Hemorrhoids are a knot-like widenings of veins in the lower part of the anus and in the anal canal. They are a very common disease, afflicting around 70% of all people above the age of 30, more commonly found in men. Hemorrhoids can however occur even in people younger than that. Usually, people only seek medical attention only if the issues become too difficult to manage or if they suspect a more serious affliction, such as intestinal cancer.
Development of hemorrhoids
Every one of us has a venous plexus in the anal area. This carries the deoxygenated blood from the lower pelvis into further, larger veins, eventually bringing it back to the heart. Hemerrhoids develop when the mucous membrane isn't attached to the submucosa and as a result it prolapses outwards. This leads to changes in veins, which widen. Blood then tends to build up in these widened areas, which is referred to as hemorrhoids.
Risk factors for the development of hemorrhoids
Risk factors are genetic on one hand, but they are also influenced by lifestyle to a large degree. The development of mehorrhoids can be caused by an unhealthy diet, lack of exercise and sedentiary lifestyle, but also certain sports, such as cycling or horse riding. Diarrhoea also has a negative effect, since it irritates the mucous membrane.
Types and symptoms of hemorrhoids
Hemorrhoids are a very common disease, affcliting both the older and the younger. Therapy is determined by the type of the hemorrhoids. Generally, we recognize two main types of hemorrhoids, internal and external.
Internal hemorrhoids happen by widening of the veins under the anal mucosa, usually when the intraabdominal pressure increases. This happens during pregnancy, obesity, when defecating or coughing. When the intraabdominal pressure increases, the veins swell, possibly leading to bleeding or the prolapse of the venous plexus outside of the anus. These hemorrhoids tend to manifest by bleeding during or after defecation. This is followed by relief. After defecating, the bright red blood usually shows on the stool. Blood from the hemmorhoids can also be absorbed. In this case, an empty skin flap is left behind, which can refill again, creating a new hemorrhoids. Bleeding should never be underestimated, because it is not necessarily just a symptom of hemorrhoids, but could also indicate an intestinal cancer. This is why it is always necessary to try and determine the cause of bleeding. Long term bleeding from hemorrhoids can even lead to anemia.
External hemorrhoids are found on the outside of the anus. They are a bag-like dilation of the veins, they are soft, painless and visible by the naked eye. They usualy don't bleed. Problems only occur when the flow of built-up blood is prevented, most commonly during excessinal straining when defecating. In this case the built-up blood coagulates, the memmerhoids starts being obstructive and painful. In most cases it needs to be removed surgically.
Diagnosis of hemerrhoids
Every person suffering from intestinal bleeding should by examined by a doctor. He will look for the presence of hemorrhoids using a rectoscope. A rectoscope is a tube, which is inserted into the anus of the patient, allowing the doctor to see the internal hemorrhoids. Even if hemorrhoids are discovered, it is still necessary to continue with the examinations and eliminate any other possible causes of bleeding, such as intestinal cancer.
Treatment of hemorrhoids
If we suspect the presence of hemorrhoids, we should always consult a doctor, who will confirm their presence. Hemorrhoids as such do not endanger the patient's life, but they can be severely reducing the patient's life quality. The treatment is usually meant to reduce the difficulties. Generally, 3 types of treatments are used.
- Conservative treatment consists of a change in lifestyle. The patient's diet should not be irritating, should be accompanied by an adequate intake of liquids, of fiber and basic exercise. Suppositories and antiinflammatory topical agents are also reccomended. Sitz baths and diarrhoea treatments can also help.
- Ambulatory treatment are beneficial both for younger and older patients. They are painless, the patient is not stressed by anesthesia and does not require any sick leave. An ambulatory treatment is not even time intensive, lasting only around 20 seconds. The succesfulness of these treatments is up to 95%
- Surgery is indicated in more severe cases, performed in general or epidural anesthesia.