What are Hemorrhoids?

Hemorrhoids (also called piles) are enlarged and swollen veins in your rectum or anus. Hemorrhoids are one of the most common known medical conditions. Worldwide, millions of people currently suffer from hemorrhoids. They occur in both men and women.


Symptoms of Hemorrhoids

The most common symptoms of persons suffering from hemorrhoids are:

  • Painless, bright-red rectal bleeding.
  • Tissue bulging around the anus.
  • Anal itching or anal pain.
  • Leakage of feces or difficulty cleaning after a bowel movement.

Causes and Risk Factors of Hemorrhoids

Hemorrhoids are caused by an increased pressure in the veins of your anus or rectum. Risk factors of hemorrhoids include:

  • Long-term constipation.
  • Repeated straining during bowel movements.
  • Age.
  • Pregnancy.
  • Spending a long time sitting on the toilet.
  • Family history.
  • Obesity.
  • Lifting too much weight.

Complications of Hemorrhoids

  • Hemorrhoids may get thrombosed and become extremely painful.
  • Blood loss resulting in anemia.
  • Infection and fever.

Diagnosis of Hemorrhoids

Your doctor will first take a detailed history and will perform the relevant physical examination. Your doctor will also perform a digital rectal examination (DRE). It is a simple bedside examination technique in which your doctor will examine your rectum and anus by inserting a gloved finger into the rectum.
Your doctor may examine the inside the anus (called anoscopy) or colon (sigmoidoscopy or colonoscopy) to confirm the diagnosis.

Treatment of Hemorrhoids

Hemorrhoids can be treated at home without surgery with lifestyle modifications:

  • Increasing the amount of fiber in the diet.
  • Fiber supplements, stool softeners, and laxative use.
  • Increasing fluids in the diet. Increase intake of plain water.
  • Avoid sitting on the toilet for a long time. Do not take newspapers or cell phones with you.
  • Avoid straining or pushing during bowel movements to reduce the pressure on hemorrhoids.
  • Pain-relievers.
  • Exercising regularly.
  • Warm baths – sitting in plain warm water for 10-20 minutes, two to three times per day to help the healing process.
  • Topical treatments for pain relief and steroid rectal suppositories may be used to help decrease pain, inflammation, and itching. You should not use topical creams for longer than one week without doctor approval.

The above conservative management is always tried first. If it fails, surgical options are then used.

Surgical Management of Hemorrhoids

Minimally Invasive Treatment
If conservative management fails, your doctor may recommend a minimally invasive procedure. Most procedures are performed as outpatient surgery. These include:

  • Rubber band ligation: rubber bands or rings are placed around the base of a hemorrhoid. The placement of a rubber band restricts the blood supply to the hemorrhoid resulting in shrinkage and degeneration of the hemorrhoid over several days.
  • Sclerotherapy: a chemical solution is injected into hemorrhoid resulting in its degeneration and scar formation.
  • Laser, infrared, or bipolar coagulation: Laser, infrared light, or heat is used to destroy and clot hemorrhoids. They are shed over the next few days.

Hemorrhoid Surgery

If minimally invasive treatment also fails, surgery may be required to remove the hemorrhoids (hemorrhoidectomy). Hemorrhoids can be surgically removed using different procedures. Your doctor will advise you regarding options suitable for you.

Diet and Exercise

The main goal in preventing hemorrhoids is to relieve constipation. It may be achieved by:

  • Increasing physical activity such as aerobics.
  • Dietary changes including increasing dietary-fiber and taking stool softeners.
  • Avoiding low-fiber foods, such as ice cream, cheese, white bread, and meat.
  • Drinking plenty of fluids. Eight to ten glasses of water a day is ideal.