Hemorrhoids – What Is It?
Hemorrhoids are usually caused by increased pressure due to pregnancy, being overweight, or straining during bowel movements. By midlife, hemorrhoids often become an ongoing complaint. By age 50, about half the population has experienced one or more of the classic symptoms, which include rectal pain, itching, bleeding, and possibly prolapse (hemorrhoids that protrude through the anal canal). Although hemorrhoids are rarely dangerous, they can be a recurrent and painful intrusion. Fortunately, there’s a lot we can do about them.
What are Hemorrhoids?
In one sense, everyone has hemorrhoids (or piles), the pillow-like clusters of veins that lie just beneath the mucous membranes lining the lowest part of the rectum and the anus. The condition most of us call hemorrhoids (or piles) develops when those veins become swollen and distended, like varicose veins in the legs. Because the blood vessels involved must continually battle gravity to get blood back up to the heart, some people believe hemorrhoids are part of the price we pay for being upright creatures.
There are two kinds of hemorrhoids: internal ones, which occur in the lower rectum, and external hemorrhoids, which develop under the skin around the anus. External hemorrhoids are the most uncomfortable, because the overlying skin becomes irritated and erodes. If a blood clot forms inside an external hemorrhoid, the pain can be sudden and severe. You might feel or see a lump around the anus. The clot usually dissolves, leaving excess skin (a skin tag), which may itch or become irritated.
Internal hemorrhoids are typically painless, even when they produce bleeding. You might, for example, see bright red blood on the toilet paper or dripping into the toilet bowl. Internal hemorrhoids may also prolapse, or extend beyond the anus, causing several potential problems. When a hemorrhoid protrudes, it can collect small amounts of mucus and microscopic stool particles that may cause an irritation called pruritus ani. Wiping constantly to try to relieve the itching can worsen the problem.
Hemorrhoids are distended blood vessels that form either externally (around the anus) or internally (in the lower rectum).
Hemorrhoids, also called piles, are vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed; the unqualified term “hemorrhoid” is often used to refer to the disease. The signs and symptoms of hemorrhoids depend on the type present. Internal hemorrhoids are usually present with painless, bright red rectal bleeding when defecating. External hemorrhoids often result in pain and swelling in the area of the anus. If bleeding occurs it is usually darker. Symptoms frequently get better after a few days. A skin tag may remain after the healing of an external hemorrhoid.
While the exact cause of hemorrhoids remains unknown, a number of factors which increase pressure in the abdomen are believed to be involved. This may include constipation, diarrhea, and sitting on the toilet for a long time. Hemorrhoids are also more common during pregnancy. Diagnosis is made by looking at the area. Many people incorrectly refer to any symptom occurring around the anal area as “hemorrhoids” and serious causes of the symptoms should be ruled out. Colonoscopy or sigmoidoscopy is reasonable to confirm the diagnosis and rule out more serious causes.
Often, no specific treatment is needed. Initial measures consist of increasing fiber intake, drinking fluids to maintain hydration, NSAIDs to help with pain, and rest. Medicated creams may be applied to the area, but their effectiveness is poorly supported by evidence. A number of minor procedures may be performed if symptoms are severe or do not improve with conservative management. Surgery is reserved for those who fail to improve following these measures.
Approximately 50% to 66% of people have problems with hemorrhoids at some point in their lives. Males and females are both affected with about equal frequency. Hemorrhoids affect people most often between 45 and 65 years of age. It is more common among the wealthy. Outcomes are usually good. The first known mention of the disease is from a 1700 BC Egyptian papyrus.
What Do Hemorrhoids Look Like?
Hemorrhoids are clumps of dilated (enlarged) blood vessels in the anus and lower rectum. The rectum is the last area of the large intestine before it exits to the anus. The anus is the end of the digestive tract where feces leaves the body.
Sometimes hemorrhoids swell when the veins enlarge and their walls become stretched, thin, and irritated by passing stool. Hemorrhoids are classified into two general categories:
- internal, originating in the rectum;
- external, originating in the anus.
Hemorrhoids (also termed piles) have caused pain and irritation throughout human history. The word comes from Greek, “haimorrhoides,” meaning veins that are liable to discharge blood. If you’ve had a bout of hemorrhoid pain, you’re not alone. It’s estimated that three out of every four people will have hemorrhoids at some point in their lives. Even Napoleon suffered from hemorrhoids, which distracted him with severe pain during his defeat at Waterloo.
Internal hemorrhoids sit in the inside lining of the rectum and are not obvious unless they are substantially enlarged, in which case they can be felt. Internal hemorrhoids are usually painless and become apparent because they cause bleeding with a bowel movement.
Sometimes internal hemorrhoids prolapse or protrude outside the anus. If so, you may be able to see or feel them as moist pads of skin that are pinker than the surrounding area. Prolapsed hemorrhoids may hurt because the anus is dense with pain-sensing nerves. Prolapsed hemorrhoids usually recede into the rectum on their own. If they don’t, they can be gently pushed back into place.
External hemorrhoids are located underneath the skin that surrounds the anus, and are lower than internal hemorrhoids. They can be felt when they swell, and may cause
- bleeding with a bowel movement.
If an external hemorrhoid prolapses to the outside (usually in the course of passing a stool), you can see and feel it.
Blood clots sometimes form within prolapsed external hemorrhoids, which can cause an extremely painful condition called a thrombosis. If an external hemorrhoid becomes thrombosed, it can look rather frightening, turning purple or blue, and could possibly bleed.
Despite their appearance, thrombosed hemorrhoids usually are not serious, though they can be very painful. They will resolve on their own in a couple of weeks. If the pain is unbearable, your doctor can remove the blood clot from the thrombosed hemorrhoid, which stops the pain.
Everyone Has Hemorrhoids
Although most people think hemorrhoids are abnormal, everyone has them. Hemorrhoids help control bowel movements. Hemorrhoids cause problems and can be considered abnormal or a disease only when the hemorrhoidal clumps of vessels enlarge.
Hemorrhoids occur in everyone, and an estimated 75% of people will experience enlarged hemorrhoids at some point. However only about 4% will go to a doctor because of hemorrhoid problems. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.