August 2014


Hemorrhoids (Piles)

Varicose of the veins are enlarged vein in the lower rectum or anus. When these enlarged veins are within the rectum they are referred to as internal hemorrhoids, when they are outside of the rectal opening they are generally called, external hemorrhoids. When hemorrhoids are painful it is generally because they are inflamed and/or thrombosed (blood has clotted in the vein and caused a blockage of the flow of blood through the vein). Hemorrhoids have a tendency to bleed when scraped or overstretched during a bowel movement.


What Causes Hemorrhoids and How Often Do the Occur?

The exact process which causes hemorrhoid to form is unknown, but it is believed to be associated with increased pressure within the veins of the rectum. This causes congestion in the hemorrhoidal veins within the rectum and anus. This increased pressure has been attributed to straining when having a bowel movement. Certain occupations which require prolonged standing or sitting, pregnancy, and chronic constipation are commonly associated with increased risk of hemorrhoids.

Hemorrhoids occur both in adults and children, and are treated as a normal finding when they are not creating a problem. Symptoms such as pain, bleeding, and protrusion of the hemorrhoids are most commonly seen in adults between the ages of 20 and 50 years of age.


What is the Process By Which Hemorrhoids Cause Problems?

Technically, a hemorrhoid is formed when a portion of the vascular mound of the hemorrhoidal venous plexus weakens and pushes away from the wall of the rectum. As we stated above this usually occurs after they have been subjected to an increase of pressure in the veins over a period of time. If the blood flow to the hemorrhoid is limited long enough they are ultimately subject to breaking down, ulceration, infection or bleeding.

Internal hemorrhoids begin above the opening of the anus, within the rectum. If they become large enough to protrude from the anus, they become squeezed, irritated and painful. Small internal hemorrhoids may bleed with bowel movements. External hemorrhoids appear outside the anal opening. They are usually not painful, and bleeding does not occur unless a hemorrhoidal vein breaks or becomes blocked (thrombosis).


What are some of the Symptoms Associated with Hemorrhoids?

The most common symptoms associated with hemorrhoids are pain, bright red bleeding into the toilet or on the toilet tissues following defecation. Generally, a rectal skin tag (a fleshy piece of skin) may be present hanging out of or from below the rectum. When strangulation or thrombosis of a hemorrhoid occurs severe pain is not unusual. Often there is increased production of mucous or slimy white discharge from the hemorrhoids.


What are the Complications Associated with Hemorrhoids?

The most common complication is strangulation, thrombosis, or ulceration and swelling of the hemorrhoid. In rare cases, severe bleeding may occur and lead to anemia. On occasion, bleeding can be extremely heavy and lead to a need for blood transfusion.


What if Any Diagnostic Tests are Needed to Diagnose Hemorrhoids?

Hemorrhoids are easily diagnosed by direct visualization of the hemorrhoids, rectal examination or by using an anoscope or tool to look up into the rectum.







How are Hemorrhoids Treated?

1. General Measures:

Often a high-fiber diet, adequate fluids; warm Sitz baths; and using of wet wipes (witch hazel pads) instead of toilet paper can allow the hemorrhoids to heal and decrease discomfort.


2. Drugs:

Discomfort may be decreased by using topical anesthetic or ointments for pain; the use of surface medication to lubricate the rectum to reduce irritation of having a bowel movement; stool softeners to decrease constipation; pain medication; hydrocortisone ointment or rectal suppositories with or without hydrocortisone.


3. Surgery:

Injection of the hemorrhoids (sclerotherapy), is often used to eliminate bleeding hemorrhoids; rubber band ligation for protruding, nonreducible internal hemorrhoids often require a hemerrhoidectomy. The tying off of the hemorrhoids is increasingly the preferred treatment. It is simple, effective, and does not require anesthesia. The hemorrhoid is grasped with a forceps and a rubber band is slipped over the enlarged part, causing the tissue to die and the hemorrhoid to fall off, usually within 1 week.



Hemorrhoids occur commonly. They are generally not dangerous, but they can be painful and can lead to loss of time from work. While bleeding can be a problem, more often it is physically much less of a problem than it is emotionally. The fear associated with bleeding from the rectum is often much worse then the actual consequences of the bleeding itself.

Constipation is the main cause of hemorrhoids and can be controlled and reduced by adequate fluid intake (8 to 10 eight ounce glasses of water or other fluids a day), high fiber diet, regular pattern for having bowel movements. Early treatment and conscientious attention to reducing constipation can make hemorrhoids as infrequent as possible.