What are Hemorrhoids?
Hemorrhoids are the swollen veins located in the lowermost part of the rectum. It is a commonly seen problem these days because of the changing lifestyle. The veins get swollen and may begin to bulge out of the anus. These swollen veins are called piles (hemorrhoids). They can be internal or external. They are the commonest cause of rectal hemorrhage. It is not a serious disorder but if not treated in time, can get severe as the constant bleeding may lead to anemia.
There are two types of hemorrhoids – Internal and External. Internal hemorrhoids are the ones which develop inside the rectum. They do not cause any pain and the only way to diagnose them is if the patient complains of rectal bleeding. External hemorrhoid form near the anal opening and are painful as there is more pain sensing nerves outside. They are diagnosed by symptoms of pain and bleeding from the rectum. If the veins swell up a lot, they may prolapse into the anus and may bulge while passing stool giving rise to bleeding hemorrhoids. These are diagnosed by examination and are seen as pinkish red bumps around the anal sphincter.
Causes of Hemorrhoids
The most common cause of hemorrhoids is mechanical pressure. The excessive pressure in the rectum causes the veins to swell up. The pressure could be due to many reasons.
- Straining or lifting very heavy weights (hard physical labor)
- Pushing during a bowel movement
- Constipation
- Passing a large, hard stool.
- Pregnancy – the growing uterus causes a pressure on the rectum and leads to swelling of the veins inside the rectum.
There are some risk factors which are known to be associated with hemorrhoids. They are sedentary lifestyle, obesity, patients with chronic diarrhea, chronic coughing or sneezing which also increases the pressure in the rectum.
Symptoms of Hemorrhoids
The symptoms of hemorrhoids is same as the symptoms of piles. However, you need to be aware and be careful about them.
- Straining and difficulty while passing stool
- History of long standing constipation
- Pain and irritation during a bowel movement
- Painless bleeding of fresh red blood in the initial stages
- Prolapsed hemorrhoids may lead to pain and bleeding together
- Itching around the anus
- Small lumps may form around the anal sphincter
- In long standing cases, the chronic bleeding can lead to anemia
- Fecal incontinence
Hemorrhoids and Pregnancy
Pregnancy and hemorrhoids are inter-connected and a common symptom experienced by many pregnant women during their pregnancy. They are seen more in the third trimester when the baby is getting bigger. Many women have them for the first time in their pregnancy. But if you already had them before, they are likely to flare up during pregnancy.
The most common reason why these changes occur during pregnancy is the pressure of the growing fetus on the inferior vena cava which is one of the largest vein of the body. Due to the pressure, the venous return slows down and the blood collects in the vein and swells it. This is also the reason why varicose veins are commonly seen during pregnancy. During pregnancy, the hormone progesterone relaxes the smooth muscles causing the veins to relax and swell even more. Constipation is common during pregnancy and it further adds to the mechanical pressure leading to hemorrhoids.
Diagnosis and Treatment of Hemorrhoids
The patient history and the symptom of painless bleeding per rectum raises the suspicion of haemorrhoid. The diagnosis is confirmed by digital rectal examination where the doctor wears a glove and applies a lubricant on the finger and inserts it into the rectal opening to check for swollen internal veins.
In some cases, sigmoidoscopy may be required. This is a procedure where a tube is inserted into the rectum and it is attached to a fiber optic camera which helps in visualization of the internal piles and the condition of the colon internally. This method is also useful in diagnosing growths, tumors etc arising from the rectum.
The treatment is mainly pain relief medications and fiber supplements to reduce the constipation which will in turn reduce the pain and the bleeding.
In severe cases, hemorrhoid surgery is also suggested to remove the piles. Other treatments available for hemorrhoid relief are schlerotherapy and band ligation.
Prevention of Hemorrhoids
- Have a high fiber diet and lots of water. Soft stool helps in relieving the pain and also controls the bleeding. Wheat bran, oatmeal, brown rice and green vegetables are good sources of fiber. You may also use psyllium husk which helps to form stool bulk and softens it.
- Avoid putting off the urge to pass stool. Do not strain hard while passing stool as it increases the pressure within the rectum.
- Use warm sitz bath every day. Sit in a tub of warm water and soak the anus for 10-15 minutes to get effective pain relief.
- Exercise regularly. Walking on a daily basis can help reduce constipation. During pregnancy, regular kegel exercises help to strengthen the anal muscles.
