What Are Hemorrhoids?

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Hemorrhoids are the masses or clumps of tissue within the anal canal that contain blood vessels and the surrounding, supporting tissue made up of muscle and elastic fibers. Hemorrhoids are not abnormal they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems and be considered abnormal or a disease. Although hemorrhoids occur in everyone, they become large and cause problems in only 4% of the general population. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.

It is not known why hemorrhoids enlarge. There are several theories about the cause, including inadequate intake of fiber, prolonged sitting on the toilet, and chronic straining to have a bowel movement (constipation). None of these theories has strong experimental support. Pregnancy is a clear cause of enlarged hemorrhoids though, again, the reason is not clear. Tumors in the pelvis also cause enlargement of hemorrhoids by pressing on veins draining upwards from the anal canal.
Hemorrhoids usually present with itching, rectal pain, or rectal bleeding. In most cases, symptoms will resolve within a few days. External hemorrhoids are painful while internal hemorrhoids usually are not unless they become thrombosed or necrotic. The most common symptom of internal hemorrhoids is bright red blood covering the stool, a condition known as hematochezia, on toilet paper, or in the toilet bowl. They may protrude through the anus. Symptoms of external hemorrhoids include painful swelling or lump around the anus.

The best way to prevent hemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure and straining, and to empty bowels as soon as possible after the urge occurs. Exercise, including walking, and increased fiber in the diet help reduce constipation and straining by producing stools that are softer and easier to pass. Spending less time attempting to defecate have been recommended.
When dealing with hemorrhoids, it is important to exclude other diseases of the anus and rectum that may cause similar symptoms such as polyps, cancer, and diseases of the skin. Conservative treatment typically consists of increasing dietary fiber, oral fluids to maintain hydration, non-steroidal anti-inflammatory drugs, sitz baths, and rest. Increased fiber intake has been shown to improve outcomes and may be achieved by dietary alterations or the consumption of fiber supplements. Other hemorrhoids treatment include topical medications, sclerotherapy, rubber band ligation, heat coagulation, cryotherapy, anal dilation, Doppler ligation, sphincterotomy, and surgical hemorrhoidectomy.

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