HemorrhoidsHemorrhoids: Causes, Symptoms, Types, Stages and Treatments

Commonly asked questions about hemorrhoids:

What are Hemorrhoids?

Hemorrhoids are swollen veins in the anus or lower rectum, similar to varicose veins. These may result from straining during bowel movements or from increased pressure on these veins during pregnancy. They may be located inside the rectum, or may develop under the skin around the anus.

What are the Symptoms of Hemorrhoids?

According to MayoClinic, signs and symptoms of hemorrhoids include but are not limited to:

  • Itching or irritation in the anal region
  • Pain or discomfort
  • Swelling around the anus
  • A lump near the anus, which may be sensitive or painful
  • Painless bleeding during bowel movements (similar to spotting)

The symptoms experienced tend to depend on the hemorrhoids’ location.

Internal Hemorrhoids

These lie inside the rectum. One cannot usually see or feel them, as they rarely cause discomfort. Straining or irritation, however, can push an internal hemorrhoid through the anal opening, which can then damage its surface and cause it to bleed.

External Hemorrhoids

These hemorrhoids are found under the skin around your anus. When irritated, they can itch or bleed.

Thrombosed Hemorrhoids

Sometimes blood may pool in an external hemorrhoid and form a clot that may result in severe pain, swelling, inflammation, and a hard lump near the anus.

What are the Risk Factors of Hemorrhoids?

Although the direct cause for hemorrhoids is unknown, these lifestyle conditions can increase the risk for developing them:

  • Alcoholism
  • Anal intercourse
  • Chronic diarrhea or constipation
  • High in fat and low in fiber diet
  • Obesity
  • Jobs that require sitting or standing for long periods
  • Lack of physical activity
  • Loss of pelvic floor muscle tone due to age, pregnancy, childbirth, or surgery.
  • Severe heart or liver disease

What Causes Hemorrhoids?

Veins around the anus are susceptible to stretching under pressure and may bulge or swell. Swollen veins (hemorrhoids) can develop from increased pressure in the lower rectum due to:

  • Straining during bowel movements
  • Sitting for long periods of time on the toilet
  • Chronic diarrhea or constipation
  • Obesity
  • Pregnancy
  • Anal intercourse
  • Low-fiber diet

What are the Types of Hemorrhoids?

Hemorrhoids can be internal or external, meaning inside the rectum or outside the anus. Internal hemorrhoids can prolapse, resulting in their appearance outside the body. External hemorrhoids may become thrombosed, meaning blood vessels within them have broken, causing them to appear blue or purple.

Internal Hemorrhoids

Generally recognized by bleeding, internal hemorrhoids are far enough inside the rectum to be invisible. Because there are no nerve endings far within the rectum, one also cannot feel them. These types of hemorrhoids do not require much treatment, and usually heal on their own.

Prolapsed Hemorrhoids

A prolapsed hemorrhoid can leave the rectum and protrude out of the body. These put pressure on the nerve endings at the anus and can be very painful. If you believe you may have prolapsed hemorrhoids, the easiest way to discover them is by their feel and appearance: soft and puffy pads of skin that look pinker than that of the anus. Often these will recede back in the anus, or may be pushed gently back.

External Hemorrhoids

These hemorrhoids are generally outside of the anus and can be seen or felt. These are most commonly treated with pain medications, as they are painful and very uncomfortable. The only reason these can be felt is because the anus has ringed sensitive nerve endings and are often rubbing together with the exterior hemorrhoids. Treatments like over-the-counter medications or herbal remedies can provide some pain relief to allow the hemorrhoid to recede on its own.

Thrombosed Hemorrhoids

This type of external hemorrhoid is one that has prolapsed and formed a blood clot surrounding the anus. Fortunately, minor thrombosed hemorrhoids resolve themselves after a few weeks, and patients may be able to just wait it out. These are the most apparent as they appear swollen and may turn purple or blue. Their appearance is not indicative of any serious health concern, although it is best to avoid irritation and keep the area as clean as possible.

What are the Stages of Hemorrhoids?

Stages of hemorrhoids are used to describe any pain or discomfort, the location of the hemorrhoid, and potential treatment options.

  • Stage 1: Rectal bleeding is a usual characteristic of eliminating solids in the beginning stage of hemorrhoids. This bleeding can occur because of pushing during elimination or inadequate fiber intake, however, it is usually not suggestive of a major problem.
  • Stage 2: In stage 2, hemorrhoids have begun to prolapse and may bleed. Generally, they will retract to their rectal cavity on their own. Although there may be some discomfort, the appearance of rectal bleeding, while alarming, is often not dangerous.
  • Stage 3: The hemorrhoid has externally prolapsed and can cause some pain. However, it may respond to gently massaging it back into the rectum. In some cases when it is clean or left alone, the hemorrhoid may simply go back into the rectum on its own.
  • Stage 4: The most serious internal hemorrhoids; these cannot be manually reinserted into the rectum, and are most likely to become thrombosed. These are especially painful and require treatment through herbal remedies.

What is Used to Treat hemorrhoids?

Treatments consist of diet modifications and laxatives. A high-fiber diet can be effective, along with over-the counter- medications, and in some cases, a removal procedure from a doctor.

Medications Include:

  • Steroid: Modifies or stimulates hormone effects, reduces inflammation or promotes tissue growth and repair.
    • Hydrocortisone
  • Anesthetic: Blocks pain at and near the site where it is given or along a blocked nerve.
    • Lidocaine
    • Pramoxine
    • Benzocaine
  • Dietary Supplement: Works alone or in conjunction with other treatments to promote health.
    • Zinc (Galzin)

Medical Procedures Include:

  • Cauterization: Burning or freezing a part of the body to remove tissue or to stop bleeding.
  • Rubber band litigation: Tying off a dilated or bleeding blood vessel with a rubber band to block its blood supply. This then causes the hemorrhoid to dry and fall off.
  • Freezing: Using extreme cold surgery or medical equipment
  • Sclerotherapy: Injecting salt water solution into abnormal blood vessels or tissues which then causes them to collapse and fade.
  • Stapled Hemorrhoidopexy: Surgical removal or enlarged hemorrhoids. The remaining tissue is then stapled back into place.

How do I Prevent Hemorrhoids?

The best way to prevent hemorrhoids is to keep stools soft, so they pass easily. These further options can also be helpful for prevention:

  • High fiber foods
  • Drink plenty of fluids
  • Consider fiber supplements
  • Don’t strain
  • Exercise
  • Avoid long periods of sitting

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