Hemorrhoids

Hemorrhoids (AmE), are varicosities or swelling and inflammation of veins in the rectum and anus.

Types and symptoms of hemorrhoids

Direct view of hemorrhoid seen on sigmoidoscopy

Prevalence

Hemorrhoids are common. It is estimated that approximately one half of all Americans have had this condition by the age of 50, and that 50% to 85% of the worlds population will be affected by hemorrhoids at some time in their life. However, only a small number seek medical treatment. Annually, only about 500,000 people in the U.S. are medically treated for hemorrhoids, with 10 to 20% of them requiring surgeries.

Causes

The causes of hemorrhoids include genetic predisposition (weak rectal vein walls and/or valves), straining during bowel movements, and too much pressure on the rectal veins due to poor muscle tone or poor posture. Hemorrhoids may also result from portal hypertension because of the portacaval anastomoses. Anal sex can also stress the anus particularly if too little lubricant is used (vaginal sex is self lubricating) and cause rectal wall strain. Hemorrhoids are also linked to sitting for prolonged periods of time.[1]

Additional factors that can influence the course of hemorrhoids (mostly by increasing rectal vein pressure), especially for those with a genetic predisposition, are obesity and a sedentary lifestyle.

Constipation, chronic diarrhea, poor bathroom habits, pregnancy, postponing bowel movements, and fiber-deprived diet may be associated with bowel movement and straining, but not all of these have been conclusively proved to cause hemorrhoids.

Squatting

Using a squat toilet has been hypothesised to reduce straining and therefore reduce the occurrence of hemorrhoids. However, the medical research into this subject is scarce, and there has been no definite proof for this hypothesis. Hemorrhoids are very rare in nations where people squat to defecate, but this epidemiological argument doesn't necessarily prove a causal relationship.

Dehydration can cause a hard stool or chronic constipation which can lead to hemorrhoidal irritation. An excess of lactic acid in the stool, a product of excessive consumption of milk products such as cheese, can cause irritation and a reduction of consumption can bring relief. Vitamin E deficiency is also a common cause.

Food

Excessive alcohol or caffeine consumption can cause diarrhea which in turn can cause hemorrhoidal irritation.

Food considered "probiotic," such as yogurt with active culture, may help keep the gut functioning normally and thus help prevent flare-ups.

Prevention

Prevention of hemorrhoids includes drinking more fluids, eating more dietary fiber, exercising, practicing better posture, and reducing bowel movement strain and time. Hemorrhoid sufferers should avoid using laxatives and should strictly limit time straining during bowel movement. Wearing tight clothing and underwear will also contribute to irritation and poor muscle tone in the region and promote hemorrhoid development. Some sufferers report a more comfortable experience without underwear or wearing only very lightweight panties, etc.

Straining can be lessened by defecating in a standing position, knees slightly bent. This position seems to use the muscles of the abdomen to expel feces preventing a strain on the anus. Fluids emitted by the intestinal tract may contain irritants that may increase the fissures associated with hemorrhoids. Washing the anus with cool water and soap may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluid. Kegel exercises for the pelvic floor may also prove helpful.

Examination

After visual examination of the anus and surrounding area for external or prolapsed hemorrhoids, a doctor would conduct a digital examination. In addition to probing for hemorrhoidal bulges, a doctor would also look for indications of rectal tumor or polyp, enlarged prostate and abscesses.

Visual confirmation of hemorrhoids can be done by doing an anoscopy, using a medical device called an anoscope. This device is basically a hollow tube with a light attached at one end that allows the doctor to see the internal hemorrhoids, as well as polyps in the rectum.

If warranted, more detailed examinations, such as sigmoidoscopy and colonoscopy can be performed. In sigmoidoscopy, the last 60cm of the colon and rectum are examined whereas in colonoscopy the entire bowel is examined. A pathologist will look for dilated vascular spaces which exhibit thrombosis and recanalization.

Treatments

Treatments for hemorrhoids vary in their cost, risk, and effectiveness. Different cultures and individuals approach treatment differently. Some of the treatments used are listed here in increasing order of intrusiveness and cost.

Temporary relief

For many people, hemorrhoids are mild and temporary conditions that heal spontaneously or by the same measures recommended for prevention. There is no medicine that will cure hemorrhoids, but local treatments such as warm sitz baths, using a bidet, extendable showerhead, cold compress, or topical analgesic (such as Nupercainal), can provide temporary relief. Consistent use of medicated creams (such as Anusol and Preparation H) during the early stages of a hemorrhoid flare-up will also provide relief and may stave off further development and irritation. However, creams containing steroid preparations weaken the skin and may contribute to further flare-ups. Keep the area clean and dry, with some lubrication provided by hemorrhoidal creams or a lubricant, such as Surgi-lube or petroleum jelly. Suppositories can also relieve the symptoms.

Surgical Treatment