Hemorrhoids (Piles) – Causes, Symptoms, Prevention, Types and Treatments

What are Hemorrhoids

Hemorrhoids, also spelled as haemorrhoids, is a normal structure of the human anatomy whose function is to pad the anal canal and help maintain continence.

Hemorrhoidal disease occurs when these hemorrhoidal structures, colloquially known as piles, become congested, inflamed, and move or prolapse out of the anal canal.

It is a very frequent disease in our environment (it has an approximate prevalence of 5%) and 50% of the population will suffer some symptom throughout their lives.

Generally, hemorrhoids are not serious disorders, as explained by José María Enríquez-Navascués, head of the General and Digestive Surgery Service of the Donostia University Hospital, although when they increase pathologically in size or slide outward, they cause discomforts such as itching, pain or burning.

Hemorrhoids are frequent around 45-65 years and manifest in both men and women, although during pregnancy the prevalence in women increases.

Causes of Hemorrhoids

According to the specialist, the main causes of hemorrhoids are:

  1. Constipation: Dry, hard stools from constipation are the most frequent factor that can cause hemorrhoids to appear. “Its frequency, as well as the significant defecation effort, aggravate the symptoms,” adds the specialist.
  2. Diarrhea: predisposes to the development of the disease and worsens the pre-existing hemorrhoidal disease.
  3. The existence of hereditary factors.
  4. Inadequate posture: staying many hours a day standing or sitting is detrimental to this pathology.
  5. Pregnancy: the pressure exerted by the fetus on the rectal area, in addition to the efforts made during childbirth , can cause the appearance of hemorrhoids.
  6. Long time sitting on the toilet and defecation efforts.

Symptoms of Hemorrhoids

The most frequent clinical manifestations of hemorrhoids are:

  • Rectal bleeding or bleeding through the anus: There is spotting when cleaning or dripping fresh red blood into the toilet bowl.
  • Prolapse or leakage of hemorrhoids through the anus. “Initially, the anus is reduced or reintroduced spontaneously, but over time they can be permanently left out,” says Colao García.
  • Fouling: Underwear is stained with a mucous, bloody discharge or even with faeces.
  • Itching or itching in the anal area.
  • Discomfort or pain.

Prevention of Hemorrhoids

To avoid the appearance of hemorrhoids, it is advisable to correct the causes that originate them. Some recommendations are:

  • Drink two litres of water a day to prevent constipation.
  • Avoid alcohol intake, as it impairs blood circulation making digestion difficult.
  • Reduce salt intake, since it favours fluid retention.
  • Consume a diet rich in fibre, fruits, vegetables and whole-grain products.
  • Avoid defecation effort: In case of chronic constipation, Guerra recommends consulting the specialist, since “he will give you the pharmacological guidelines and eating habits that will allow you to treat constipation while avoiding the appearance of hemorrhoids.”
  • Practice sports regularly to activate blood circulation and help improve intestinal transit.
  • Avoid making great efforts in which the abdominal area is especially important.

Types of Hemorrhoids

There are two types of hemorrhoids:

Internal Hemorrhoids

They are hemorrhoids that bleed with the stool and those that prolapse through the anus. They are not painful unless accompanied by hemorrhoidal thrombosis. There are four grades to classify them:

  • Grade I: normal hemorrhoids.
  • Grade II: Hemorrhoids that come out of the anus with the stool and reintroduce themselves.
  • Grade III: those that come out of the anus with the stool and must be reintroduced.
  • Grade IV: Internal hemorrhoids that come out through the anus and are always found on the outside. They differ from external hemorrhoids in that the latter is covered by normal skin.

External Hemorrhoids

External hemorrhoids are those that occur around the anus and that frequently accompany internal hemorrhoids or other processes such as anal fissure. External hemorrhoids do not bleed, although they can cause a feeling of heaviness and anal pain when thrombosed.

Diagnosis of Hemorrhoids

Guerra argues that “to make a proper diagnosis, the main thing is to go to a specialist in the digestive system , because many times the only symptom that can occur is bleeding, which is not only indicative of the presence of hemorrhoids, but also of other diseases more severe digestive disorders such as colon cancer. ”

Once in the consultation, the diagnosis consists initially of making a medical history with the patient’s medical history and the symptoms he presents for a subsequent manual examination by the doctor.

In cases where the hemorrhoids are not external, but internal, the specialist will prescribe a colonoscopy for confirmation of the disease.

Treatments of Hemorrhoids

Hemorrhoids can appear without symptoms. In those cases it is not necessary to follow any treatment.

Mild symptoms

In these situations, the expert at the University Hospital of Torrejón recommends treating the piles with hygienic-dietary measures:

  • Drink plenty of fluids.
  • Eat a diet rich in copious fibre in fruits and vegetables.
  • Avoid alcoholic beverages and spicy or highly spicy foods.
  • Reduce caffeine intake (coffee, tea, cola, etc.).
  • Avoid abuse of astringent medication: non-steroidal anti-inflammatory drugs, better known as NSAIDs (among which are ibuprofen and naproxen), anxiolytics and antidepressants.
  • Avoid long periods of time sitting on the toilet.
  • Clean the area with anal wipes with aloe-vera.

Moderate symptoms

To these measures can be added in case the symptoms are moderate:

  • Use of laxatives. ” The objective is to get formed stools, with a putty consistency, thus avoiding defecatory efforts,” says the specialist at the University Hospital of Torrejón.
  • Suppositories and ointments: Can be useful in acute uncomplicated cases to lubricate, reduce pain, relieve itching, reduce inflammation, protect the mucosa and promote healing. “Some may contain corticosteroids and cause side effects, so they should not be used for more than 5-7 days,” he adds.
  • Sitz baths with warm water: Recommended in cases of hemorrhoidal crisis.
  • Venotonic medication: They reduce edema by reducing bleeding through the anus (rectal bleeding) in the early stages.

Colao specifies that if there is no improvement with these hygienic-dietary measures, there are other options that include:

In the case of mild cases:

Elastic band ligation: It is based on the placement of a small elastic ring just above the hemorrhoidal group, inside the anus, which generates a fibrosis area that prevents hemorrhoid from moving to the outside.

In the most severe degrees, the specialist may choose surgical treatment:

Hemorrhoidectomy: consists of the removal of the hemorrhoidal tissue from the skin to its base, under anaesthesia.

Hemorrhoidopexy: In these cases, resection is performed using a special endoanal stapler above the base of the hemorrhoids, thus moving the hemorrhoids into the anus.

Other data of Hemorrhoids

Should you go to the doctor when they bleed?

Whenever bleeding occurs continuously with stools, the primary care physician should be consulted to assess the possible hemorrhoidal origin.

What can we do if a person is prone to hemorrhoids and spends many hours sitting down?

First, you should try to walk 5 minutes every hour and perform contraction exercises of the anus to stimulate circulation in the area.

Other measures that can help is not wearing tight clothing at the pelvic-genital area.

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