What Are Hemorrhoids?

Hemorrhoids, often referred to as piles, are clusters of blood vessels found within the smooth muscles of the rectum and anus. These vascular structures are a natural part of the body’s anatomy and are situated at the junction where small arteries meet veins. Protected by smooth muscles and connective tissue, their location concerning the pectinate line, which divides the upper 2/3 and lower 1/3 of the anus, is crucial due to the type of cells lining them and their sensory nerves.

• Internal Hemorrhoids: These are situated above the pectinate line and are covered by the same type of cells found throughout the intestines.
• External Hemorrhoids: Found below the pectinate line, these are covered by skin-like cells.

Hemorrhoids typically become problematic when they swell, leading to symptoms such as itching, pain, and bleeding.

What Do Hemorrhoids Look Like?

Normally, hemorrhoidal tissue is not visible as it must swell or become inflamed, or clot before symptoms arise. Swollen external hemorrhoids or internal prolapsed hemorrhoids can be seen outside the anus, but internal hemorrhoids remain hidden. Thrombosed hemorrhoids, caused by clotting within a swollen blood vessel, appear as a bluish lump protruding from the anus. Non-thrombosed hemorrhoids present as rubbery lumps. Multiple swollen hemorrhoids can occur simultaneously.

What Causes Hemorrhoids?

While hemorrhoids are a part of normal anatomy, they’re often considered abnormal when they cause symptoms. Hemorrhoid swelling results from increased pressure in the small vessels comprising hemorrhoids. Several factors can contribute to this increased pressure:

• Straining during bowel movements due to a low-fiber diet and hard stools.
• Pregnancy, which places additional pressure on the rectum and anus due to an enlarged uterus.
• Prolonged sitting on the toilet, particularly common in today’s sedentary lifestyles.
• Obesity.
• Diarrhea, both acute and chronic.
• Colon cancer.
• Previous rectal surgery.
• Spinal cord injuries and the absence of an erect posture.

Symptoms of Hemorrhoids

Hemorrhoids are a common cause of rectal and anal discomfort, with symptoms including:

• Painless bleeding from the anal area.
• Anal itching.
• Pain in the anal area.
• Swelling.
• Feeling a lump in the anus.

Rectal bleeding or blood in stool should never be dismissed as normal, as it can be a sign of life-threatening conditions. Seek medical attention, especially if you are taking blood-thinning medications.

Diagnosis of Hemorrhoids

Diagnosis is typically made through a medical history and physical examination, with questions about associated symptoms like constipation, hard stools, and straining during bowel movements. Other potential causes of rectal bleeding will also be explored, such as tumors, inflammatory bowel disease, or gastrointestinal bleeding.

Physical examination confirms the diagnosis and may involve a rectal exam. In some cases, further tests like anoscopy, sigmoidoscopy, or colonoscopy may be ordered.

Treatment of Hemorrhoids

Treatment options vary based on the severity of hemorrhoids:

• Grade 1: Symptomatic treatment may involve warm sitz baths and avoiding spicy foods.
• Grade 2 and 3: Techniques to destroy hemorrhoids, including injecting the hemorrhoid vein, rubber band ligation, or other procedures to shrink hemorrhoidal tissue.
• Grade 4: Surgery may be required to remove swollen hemorrhoids and external skin tags. Options include traditional hemorrhoidectomy or stapled hemorrhoidectomy for less invasive procedures.

Prognosis

Hemorrhoids are a normal part of the body and are not a cause for concern unless they become inflamed or bleed. With appropriate treatment and lifestyle adjustments, the aim is to manage hemorrhoid inflammation and avoid surgery. Hemorrhoids are typically a lifelong condition to be controlled, not cured. Recurrence rates after surgery are low (5%), while nonsurgical treatments have a higher recurrence rate (about 50%).