Definition of hemorrhoids
Hemorrhoids are swollen veins in the last part of the rectum. They can develop under the skin around the anus. Internal hemorrhoids are not visible and usually cause relatively little discomfort. Hemorrhoids can also protrude from the anus; these are referred to as external hemorrhoids. These hemorrhoids can become inflamed, making them more sensitive, more likely to bleed and more likely to form blood clots. On average, half of all people have experienced hemorrhoids by the age of 50.
Symptoms of hemorrhoids
Bleeding during bowel movements is the most common symptom of hemorrhoids. However, this bleeding can also occur with other conditions, such as colorectal (colon) and anal cancer. Consult your doctor if you notice blood loss. Other symptoms of hemorrhoids include:
- Small amounts of bright red blood noticed on toilet paper or in the toilet bowl
- Irritation and/or increased bleeding when straining
- Itching
- Irritation in the anal area
- Discomfort caused by swelling in or around the anus
- An uncomfortable feeling, including while sitting
- Painful passage of stool
- Inflammation around the anus
Note: Black or very dark, tarry stools, blood clots or blood mixed with the stool are not symptoms of hemorrhoids. These signs may indicate bleeding in the digestive tract. Consult your doctor if you experience these symptoms.
Causes of hemorrhoids
Factors that can cause hemorrhoids include:
- Increased pressure
- Straining during bowel movements
- A sedentary occupation
- Sitting on the toilet for long periods
- Chronic diarrhea or constipation
- Obesity
- Pregnancy
- Anal sex
- A low-fiber diet
- Older age. As we age, the tissues that support the veins in the rectum and anus can weaken and stretch further.
Diagnosis
There are several ways to determine whether symptoms are caused by hemorrhoids:
- Inspection: a doctor can determine whether you have external hemorrhoids by examining the anus.
- Rectal examination: the doctor can use a gloved, lubricated finger to feel inside the rectum for swelling.
- Proctoscopy: using a proctoscope, a specialist can look inside the rectum and examine the final part of the colon and rectum.
- Colonoscopy: this is an internal examination of the entire colon that may be performed for chronic gastrointestinal complaints; see the inflammatory markers test.
Treatment of hemorrhoids
Hemorrhoids can be treated with medication or surgery.
Treating hemorrhoids with medication
For mild discomfort from hemorrhoids, creams, ointments or suppositories can be tried. These products may contain ingredients such as witch hazel or hydrocortisone, which can temporarily reduce pain and itching. For mild pain, swelling or inflammation, a warm bath or sitz bath may help relieve symptoms. After bathing, gently dry the area with a hair dryer. Do not use dry toilet paper. Also avoid soap, scented toilet paper and wipes containing alcohol.
Surgical treatment
Hemorrhoids can be surgically removed in several ways:
- Incision. Blood clots in an external hemorrhoid can be removed through a simple incision.
- Rubber band ligation. The doctor places one or two small rubber bands around the base of a hemorrhoid to cut off its blood supply. Rubber band ligation is effective for many people.
- Shrinking. Coagulation techniques are performed using laser or infrared light. The heat causes small areas of bleeding. This can cause the hemorrhoids to harden and shrink.
- Surgical removal. A so-called hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. Most people experience some pain after the procedure.
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