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Hemorrhoids

Overview

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Hemorrhoids, also known as piles, are swollen veins located around the anus or in the lower rectum. They can cause discomfort, itching, pain, and bleeding, particularly during bowel movements.

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Symptoms
  • Bleeding: Bright red blood on toilet paper, in the toilet bowl, or on the surface of stools.
  • Pain: Pain or discomfort around the anus, especially when sitting or during bowel movements, primarily with external hemorrhoids.
  • Itching: Itching or irritation in the anal region.
  • Swelling: Swelling or a lump near the anus, which can be tender to the touch.
  • Discharge: Mucous discharge or irritation around the anus.
Complications
  • Thrombosis: Formation of a clot in an external hemorrhoid, leading to severe pain and swelling. This is known as a thrombosed hemorrhoid.
  • Prolapse: Internal hemorrhoids may protrude from the anus (prolapse), which can cause discomfort and requires medical attention.
  • Infection: Although rare, hemorrhoids can become infected if there is a break in the skin.
  • Anemia: Chronic bleeding from hemorrhoids can potentially lead to anemia, though this is uncommon.
Causes
  • Straining During Bowel Movements: Excessive straining can put pressure on the veins in the rectal area, leading to hemorrhoids.
  • Chronic Constipation or Diarrhea: Ongoing bowel issues can irritate and inflame the rectal veins.
  • Pregnancy: Increased pressure from the growing uterus can lead to hemorrhoids. Hormonal changes can also contribute.
  • Obesity: Excess body weight increases pressure on the veins in the pelvic region.
  • Sedentary Lifestyle: Lack of physical activity can contribute to poor bowel function and increased pressure on the rectal veins.
  • Heavy Lifting: Frequent heavy lifting or strenuous physical activity can strain the rectal veins.
Prevention
  • High-Fiber Diet: Eating a diet rich in fiber can help prevent constipation and reduce the need for straining. Include fruits, vegetables, whole grains, and legumes.
  • Hydration: Drinking plenty of water helps keep stools soft and easier to pass.
  • Regular Exercise: Engaging in regular physical activity can promote healthy bowel function and prevent constipation.
  • Avoid Prolonged Sitting: Avoid sitting for long periods, especially on the toilet, which can increase pressure on the rectal veins.
  • Healthy Bowel Habits: Respond promptly to the urge to have a bowel movement and avoid straining or sitting on the toilet for extended periods.
Risk Factors
  • Age: Hemorrhoids are more common in individuals over 45.
  • Pregnancy: Hormonal changes and increased abdominal pressure during pregnancy can lead to hemorrhoids.
  • Family History: A family history of hemorrhoids may increase the likelihood of developing them.
  • Chronic Conditions: Chronic conditions like chronic constipation or diarrhea can contribute to hemorrhoid formation.
  • Lifestyle Factors: Sedentary lifestyle, poor diet, and obesity are contributing factors.
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How is it treated?

Self-Care Measures

  • Over-the-Counter Medications: Creams, ointments, or suppositories containing hydrocortisone or witch hazel can help reduce pain, itching, and inflammation.
  • Warm Baths: Soaking in a warm bath (sitz bath) several times a day can relieve discomfort.
  • Cold Compresses: Applying cold packs to the affected area can help reduce swelling and pain.
  • Fiber Supplements: If dietary fiber intake is insufficient, fiber supplements can help soften stools and reduce straining.

Medical Treatments

Minimally Invasive Procedures: Procedures performed in a doctor's office to treat hemorrhoids include

  • Rubber Band Ligation: A rubber band is placed around the base of an internal hemorrhoid to cut off its blood supply, causing it to shrink and fall off.
  • Sclerotherapy: Injection of a chemical solution into the hemorrhoid to shrink it.
  • Infrared Coagulation: Application of infrared light to the hemorrhoid to cause it to shrink.

Surgical Treatments: For severe cases or when other treatments fail, surgical options may be necessary

  • Hemorrhoidectomy: Surgical removal of hemorrhoids. This is often used for large or prolapsed hemorrhoids.
  • Stapled Hemorrhoidopexy: A procedure to reposition and secure prolapsed internal hemorrhoids and reduce blood flow to them.
  • Summary Hemorrhoids are a common condition that can cause discomfort and bleeding. They can often be managed with lifestyle changes, over-the-counter treatments, and medical procedures if necessary. Preventive measures, such as a high-fiber diet and regular exercise, can help reduce the risk of developing hemorrhoids and manage symptoms effectively. If symptoms are severe or persistent, consulting a healthcare provider for appropriate treatment is essential.
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How is it Diagnosed?

Hemorrhoids are diagnosed primarily through history and physical examination. Patients usually present with symptoms like painless rectal bleeding, itching, swelling, and prolapse during defecation.

A visual inspection of the anus is done to identify external hemorrhoids or prolapsed internal hemorrhoids. A digital rectal examination is performed to detect internal hemorrhoids or other anorectal disorders.

Anoscopy allows direct visualization of internal hemorrhoids using a short, rigid tube equipped with a light. In cases of persistent or unexplained rectal bleeding, sigmoidoscopy or colonoscopy may be recommended to rule out colorectal cancer or polyps, especially in individuals over 50 or those with risk factors.

Severity is classified into grades I to IV based on prolapse and reducibility, guiding treatment decisions.

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