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What is Hemorrhoid?

Hemorrhoids (commonly known as piles) arise from congestion of the internal / external venous plexuses around the anal canal causing inflammation or bulge venous plexus which then protrudes outside the anal canal.

What are the types of hemorrhoids?

They are of two types:

i) Internal hemorrhoids: when the internal venous plexus is bulged or enlarged it is called internal hemorrhoids. Internal hemorrhoids are located above the dentate line and proximal to dentate line.

ii) External hemorrhoids: when the external venous plexus is swollen or enlarged it is called external hemorrhoids. External hemorrhoids are located below the dentate line and distal to the dentate line.

What are the risk factors/causes of hemorrhoids?

i) Chronic constipation

ii) Obesity

iii) Pregnancy

iv) Regular heavy lifting

v) Having low fiber diet

What are the symptoms of hemorrhoids?

Internal Hemorrhoids:

• Rectal fullness/Discomfort

• Painless bleeding while defecation. You may notice Bright red rectal bleeding when defecating.

• Hemorrhoids project beyond the anal opening/ anal verge (prolapsed or protruding hemorrhoid) results in pain and irritation when passing stool.

External Hemorrhoids:

• Sudden severe perianal pain

• Perianal mass may felt

• Pain while passing stool (Particularly if thrombus occur (called as Thrombus Hemorrhoids.))

• Bleeding (usually darker)

• A skin tag may remain after the healing of an external hemorrhoids

• Itching or irritation around the anus.

What are the stages of internal hemorrhoids?

Stages of internal hemorrhoids: It is classified based on their degree of prolapse into the anal canal.

Grade I - There will be a slight enlargement of the internal venous plexus and hemorrhoids project into the anal canal but do not prolapse. Bleeding occurs in this stage.

Grade II - The internal hemorrhoids plexus slightly pass the pectinate line (also called as dentate line). The hemorrhoids protrude beyond the anal verge/anal opening while defecating or straining bowel movements. But it reduces spontaneously when straining ceases.

Grade III - The internal hemorrhoids spontaneously protrude while straining and requires manual reduction to replace into the anal canal.

Grade IV - The internal hemorrhoids prolapsed chronically and cannot be reduced manually.

What is the treatment of hemorrhoids?

1. Non- Pharmacological treatment:

• Eat foods rich in fiber - Having fiber rich foods will softens and increases the bulkiness of the stool which reduces the straining bowel movements. Therefore worsening of the condition or symptoms can be reduced.

• Drink plenty of water

• Sitz bath :-

Procedure: Take a warm water in a tub. Add salt or povidone-Iodine. Sit in the warm water for 10-20 minutes. After that gently pat the anal area/perineum with towel.

Advantage of sitz bath:

• This causes vasodilatation, therefore leads to increased blood circulation

• Muscle relaxation, hence it provide relief from pain or any discomfort

• It reduces the itching or irritation in the anal area/perineum

• It reduces the inflammation.

2. Symptomatic treatment or Pharmacological treatment:

· Laxative: To treat constipation

· Topical creams (Steriod cream/anti-itching agent): To reduce pain and itching temporarily.

3. Surgical management:

• Removal of hemorrhoids (hemorrhoidectomy)

• Hemorrhoid stapling (stapled hemorrhoidopexy)

4. Minimal invasive procedure:

• Rubber band ligation

• Injection (sclerotherapy)

• Coagulation (infrared/ laser)

What are the ways to prevent hemorrhoids?

• Eat food rich in fiber - Taking fiber rich food will reduce the straining bowel movements by making the stool soft and bulk

• Drink plenty of water - Taking 6 to 8 glasses of water each day will reduce straining defecation by making the stool soft.

• Do not hold the stool - If you hold the stool, the stool could dry out and it will be harder to defecate.

• Avoid sitting in the toilet for long period – Sitting longer period in toilet will increase the pressure on the rectal veins

• Do not strain while defecating: Straining while passing stool will increase the pressure on the rectal veins.