Hemorrhoids

Cause

Hemorrhoids are caused by increased pressure in the veins of the anus or rectum. This pressure makes the blood vessels expand and bulge. The following factors may contribute to an increased pressure:

• Repeated excessive pressing during defecation.
• Sitting on the toilet for long periods, so the pelvic floor muscles become fatigued.
• Chronic (prolonged) diarrhea, chronic constipation or irregular bowel movements.
• Overweight.
• Age: when getting older, blood vessels wear off and weaken.
• Anal sex.
• Anal infections.
• Pregnancy and childbirth.
• Frequent heavy lifting.
• Too much sedentary work: moving improves intestinal peristalsis, sitting slows down the peristalsis.
• Coughing a lot: coughing increases pressure on the blood vessels around the anus.
• Hereditary factors: hemorrhoids are more common in some families.

Hemorrhoids are not contagious.

Symptoms

Whether hemorrhoids cause symptoms or not, depends on the size and location of the hemorrhoids. The size of the hemorrhoids can range from a protrusion as small as a fingernail to one as big as a golf ball.
The most common signs and symptoms are:

• Itch, pain or a burning sensation.
• Fresh, bright red blood in the stool; the hemorrhoid often gets slightly damaged by pressing, causing blood in the stool.
• Discharge: the hemorrhoid doesn’t close the anus entirely then, so some discharge can flow along the hemorrhoid.
• A visible swelling around or in the anus.
• The feeling that not all stool has gotten out from the intestines.

Sometimes, hemorrhoids cause no symptoms at all.

Diagnosis

The diagnosis of hemorrhoids can usually be based on the medical history, symptoms and physical examination. Upon physical examination, the doctor will perform a rectal examination. The doctor feels gently with a finger into the rectal canal to look for any defects. If necessary, additional internal inspection can take place in the form of a proctoscopy, colonoscopy or sigmoidoscopy.

Treatment

A high-fiber diet, adequate fluid intake, sufficient exercise and healthy toilet behavior will reduce the symptoms within a few days and cause the swelling to disappear within a few weeks. If symptoms persist, hemorrhoid ointment or suppositories may help. When constipation symptoms last, the doctor may prescribe a drug to soften the stool.
For a painful thrombosed hemorrhoid, the doctor may relieve the pain by removing the clot. This is done by making a small cut in the hemorrhoid, under local anesthesia. In case of complications or persistent problems, there are other treatment options:

• Ligation. A small rubber band is applied around the base of the hemorrhoid. The band closes off the blood supply to the hemorrhoid, which dies and falls off without pain within a couple of days.
• Sclerotherapy. A chemical solution is injected around the blood vessels to let the hemorrhoid shrink.
• Electrical, laser or infrared coagulation. Heat is applied to shrink or burn away the hemorrhoids.
• Hemorrhoidectomy. The surgical removal of the hemorrhoid. Usually, the doctor suggests this option in case of excessive bleeding, when hemorrhoids are very large or if none of the other treatments have been effective. Hemorrhoidectomy is the most effective and most comprehensive way to remove hemorrhoids.

Prognosis

The prognosis of hemorrhoids is generally good, provided they are treated in time. In case of complications, such as infection, clot, sudden severe pain around the anus, fever and repeated blood in the stool, immediate contact with the doctor is required.

Considerations

Constipation and increased pressure on the anus should be prevented:

• Eat healthy, varied and high-fiber food for good bowel function and a soft and smooth stool. Fibers are especially found in fruits, vegetables and whole-wheat products.
• Drink sufficient fluids every day. When using high-fiber food, it is recommended to drink extra. Fibers need fluid to work properly.
• Get plenty of exercise and take care of a healthy weight.
• Provide healthy toilet habits. When feeling urge, it’s important to go to the toilet immediately. Don’t push hard when there is no urge. Good posture on the toilet is also important: somewhat bent over with a footrest under the feet.
• Ensure good hygiene. When you suffer from hemorrhoids, wash the anus with lukewarm water after bowel movements. Then pat the anus dry. Using soap or perfumed toilet paper can irritate and worsen itch. A warm bath may help against itch and pain.

Facts

• The term ‘hemorrhoids’ is derived from the Greek words haem (blood) and rhoos (flow, current).
• The prevalence of hemorrhoids is 5%.
• Especially people over 50 years suffer from hemorrhoids.
• Women are more likely to have hemorrhoids than men.