What are hemorrhoids?
By hemorrhoids the veins around the anus or in the lower rectum are swollen and inflamed.
Hemorrhoids are either inside the anus (internal) or under the skin around the anus (external).
Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching (pruritus ani), have similar symptoms and are incorrectly referred to as hemorrhoids.
Hemorrhoids are very seldom dangerous or life threatening. In many cases, hemorrhoidal symptoms will go away within a few days. but they may become persistent or often reappearing.
External and internal hemorrhoids
Hemorrhoids inside the rectum and hemorrhoids at or around the rectal opening cause different symptoms:
Symptoms of internal Hemorrhoids- Bright red blood in your stool and on the toilet paper. However, bleeding from the rectal opening may also be due to more serious diseases, and should be examined by a doctor.
Symptoms of external Hemorrhoids- Itching and burning and sometimes even pain and swelling.
Symptoms of hemorrhoids
An always present symptom of hemorrhoids is swelling of one or more blood vessels around the anal opening, in the opening, or in the rectal amupulla further inside. The ampulla is the terminal part of the rectum. The swelling can be a soft painless lump or be hard and painfull. If a person does not have other symptoms than soft swelling, he may not be avare of his hemorrhoids without examining his rectal area or anus with a finger or a mirror.
There may also be hard lumps in the anal region resulting from blood coagulated in the swollen vein, which is called a thrombosed hemorrhoid.
Hemorrhoids can get infected and thereby become inflamed. The inflammation will cause extra swelling.
Hemorrhoids often cause itching, especially when inflamed. But rectal or anal itching is not allways due to hemorrhoids.
The swollen hemorrhoids can rupture, emptying its content and bleed.
The tears from a ruptured hemorrhoid can be bleeding for an extended time. Bleeding is therefore an important symptom of hemorrhoids. The blood is freshly red. If the blood comming out is not red, it can originate further up in the intestines and are caused by other diseases, sometimes cancer or inflammations.
When healing, the rupture may leave behind itself permanent scarrings or constrictions. The scars can often be felt as small permanent hard or sharp lumps or protrutions.
The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl.
An internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful, which is called as a protruding hemorrhoid.
A swollen protruded or external hemorrgoid feels like a ball residing in the rectal area between the buttocks.
In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.
Once the body tissue has been damaged, it may not heal. This is why people with hemorrhoids can't seem to get rid of the itching and the blood on the toilet paper. One must treat the hemorrhoids to aid in the healing process.
Doctors sometimes employ a grading system for internal hemorrhoids.First-degree hemorrhoids are bleeding, but not protruding. Second-degree hemorrhoids prolapse through the anus by pressure but retract themselves again. Third-degree hemorrhoids prolapse but must be pushed back again. Fourth-degree hemorrhoids prolapse and are impossible to push them back again.
What causes hemorrhoids
Hemorrhoids may result from factors giving a over-pressure in the colon and rectum such as
- Lifting heavy weights
- Straining when having bowel movements
- Bad habits of eating - too little fibre in the diet
- Weak pelvic muscles
- Too little fluid Intake
- Food Allergies
- Chronic constipation or diarrhea
- Pregnancy
- Use of too great force during anal intercource
The pressure of the fetus in the abdomen, as well as hormonal changes, cause the hemorrhoidal vessels to enlarge. These vessels are also placed under severe pressure during childbirth. For most women, however, hemorrhoids caused by pregnancy are a temporary problem.
Conditions weakening the walls of the veins also contribute to hemorrhoids, for example: Aging, food allergy and infections.
Since over-weight and obesity increases the weight of the mass in the stomack area, this condition will also increase the abdominal pressure and contribute to hemorrhoids.
The prevalence of hemorrhoids
Hemorrhoids are very common in both men and women. 33% have the problem before the age of 50, and about half of the population have hemorrhoids by age 50. Hemorrhoids are also common among pregnant women.
Natural prevention of hemhorroids
The best way to prevent hemorrhoids is to avoid elevated pressure from an over-filled colon, to avoid pressure from straining to get hard stool out, and prevent injury to the rectal opening from hardened stool.
This is achieved by measures that give the bowel content a soft consistency, but not too soft, and measures to stimulate the vigour of the bowel so it empties regularly. Right stool consistency and necessary bowel vigour is achieved by a combination of measures:
- Drinking enough water: Too little water makes the stool hard and difficult to pass.
- Consuming the right amount of fat, not too little and not too much. Some fat in the bowel content makes the stool softer and smoother so it passes easily. The fat you consume should idelly be from a blending of sources like oilve oil, rape oil, fish, soy oil, nuts, sunflower seeds, almonds and the like. Then you get healthy fat and all the essential fatty acids you need.
- Consuming enough fibre in the diet: Fibre stimulates the bowel movement. It also capture water and swell, so that the bowel content gets the right wolume and consistensy. Good sources of fiber are whole grain or cereals, fruit and vegetables.
- Regular physical exerecise: Exercise and movement stimulate the bowel to work more efficiently. Regular daily walking is often enough to give the wanted effect.
- To empty the bowels as soon as possible after the urge occurs, also helps reduce prolonged pressure.
- To eat at regular intervals 4 times a day, and not to over-eat. - To take good time when eating and chew the food well. This way the food will be easy to handle for the intestines and the bowel content will get a regular consistence.
- Using a squatting position when emptying the rectum and bowel may help to prevent and cure hemorrhoids. This position helps to empty the bowel better and with less straining. People living in areas where one uses this defecation position have much less hemorrhoids than people in western countries. Diagnosis of hemhorroids
A thorough evaluation by the doctor is important by bleeding from the rectum or blood in the stool. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.
The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.
The rectum may be examined closer with an anoscope, a hollow, lighted tube useful for viewing internal hemorrhoids, or an optical device, proctoscope, useful for more completely examining the entire rectum.
If other causes of gastrointestinal bleeding is suspected, the doctor may examine the rectum and lower colon (sigmoid) with sigmoidoscopy or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures by the use of lighted, flexible tubes inserted through the rectum, furnished with bundles of optical fiber to carry the internal picture to the doctors eye.
Diagnosis of hemhorroids
A thorough evaluation by the doctor is important by bleeding from the rectum or blood in the stool. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.
The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.
The rectum may be examined closer with an anoscope, a hollow, lighted tube useful for viewing internal hemorrhoids, or an optical device, proctoscope, useful for more completely examining the entire rectum.
If other causes of gastrointestinal bleeding is suspected, the doctor may examine the rectum and lower colon (sigmoid) with sigmoidoscopy or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures by the use of lighted, flexible tubes inserted through the rectum, furnished with bundles of optical fiber to carry the internal picture to the doctors eye.
How to cure hemorrhoids - some general facts
To cure hemorrhoids it is først
necessary to stop the inflammation and infection and make swollen hemorrhoids
shirink. The successful treatment of the infection and the inflammation
will itself help tho shrink the swallen hemorrhoids. Another necessary means to
get the swallen tissue shrink is to alleviate the over-pressure in the stomach
that makes an excessive pressure in the swalllen blood vessels. Regulating the
stomach functions and the bowel movevents to normal patterns will take away the
excessive pressure. Without these basic measures, the problem will not get away,
even if a henorrhoid is taken away by for example surgery.
Then one mist bring back the
tissue to normal structure. The best way to achieve this is by stimmulating the
tissue in the blood vessels and the surroundings to heal by itself. When the
infections, swellings and over-pressure have been taken care of, the tissue will
also often by itself have a great capacity to heal, but the healing can also be
stimulated by various means. If that is not successful, several surgicel
techiques are available.
Treatment of hemorrhoids with dietary and lifestyle methods
Correct lifestyle habits will allways make it more easy to cure hemorrhoids, and it is sometimes possible to get rid of hemorrhoids only by changing lifestyle habits.
Furthermore, lifestyle regulations are allways necessary to avoid new hemorrhoids to occur, after the original onces have been cured.
Preventing the recurrence of hemorrhoids will require relieving excessive pressure in the bowel, avoiding the pressure from straining to get out hard stool, and avoiding the injury that hard stool can do to the rectal mucosa.
Relieving of these physical conditions is also important to prevent the hemorrhoids from getting worse and from protruding out of the rectal opening.
The principle of getting rid of these physical conditions is to make the stool softer and to stimulate the bowel to work more efficiently. Lifestyle regulations can help to give these effects.
Lifestyle measures to treat hemorrhoids and to prevent relapse, are the same as the measures to prevent hemorrhoids from appearing at the first place:
- Drinking enough water.
- Consuming the right amount of fat, not too little and not too much, obtained by consuming a blend of healthy fat sources like olive oil, rape oil, fat fish, soy oil, nuts, sunflower seeds, almonds.
- Consuming enough fibre in the diet from whole grain or cereals, fruit and vegetables.
- Regular physical exerecise.
- Regular toileting habits, emptying the bowel as soon as the urge appears.
- To eat at regular intervals 4 times a day, and not to over-eat.
- To take good time when eating and chew the food well.
- Reducing an excessive weight will contribute to lovering abdominal pressure and help to reduce or take away hemorrhoids. The measures used to take away an excessive weight, for example exercises will also render the intestines more active and in this way also give treatment against hemorrhoids.
Dietary supplements for treatment of hemorrhoids
To achieve an even greater effect, doctors may suggest a bulk stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).
In the market you can also find dietary supplements that combine two or more of the following effects:
- Softening of the stool.
- Stimulation of the bowel to work more efficiently and more regularly.
- Stimulation of the rectal mucosa to heal faster.
- Reduction of inflammation.
These supplements are made from herbs, vitamins and minerals that either has been proven efficient by long traditional use or been proven effective by scientific study.
Drinking 99% Aloe vera juice, or chamomile tea are found by some to better the condition.
Supplements helping against hemorrhoids often contain ingredients like: Butcher's broom, horse chestnut, bromelain, Aloe vera and Japanese pagoda tree extracts.
Topical creams and ointments to treat hemorrhoids that are applied directly on the affected area Cream can be applied to the affected area to fights infections, alleviate inflammation and lubricate to make the stool pass easier.
There are also creams to be injected ito the rectum to treat internal hemorrhoids.
Such creams can contain natural oils and herbal extracts, they can contain syntetic pharmacological substances or both.
Suppositories for hemorrhoidal treatment
Also suppositories can be usd to fights infections, alleviate inflammation and lubricate to make the stool pass easier, and thereby help to cure hemorrhoids.
Suppositories can also be used to stimulate the movement of the bowel and emptying of the stool.
Suppositories are small conical objects consisting of a fatty or vaxy substance where the effective ingredients are dissolved. The suppository, once inserted, gradually melts, releases its ingredients and then makes its effect.
The extract of mediterranean pine bark called Pycnogenol has shown to stimulate repair of hemorrhoids. The remedy has general effetcs against inflmmation and edema and is generally good to stimulate tissue repair, including the anal area.
Physiological ways to treat hemorrhoids
One way used to alleviate hemorrhoids are warm tub baths several times a day in plain, warm water for about 10 minutes.
If constipation aggarvates the condition, small enemas can be used to allevaiate the situation. Bigger enemas should not be used, because these can increase the internal pressure and make the hemprrhoids grow worse
Traditional and modern surgical way of treating hemorrhoids
Sometimes hemorrhoids must be treated endoscopically or surgically to shrink and destroy the hemorrhoidal tissue. The doctor will perform the procedure during an office or hospital visit.
Methods usable in these case are several:
- Use of leeches Application of leeches of the species Hirudinea officinalis is an old treatment for disorders of blood vessels and poor circulation in veins. They have traditionally beenhused to treat varicose veins and hemorrhoids. The modern medicine has again begun to investigate this treatment modlity. The leech bites a hole in the hemorrhoid wall, and then sucks out blood and other venous content. When it is full it splips off by itself.
The leech makes an enyme that hinders coaguløation and an enzyme that dissolves allready coagulated blood. Thus it makes the content of the hemorrhoid dissolve and sucks this out. The leech also makes antibacterial substances and antiinflammatory substances and thus helps to heal hemorrhoids also this way.
- Infrared coagulation: A worm instrument is used to direct infrared irradiation to the hemorrhoids, thus worming them up so that the tissue in the hemorrhoid is destroyed, and the blod inside the hemorrhoid coagolates. Then the destroyed hemorrhoid needs some time to dissolve or fall off, and the resulting sore must have some time to heal.
- Rubber band ligation: A rubber band is placed around the base of the hemorrhoid inside the rectum. This band cuts off the circulation in the hemorrhoid. The blood inside the hemorrhoid coagulates, making the hemorrhoid hard. The hemorrhoid tissue then dies and then the hemorrhoid withers away or falls off in some days. There will be a sore at the place where the hemorrhoid has been that needs some time to grow.
- Injection treatment / Sclerotherapy: A chemical solution is injected into the inside of the extended blood vessel at the core of the hemorrhoid. This chemical makes the blood inside the hemorrhoid coagulate. The tissue in the hemorrhoid will then lack blood supply and die. The hemorrhoid hardens and shrinks. The hardened hemorrhoid then falls off within some days. There will then be a sore that takes some time to heal. Slerotherapy is mostly used for small internal hemorrhoidfs.
- Electric treatment / Electrocoagulation: By this techique a needle is stuck into the inside of the hemorrhoid and a very small electric current is sent through the needle for some minutes. This destroys the tissue in the hemorrhoid. The hemorrhoid will then dissolve or dry up and fall off in some days. Then there will be a sore that takes some days to heal.
- Surgical removal of hemorrhoids / Hemorrhoidectomy: Serious internal or external hemorrhoids may require removal by cutting the hemmorrhoids out surgically and suturing the skin together again over the place from where the hmorrhoids were removed.
This is an image of hemorrhoids inside the anal opening taken through an endoscopic instrument (A free picture from wikipedia.org). The dark object is a part of this instrument. There are hemorrhoids in various stages of development and sizes all around inside the anal opening. Those having come furthest in the development appars in the mid of the picture and have coagulated blood inside.