They develop when the veins in the anal canal become abnormally swollen and inflamed, making them painful. Other contributing factors include pregnancy, ageing, chronic constipation or diarrhoea, natural birth, and anal intercourse. In some cases, they can also be caused by other diseases, such as liver cirrhosis. They rarely need medical treatment, unless a vein bursts, blood pools under the skin and a painful lump develops this is called a clotted or thrombosed haemorrhoid.
Internal haemorrhoids can range in size from a slight swelling under the wall of the canal to large, sagging veins that protrude from the anus. For treatment purposes, internal haemorrhoids are graded according to their size: The vein bulges and may bleed during bowel movements. The vein comes out of the anus during bowel movements, but goes back by itself.
The vein comes out during bowel movements, but doesn't go back by itself. It has to be replaced by hand. The vein protrudes from the anus at all times and cannot be replaced. It is possible for a person to have both internal and external haemorrhoids at the same time. Cause Haemorrhoids result from increased pressure on the veins in the pelvis and rectal area that causes the veins to bulge and expand.
The increase in pressure is commonly related to: Poor bowel habits — straining from long-term constipation or diarrhoea; Overweight, which often leads to straining to pass stools; Standing or sitting for long periods; Breathing improperly while lifting heavy weights inhaling rather than exhaling while pushing against the weight ; Pregnancy, which results in increased blood flow to the pelvic area; Pushing and pressure of natural childbirth Medical conditions, such as long-term chronic heart and liver disease, which causes blood to pool in the abdomen and pelvic area; Anal infections; Genetic inherited factors.
Symptoms The most common symptoms of both internal and external haemorrhoids include bleeding during bowel movements you may see streaks of bright red blood on toilet paper after you strain to have a bowel movement ; itching; and rectal pain. External and internal haemorrhoids manifest as follows: It may only feel like extra skin around the anus.
These skin tags can become inflamed, causing a feeling of pressure in the anus. They can also make it hard to keep the anal area clean, which can lead to skin irritation, itching and burning.
If a vein becomes quite large, it may cause discomfort, especially during bowel movements. The discomfort may discourage you from cleaning the anal area as well as you should, which can also lead to skin irritation.
A clotted haemorrhoid can be extremely painful, even inhibiting you from sitting or walking. The skin covering the lump may be blue because of collection of blood under the skin and shiny due to stretching of the skin. If the lump is not removed within 24 to 48 hours, the pain will gradually lessen over the following four to five days.
The skin covering the lump may break open on its own, causing mild bleeding. With good self-care, pain and bleeding will stop within two weeks. You may notice bright red streaks of blood on toilet paper after having a bowel movement or blood on the surface of stools. If you strain to pass stools, blood may spurt spraying the sides of the toilet bowl or trickle colouring the water in the toilet bowl from your anus.
You may have an uncomfortable feeling of fullness after passing stools because of bulging of the haemorrhoid in the anal canal. Haemorrhoids that are large enough to protrude from the anus grade III and IV may secrete mucus, causing mild skin irritation and itching. You may see or feel protruding haemorrhoids as moist pads of skin sticking out. It may recede into the rectum on its own or can be pushed back into place.
Very large haemorrhoids may become painful if they swell and are squeezed by the anal sphincter muscle that controls the opening and closing of the anus. At their worst, large internal haemorrhoids protrude from the anus at all times. In rare cases, the opening and closing of the anus may cut off blood supply to the swollen veins. This causes tissues inside the rectum to die, and emergency surgery is required to prevent serious damage.
Prevalence Haemorrhoids are common in both men and women. About half of the population has haemorrhoids by age Haemorrhoids are also common among pregnant women. The pressure of the foetus on the abdomen, as well as hormonal changes, causes the haemorrhoidal vessels to enlarge.
These vessels are also placed under severe pressure during childbirth. For most women, however, haemorrhoids caused by pregnancy are a temporary problem. When to see a doctor A visit to a doctor is indicated when: Rectal bleeding occurs for no apparent reason and is not associated with trying to pass stools. Rectal bleeding continues for more than one week. Stool becomes more narrow than usual. A lump near the anus gets bigger or becomes more painful. Pain or swelling due to haemorrhoids is severe.
Moderate pain lasts longer than one week after home treatment. Any unusual material seeps from the anus. Tissue from inside the body sticks out of the anus and does not return to normal after three to seven days of home treatment. Diagnosis A number of ailments that affect the anal canal, rectum, and colon large intestine can cause bleeding, discharge, itching and discomfort. Most people who have these symptoms assume they have haemorrhoids, but this is often not the case.
The purpose of a visit to the doctor is to evaluate the symptoms, rule out life-threatening conditions, and to make a diagnosis of haemorrhoids. The diagnosis is based on the following: The patient's medical and social history, including personal habits such as diet.
Visual examination of anus and rectum. Digital rectal examination, where the doctor feels inside the rectum with a lubricated gloved finger for abnormalities. With an anoscopy, the doctor uses a small, hollow lighted tube to help view internal haemorrhoids inside the anal canal and lower part of the rectum.
A proctoscopy is similar to the anoscopy, but provides a more thorough rectal examination. A faecal occult blood test may be done if internal haemorrhoids cannot be detected with a digital rectal examination or anoscopy.
This procedure may be undertaken to view the lower colon and so rule out other causes of rectal bleeding, even if haemorrhoids are evident. Further examination of the entire colon with colonoscopy, when indicated. Treatment Treatment of haemorrhoids depends on the degree of prolapse and the extent of symptoms. Home treatment and medication Lifestyle changes are an integral part of treatment and can be used by patients with all stages of haemorrhoidal disease as a preventative measure.
Some home treatment techniques and remedies for small haemorrhoids: Do not sit for long periods. Insert petroleum jelly on the inside rim of the anus to make bowel movements less painful. Stool softeners can reduce straining and constipation during bowel movements.
Be gentle when wiping after a bowel movement. If toilet paper is irritating, try dampening it first, or use cotton balls or alcohol-free baby wipes. You may prefer washing yourself and then dabbing the area dry. It is important to keep the anal area clean and regular bathing is suggested. Use soaps that contain no perfumes or dyes. Resist the temptation to scratch the area as this irritates the inflamed veins more, damages the surrounding skin and intensifies the itchiness. Ointments that contain hydrocortisone may help decrease inflammation and speed healing.
Non-prescription pain relievers and nonsteroidal anti-inflammatory medicine can help with pain and swelling. To relieve pain and itching, apply ice several times a day for 10 minutes at a time. Follow this by placing a warm compress such as a warm, damp towel on the anal area for another 10 to 20 minutes. External haemorrhoids External haemorrhoids usually do not need surgical treatment, unless an enlarged vein near the anus bursts, forming a hard and extremely painful lump under the skin thrombosed haemorrhoid.
If the pain is not too severe, stool softeners, topical pain-relieving creams and sitz baths sitting in a bathtub of warm water for 15 minutes several times a day, especially after a bowel movement may be sufficient. If pain is severe, surgical treatment may be required. If the lump is not removed within 24 to 48 hours, the pain will gradually lessen over the next four to five days.
With good self-care, pain and bleeding stop within two weeks although the lump may remain for several weeks. Internal haemorrhoids Anaesthetising creams and suppositories to reduce inflammation may relieve irritation and pain. Internal haemorrhoids that continue to bleed after a trial of home treatment or become so large that they stick out of the anus may require professional treatment.
Surgery and fixative procedures This section discusses surgery and fixative procedures for internal and external haemorrhoids. External haemorrhoids The most effective treatment for thrombosed external haemorrhoids an external haemorrhoid that causes a painful lump is to surgically drain it, as this provides immediate relief from pain.
It is best if it is removed during the first 24 to 48 hours after formation of the lump. This procedure is easily performed in the doctor's office using local anaesthetic to numb the skin.
Conservative treatment for thrombosed external haemorrhoids includesitz baths, mild analgesics, and stool softeners to relieve the symptoms. The thrombus will slowly be absorbed during the course of several weeks, the pain usually will subside after two or three days, and the mass will resolve within seven to 10 days. Surgical removal haemorrhoidectomy is only considered for external haemorrhoids when the veins are so large that they cause significant discomfort and make it difficult to keep the anal area clean.
If skin tags cause repeated problems, they can be removed surgically. Internal haemorrhoids Non-surgical treatments are used to cure most smaller grade I and II and some larger grade III internal haemorrhoids. The goal of most non-surgical procedures is to cut off the flow of blood to the enlarged vein, causing the vein to fall off and a scar to form in its place on the wall of the anal canal. These are called fixative procedures because the scar keeps nearby veins from drooping into the anal canal.
Fixative procedures include the following: