Hemorrhoids 101

 

Hemorrhoids are swollen blood vessels in the lower rectum and anus. They are among the most common causes of anorectal complaints, and only a small proportion of those people seek therapy.

Epidemiology

The prevalence of hemorrhoids is not well documented due to the lack of clinical research on this topic. There has been a scarcity of literature reporting on the epidemiology of hemorrhoids.
It is estimated that the overall prevalence of symptomatic hemorrhoids in the general population is about 4.4%, but the true prevalence of hemorrhoids, including asymptomatic hemorrhoids should be much higher than 4.4%.

According to a study done in a hemorrhoid center, estimates suggest that around half of Americans develop hemorrhoids by time they are 50. The number of people in the US suffering from symptomatic hemorrhoids is estimated to be around 10 million, with 1 million new cases occurring each year. Up to one third of those 10 million people with hemorrhoids seek medical treatment.

There is no known sex predilection, although men seem to be more likely to seek medical attention. However, the physiological changes that occur during pregnancy also increase the likelihood that hemorrhoids will become symptomatic and may increase the incidence of thrombosis in females.

Caucasians are more frequently present with hemorrhoidal disease and seek treatment more often than other races.

Some individuals are more genetically predisposed to hemorrhoids than others. But there are no indicative factors that can be used to identify this group of patients.

The prevalence of hemorrhoids increases as people age. In most cases, hemorrhoids develop in individuals who are over 30 years old, with a peak in persons aged 45-65 years, although they can develop at any age. External hemorrhoids tend to occur more commonly in younger adults.

People who live in rural areas and those with a higher socioeconomic status appear to be more likely to develop hemorrhoids.

Four Cardinal Symptoms of Hemorrhoids

Although hemorrhoidal symptoms and complaints are common and typically not a serious concern, all patients should be examined for signs of possible cancer and other associated diseases. There are four cardinal symptoms of hemorrhoids, including rectal pain, bleeding, anal itching, and rectal mass or lump.

Anal Itching
Anal itching is the most common complaint in the hemorrhoid patients. It often comes and goes. The initial relief of the itching does not necessarily mean the problem goes away. Continuous scratching or excessive cleaning of the anal area may further harm the sensitive tissues and worsen symptoms. In addition, the area can be highly sensitive to perfumes, soaps, fabrics, dietary intake and superficial trauma. When chronic itching occurs, the perianal area becomes white with fine fissures.

Treatments for anal itching include taking antihistamine as a sedative prior to sleeping to prevent the patient from unconsciously scratching, or using a topical corticosteroid to alleviate the itching. Underlying hemorrhoids and other rectal diseases must be considered and treated when diagnosing and treating anal itching.

Anal pain
Anal pain is a common sign of hemorrhoids. The patients with hemorrhodis often complain the aching pain, irritating pain, and spasmodic pain. If the hemorrhoid patient also has anal fissure, sharp pain may occur during intense, forced bowel movements that are often accompanied by rectal bleeding. Immediate onsets of intense pain accompanied by a palpable mass are usually a result of an external thrombosed hemorrhoid, which may last a few days to a couple of weeks. Internal hemorrhoids, however, are not very painful due to being located above the dentate line of the rectum.

Proctalgia fugax is a more serious anal pain condition that involves short spasms of intense pain at night. Hemorrhoids could be its trigger or cause.

Rectal Lump
A palpable anal lumps can be caused by a variety of conditions including anal warts, hemorrhoids, polyps, fissures, or cancer.

Hemorrhoids are probably the most common reason for having a rectal lump. It can be caused by internal hemorrhoids, but more commonly by external hemorrhoids. If a rectal lump is related to internal hemorrhoids, it usually gets bigger and more prolapsed right after the bowel movement; it could be spontaneously reduced in the early stage of internal hemorrhoids. But it could be non-reducible in the late stage of hemorrhoids.

The thrombosed external hemorrhoids often cause very painful, bluish anal lumps when the hemorrhoidal veins rupture and the blood clots develop.

Rectal bleeding
Rectal bleeding can be caused by hemorrhoids and other conditions, but even the slightest amount of bleeding should be taken seriously. Common causes of bleeding are internal hemorrhoids, ruptured thrombosed external hemorrhoids, fissures, diverticulosis, colon cancer, colitis, polyps and angiodysplasias. Patients of older age or with significant family history of bowel disease or cancer should consider further examination. In addition, patients who were previously treated for rectal bleeding but continued to experience bleeding must be further examined.

The source of rectal bleeding is determined by history, physical examination and blood tests, assisted with anoscopy, sigmoidoscopy, colonoscopy, radionuclide scans, and angiograms.

Types of Hemorrhoids

hemorrhoidsEveryone has had a normal hemorrhoidal tissue in their rectum and anus. It’s only when your hemorrhoidal veins enlarge and become varicose veins that they’re considered abnormal or diseased. There are three types of hemorrhoids – internal, external, and mixed. Internal hemorrhoids form above the dentate line, while external hemorrhoids form below the dentate line. Mixed hemorrhoids can either refer to lesions formed at the dentate line, or to the presence of both internal and external hemorrhoids.

External hemorrhoids are those occur outside the anal verge. External hemorrhoids usually affect the cleansing after the bowel movement and cause the skin irritation and itching. The thrombosed external hemorrhoids are sometimes very painful if the varicose veins rupture and the blood clots develop, it is often accompanied by swelling and irritation. These hemorrhoids are typically treated with either incision and removal of the clot or with external hemorrhoidectomy. Simply draining the clot can lead to recurrence, so it is generally recommended to completely excise the thrombosed hemorrhoids.

Internal hemorrhoids are graded from I to IV based on the degree of prolapse. Grade I hemorrhoids have no prolapse. Grade II lesions bulge with defecation but then recede spontaneously. Grade III hemorrhoids require digital replacement after prolapsing, while grade IV hemorrhoids cannot be replaced once prolapsed.

Treatment of Hemorrhoids

anal tagThere are many treatment options for the internal hemorrhoids. Very early hemorrhoids can often be effectively dealt with by dietary and lifestyle changes. The lifestyle changes should also be part of treatment plan for the more advanced hemorrhoids. Infra-Red Coagulation (IRC) has become the world’s leading office treatment for hemorrhoids. This non-surgical treatment is fast, well tolerated, and remarkably complication-free. The infrared light quickly coagulates the vessels that provide the hemorrhoid with blood, causing the hemorrhoids to shrink and recede. Rubber band ligation is widely used for the treatment of more advanced (more prolapsed) internal hemorrhoids. The ligated tissue dies-off after rubber bands are placed around the hemorrhoid tissue. Rubber band ligation downgrades the hemorrhoids to grade 1 or 2, most patients usually need to do IRC treatments after rubber band ligation. In the severe cases, a hemorrhoidectomy surgically removes the tissue that causes bleeding or protrusion.

Prevention of Hemorrhoids

Now that you feel much better after hemorrhoid care and you are very happy that your quality of life is back, you are ready to enjoy the beautiful spring seasons in Minnesota. However, you may raise the question, do hemorrhoids come back? If so, how do I prevent them? Hemorrhoids are a varicose vein disease. It is possible to relapse after hemorrhoid care, especially in the advanced hemorrhoids, but recurrence rate is much lower in the mild hemorrhoids.

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Hemorrhoids are one of the most persistent chronic medical conditions, leading to many people becoming frustrated at the recurrent symptoms. Luckily, there are numerous different measures available to prevent them to come back.

One of the best things you can do to prevent hemorrhoids is to make important dietary changes. Follow a high fiber diet. Why is fiber so very important? People in Minnesota who do not get enough fiber in their diet tend to have constipation with hard stool and strain when going to the bathroom. In turn, this pressure constitutes one of the greatest risk factors to those who are vulnerable to developing hemorrhoids. In order to prevent the onset or return of hemorrhoids, you should strive to eat a diet rich in fruits, vegetables, and fibers.

For those who have a history of hemorrhoids, it is recommended that these patients should integrate bulking agents into their daily diets, such as Metamucil The use of bulking agents is an important step in preventing the onset of hemorrhoids. These bulking agents work better if you drink plenty of water every day (6-8 glasses of water daily).

You should have good bowel habits and maintain smooth stool. Constipation with hard stool and straining can increase abdominal pressure rapidly, as well as expansion of venous plexus, often causing rupture of hemorrhoidal veins and anal skin tearing. If you develop chronic constipation, you should treat it aggressively by having a high fiber diet, increasing water intake, walking daily, and taking bulking agents and laxatives. However, frequent diarrhea does not help, either. Straining related to diarrhea also can rapidly increase the pressure in the abdomen and hemorrhoid venous complex, too. The toilet time should not be too long; you should avoid the bad habit of reading newspapers or surfing on the Internet in the toilet.

Individuals who are prone to developing hemorrhoids should also avoid standing for extended periods of time and constant heavy lifting.

Obese patients in Minnesota are 2-4 times more likely to develop hemorrhoids than the average patients, so weight loss may help to reduce the recurrence.

People with other medical problems, such as liver cirrhosis with portal hypertension, cardiovascular diseases, and abdominal tumors are more likely to develop hemorrhoids. The treatment of these underlying medical diseases is important to prevent hemorrhoids.

You may program your bowel movement in the way that you always try to have bowel movements right before your regular shower. For example, if you are a morning person, you go to toilet first before you take a shower, so the anus is always clean without residual feces. Residual feces are irritable to the skin around anus. If you starting having recurrent symptoms, then a daily Sitz bath helps a lot to relieve the symptoms.

Finally, once the hemorrhoids come back, you should immediately request an experienced practitioner in Minnesota to treat it. One Stop Medical Center serves the entire Twin Cities and offers the comprehensive hemorrhoid treatment in Edina, Minnesota.

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