Hemorrhoids

What causes internal hemorrhoids?

Internal hemorrhoids occur when veins inside the rectum become swollen and inflamed. This can happen for several reasons, including straining during bowel movements (often due to constipation), a low-fibre diet, chronic diarrhea, pregnancy, sitting for long periods of time, and age, as the tissues that support the rectal veins weaken and stretch over time. These factors increase the risk but don't necessarily cause hemorrhoids in every case.

What causes external hemorrhoids?

External hemorrhoids occur when veins near the anus become swollen and inflamed. Contributing factors include:

• Straining during bowel movements due to constipation
• Pregnancy — increased pressure and hormonal changes
• Obesity — excess weight puts pressure on the veins around the anus
• Sitting for long periods of time
• Aging — supporting tissues weaken and stretch
• Straining during heavy lifting or exercise

Diagnosis

Hemorrhoids can be diagnosed through a physical examination by a healthcare provider, which usually includes a visual inspection of the anal area and may include a digital rectal exam. If needed to rule out other conditions with similar symptoms, additional tests may include:

• Colonoscopy: a thin, flexible tube with a camera examines the entire length of the colon.
• Anoscopy: a small, rigid tube with a camera examines the lower part of the rectum.
• Sigmoidoscopy: similar to a colonoscopy but examines only the lower colon.
• Barium enema: an X-ray test using contrast material to highlight the colon and rectum.

Reference: Hopkins Medicine

Who is at risk?

Some factors that may increase the risk of developing hemorrhoids include age, genetics, chronic constipation or diarrhea (straining puts pressure on rectal veins), pregnancy, obesity, a sedentary lifestyle, and a poor diet low in fibre, which can lead to constipation and straining.

Symptoms

Symptoms can vary depending on severity and may include pain or discomfort around the anus, bleeding during bowel movements (bright red blood on toilet paper, in the bowl, or on the stool), swelling or a noticeable lump, leakage of feces in severe cases, itching or irritation, painful bowel movements, and mucous discharge.

Treatment

Treatment depends on the severity of the condition and the symptoms being experienced. The goal is to relieve symptoms and improve overall comfort:

1. Home remedies: increasing water and fibre intake, avoiding straining during bowel movements, and taking warm sitz baths.
2. Over-the-counter medications: creams, ointments, or suppositories containing hydrocortisone, witch hazel, or lidocaine.
3. Medical procedures: rubber band ligation, sclerotherapy, infrared coagulation, or surgery, if home remedies and OTC medications aren't effective.
4. Prescription medications: prescription-strength creams or ointments, or medications to reduce inflammation and pain.

While hemorrhoids are generally not a serious medical condition, persistent bleeding, significant pain, or other concerning symptoms warrant a conversation with a healthcare provider to rule out other causes.

Lifestyle changes to prevent hemorrhoids

1. Eating a high-fibre diet: whole grains, fruits, vegetables, and legumes help prevent constipation.
2. Drinking plenty of water to stay hydrated and support bowel function.
3. Exercising regularly to improve bowel function and overall health.
4. Avoiding straining during bowel movements — take your time, and avoid holding your breath.
5. Taking breaks from sitting: stand up and move around periodically.
6. Practicing good hygiene: gently clean the anal area with mild soap and warm water after bowel movements.
7. Avoiding excessive use of laxatives: use sparingly and only under a healthcare provider's guidance.

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