Hemorrhoids are swollen, vascularized tissues in the wall of the rectum and anus that sometimes cause minor bleeding or form small blood clots.
Hemorrhoids occur when tissues swell, weaken and pull away from the structures that support them. The result is a sac-like swelling that extends into the anal area.
Hemorrhoids only affect humans - no animals have them. They are very common - up to 86% of the population will complain of having suffered from hemorrhoids at some point, but many people often use the term for any anorectal problem, including itching. Hemorrhoids can occur at any age but are most common in people between the ages of 45 and 65 and, among younger people, in pregnant women.
Although they are commonplace, even for young, fit people, they are an embarrassing topic of conversation. They can be painful and uncomfortable, but they are usually not serious. Hemorrhoids vary in location and in the amount of pain or discomfort they cause.
Internal hemorrhoids are located inside the rectum. They do not usually cause pain, as there is no sensory nerve in this tissue. The severity of these hemorrhoids is assessed according to the size and frequency of their protrusion into the anal canal or out of the anus (a prolapse):
- Stage I where they are small and do not protrude. Minor painless bleeding may occur after passing stool;
- Stage II where the hemorrhoids may protrude during the passage of stool, but then spontaneously reappear;
- Stage III where the hemorrhoids must be replaced manually;
- Stage IV where the hemorrhoids cause prolapse - they protrude continuously and come out if pushed back into the rectum. They can cause bleeding. These hemorrhoids can be painful.
External hemorrhoids form under the skin just inside the opening of the anus. They may swell and the surrounding area may become firm and painful and turn blue or purple when thrombosed. A thrombosed hemorrhoid is hemorrhoid that has formed a clot. This clot is not dangerous and will not move around the body, but it is painful and must be drained. External hemorrhoids can be itchy and very painful, especially when passing stool. They can also form a prolapse.
Causes of external hemorrhoids
Hemorrhoids are caused by constant or repeated pressure on the rectal or anal veins. The pressure is usually caused by intense and prolonged defecation efforts. Other factors can also increase the risk of hemorrhoids, including constipation, diarrhea, lifting heavy objects, poor posture, prolonged sitting or standing, pregnancy, anal sex and obesity. Liver damage and certain food allergies can also increase the strain on the rectal veins.
Symptoms and Complications of external hemorrhoids
External hemorrhoids often cause itching, burning, or bleeding and can be painful and swollen. They are the most common cause of bleeding during defecation.
The painless emission of a small amount of very bright red blood, which can be seen in the stool or on the toilet paper, is a sign of internal hemorrhoids because the blood is only present on the surface of the stool and does not mix. If it's just a little bleeding, it's not a big problem. If this is your first time bleeding, see your doctor confirm that it is hemorrhoids. If the bleeding continues, see your doctor because the constant loss of blood can lead to anemia, a condition in which there are not enough red blood cells to provide oxygen to the tissues.
Pay attention to pain that lasts more than a week, as well as blood loss that is accompanied by weakness, dizziness, or infection. All of these symptoms should be reported to your doctor. Also see your doctor if bleeding is not caused by passing stool, and is brownish or recurring. These could be signs of a more serious disorder higher up in the colon and unrelated to hemorrhoids.
Finally, children under the age of 12 should be referred to a doctor if they have symptoms of hemorrhoids.
Diagnosis
Examinations for hemorrhoids always involve a digital rectal exam. The doctor puts a glove on and inserts a finger into the rectum to examine the hemorrhoids. This allows the doctor to determine if the hemorrhoids are external or internal, and to assess the stage of internal hemorrhoids. A blood test is not usually necessary.
An instrument called an anoscope or proctoscope allows the doctor to examine the internal hemorrhoids. The examination should also include a lifestyle interview. This will help your doctor identify risk factors and suggest changes.
Be sure to tell your doctor about :
- Your medical and family history of hemorrhoids and bowel conditions;
- Your medication history (the medications you have taken or are taking), especially if they include anti-coagulant agents (e.g. clopidogrel*, warfarin)*.
Treatment and Prevention of external hemorrhoids
A high-fiber diet and drinking large amounts of water can treat Stage I internal hemorrhoids and painless external hemorrhoids. These measures soften the stool and reduce constipation and straining. They also reduce inflammation of the veins. A number of over-the-counter creams, ointments, suppositories, and wipes can also reduce pain and inflammation in the anal area. These include topical hemorrhoidal preparations that contain local analgesics with soothing properties. Your pharmacist can help you choose an appropriate topical application. Prescription medications include cortisone-based anti-inflammatory creams.
Using a stool softener or stool expander to prevent constipation and 15-minute sitz baths 3-4 times a day can also help. A sitz bath consists of filling a container with warm water on the toilet seat. Cold compresses followed by warm compresses in the affected area can help dissolve blood clots if the hemorrhoid is external.
When hemorrhoids are more severe, medical attention may be required. External hemorrhoids can be removed or drained by a doctor under local anesthesia, using a scalpel, if they have formed a blood clot in the previous 72 hours.
Internal hemorrhoids, depending on their stage, may require procedures that can be performed either in the doctor's office or under surgery. A hardening agent is sometimes injected into internal hemorrhoids to decrease their volume and make them firmer. Stage I to III internal hemorrhoids can be tied with an elastic band. The blood supply is then cut off, and the hemorrhoid tissue eventually dies and falls off 5-7 days later. Hemorrhoids can also be destroyed with electric current, laser, heat, cold or infrared rays. These procedures may cause some discomfort.
A hemorrhoidectomy is a type of surgery performed under general anesthesia and allows for the complete removal of internal hemorrhoids. It is reserved for severe cases where other types of treatment have failed or have not been tolerated. Hemorrhoidectomy is characterized by the lowest rates of recurrence (return of hemorrhoids) but the highest rates of postoperative pain.
Here are some quick tips on hemorrhoid prevention:
- have a bowel movement as soon as the need arises because the fecal matter may harden;
- Avoid making intense efforts to defecate and do not sit on the toilet seat for too long;
- Drink at least 8 glasses of water a day;
- Eat high-fibre foods such as whole grains, vegetables, and fresh fruit - especially prunes and bran;
- Get plenty of exercises and don't sit for too long. Try to go for short walks;
- lose the extra weight you have.
No comments:
Post a Comment