pass stool.
  • Chronic disturbances in bowel habit like constipation or diarrhea.
  • Pregnancy.
  • Obesity.
  • Inflammatory bowel disease.
  • Liver disease.
  • Spinal cord injury.
  • Colon cancer.
  • Rectal surgery.
  • Episiotomy.
  • Anal intercourse.

It is important to note that not all these conditions may cause hemorrhoids but rather increases the chances of hemorrhoids developing. In other words some of these conditions are risk factors, not causative factors.

Types of Hemorrhoids

There are broadly two types of hemorrhoids – internal and external. Both can occur at the same time. The different types are based on the location of the swollen and inflamed veins.

  • Internal hemorrhoids arise from veins in the rectum and anal canal. Grades I to IV.
  • External hemorrhoids occur under the skin around the anus.

Despite the location, internal hemorrhoids can still be visible if it protrudes through the anus. External hemorrhoids are supplied by the same nerves that supply the skin around the anus. However, internal hemorrhoids lack this type of sensory nerves and pain may not always be as prominent as is the case with external hemorrhoids.

Signs and Symptoms

It is not uncommon for most people to associated all perianal symptoms with hemorrhoids. However, there are a number of other conditions, like proctitis, that may cause some similar symptoms.  Internal hemorrhoids may not always present with the typical symptoms. External hemorrhoids on the other hand can produce severe symptoms even in mild cases. These hemorrhoid symptoms include:

  • Discomfort, burning and/or pain in rectum and anus worse after defecating.
  • Bleeding from the anus often noticed when wiping after a bowel movement.
  • Itchy rectum and anus.
  • Swelling around the anus.
  • Tender lump(s) around the anus.
  • Anal leakage.

Although internal hemorrhoids may not pain and usually cannot be seen or felt, it may cause rectal bleeding during straining and defecation. These hemorrhoids may also protrude through the anus (prolapse) in severe cases and can the present with pain or discomfort.

Treatment of Hemorrhoids

The treatment of choice for hemorrhoids usually depends on its severity. It is possible to treat hemorrhoids solely with lifestyle changes in milder cases. In fact most hemorrhoids resolve on its own without any treatment. However, the recurrence rate is usually higher without medical treatment. Severe hemorrhoids may require surgery.  If left untreated the repeated bleeding can cause anemia over time. Sometimes hemorrhoids may become strangulated leading to gangrene due to the interruption of the blood supply.

Medication

Medication for hemorrhoids mainly treats the symptoms of hemorrhoids or targets some of the underlying causes like constipation. If the hemorrhoids do not resolve over time then surgery may be required.

  • Stool softeners to minimize straining and ease constipation.
  • Topical anesthetics to relieve pain.
  • Hydrocortisone to reduce inflammation.
  • Analgesics for pain management.

Procedures

There are several minimally-invasive procedures that are effective in treating and even curing mild to moderate hemorrhoids. These treatments destroy the veins by using mechanical forces, chemicals, electricity and laser therapy so that it can eventually fall off. However, if these procedures fail then surgery may be necessary.

  • Rubber band ligation
  • Coagulation, cauterization and electrotherapy
  • Sclerotherapy
  • Cryotherapy
  • Ablation (laser or radiowave)

Surgery

More invasive procedures are considered if other treatment options fail to yield the desired result and when the hemorrhoids are large.

  • Hemorrhoidectomy is the surgical removal of the hemorrhoids.
  • Hemorrhoid stapling to interrupt blood flow to the affected veins.

The choice of surgical procedure depends on a number of factors. While stapling is less painful and tends to have fewer complications, the recurrence rate and risk of prolapse is much higher than with a hemorrhoidectomy.

References:

emedicine.medscape.com/article/775407-overview

www.mayoclinic.org/diseases-conditions/hemorrhoids/basics/definition/con-20029852

www.webmd.com/digestive-disorders/tc/hemorrhoids-topic-overview