Basic Facts About Hemorrhoids

What Are Hemorrhoids?
Hemorrhoids are clumps of blood vessels (veins) in the rectum. The hemorrhoidal veins are located in the lowest area of the rectum just above the anus. Sometimes they swell when the veins enlarge and their walls become stretched, thin, and irritated by passing stool. Hemorrhoids are classified into two general categories, 1) internal, and 2) external.

Internal Hemorrhoids
Internal hemorrhoids are located higher in the inside lining of the rectum and cannot be felt unless they are substantially enlarged. They usually are painless and make their presence known by causing 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
External hemorrhoids are located underneath the skin that surrounds the anus (lower than internal hemorrhoids). They can be felt when they swell, and may cause itching, pain, or 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, they are present in everyone. It is only when the hemorrhoidal clumps enlarge that hemorrhoids can cause problems and be considered abnormal or a disease.
Although hemorrhoids occur in everyone, they can become large and cause serious proble
ms in about 4% of the general population. Hemorrhoids that cause problems are found
equally in men and women, and their prevalence peaks between 45 and 65 years of age.

What Causes Hemorrhoids?

Researchers are not certain what causes hemorrhoids. It's likely that extreme abdominal pressure causes the veins to swell by blocking the flow of blood through them. They then become susceptible to irritation. The increased pressure can be caused by obesity, pregnancy, standing or sitting for long periods, straining on the toilet, coughing, sneezing, vomiting, and holding your breath while straining to do physical labor.

Hemorrhoids and Diet

Diet is believed to have a pivotal role in causing  and preventing hemorrhoids. People who consistently eat a high-fiber diet are less likely to get hemorrhoids, while those people who prefer a diet high in processed foods are at higher risk. A low-fiber diet can cause constipation, which can contribute to hemorrhoids in two ways:

it promotes straining on the toilet; and it also aggravates the hemorrhoids by producing hard stools that further irritate the swollen veins.

What Are the Symptoms of Hemorrhoids?

The most common symptom and sign from hemorrhoids is painless bleeding. There may be bright red blood on the outside of the stools, on the toilet paper, or dripping into the toilet. The bleeding usually is self-limiting. Bleeding with a bowel movement is never normal and should prompt a visit to a health care professional. While hemorrhoids are the most common cause of bleeding with a bowel movement, there may be other reasons to have bleeding including inflammatory bowel disease, infection, and tumors.

Stages of Hemorrhoids

• First-degree hemorrhoids: Hemorrhoids that bleed, but do not prolapse.
• Second-degree hemorrhoids: Hemorrhoids that prolapse and retract on their own (with or without bleeding).
• Third-degree hemorrhoids: Hemorrhoids that prolapse but must be pushed back in by a finger.
• Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be pushed back in the anal canal. Fourth-degree hemorrhoids also include hemorrhoids that are thrombosed (containing blood clots) or that pull much of the lining of the rectum through the anus.

How Are Hemorrhoids Diagnosed?

Most individuals who have hemorrhoids discover them by either feeling the lump of an external hemorrhoid when they wipe themselves after a bowel movement, note drops of blood in the toilet bowl or on the toilet paper, or feel a prolapsing hemorrhoid (protruding from the anus) after bowel movements. By the history of symptoms, the physician can be diagnosed on the basis of a careful examination of the anus and anal canal. Although the physician should try his or her best to identify the hemorrhoids, it is perhaps more important to exclude other causes of hemorrhoid-like symptoms that require different treatment such as anal fissures, fistulae, perianal (around the anus) skin diseases, infections, and tumors.

Hemorrhoid Treatment - Diet

It is recommended that individuals with hemorrhoids soften their stools by increasing the fiber in their diets. Fiber is found in numerous foods including fresh and dried fruits, vegetables, grains, and cereals. Generally, 20 to 30 grams of fiber per day is recommended, whereas the average American diet contains less than 15 grams of fiber. Supplemental fiber (psyllium, methylcellulose, or calcium polycarbophil) also may be used to increase the intake of fiber. Stool softeners and increased drinking of liquids also may be recommended. Nevertheless, there is no strong, scientific support for the benefits of fiber, liquids, or stool softeners.

Hemorrhoid Treatment – Over-the-Counter Medications

Products used for the treatment of hemorrhoids are available as ointments, creams, gels, suppositories, foams, and pads. Ointments, creams, and gels - when used around the anus - should be applied as a thin covering. When applied to the anal canal, these products should be inserted with a finger or a "pile pipe." Pile pipes are most efficient when they have holes on the sides as well as at the end. Pile pipes should be lubricated with ointment prior to insertion. Suppositories or foams do not have advantages over ointments, creams, and gels.

Hemorrhoid Treatment – Warm Sitz Baths

Sitting in a few inches of warm water three times a day for 15 to 20 minutes (sitz bath) may help decrease the inflammation of the hemorrhoids. It is important to dry off the anal area completely after each sitz bath to minimize moisture that irritates the skin surrounding the anus.

Hemorrhoid Treatment – Stool Softeners

Stool softeners may help, but once hemorrhoids are present, even liquid stools may cause inflammation and infection of the anus. Your health care professional and pharmacist are good resources for discussing their use.

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