Hemorrhoids

What are Hemorrhoids?

Humans normally have a number of blood vessels in an around the anal area, known as the "hemorrhoidal plexus." When the blood vessels become swollen, then we refer to them as "hemorrhoids." Hemorrhoids may either be internal (inside the anus) or external hemorrhoids (around the skin outside the anus). Most people who have internal hemorrhoids are not aware of them unless they protrude or bleed. External hemorrhoids can usually be felt as a protrusion or bulge around the anus.

What Causes Hemorrhoids?

Hemorrhoids most commonly develop from dilation and swelling of the blood vessels due to pressure and straining with bowel movements. Other contributing factors may include chronic constipation or diarrhea, pregnancy and aging.

What are the Symptoms of Hemorrhoids?

Many people with hemorrhoids have little to no symptoms other than some bulging or protruding around the anus. The primary symptom of hemorrhoids is bleeding - remember that a hemorrhoid is a blood vessel. When hemorrhoids bleed, this can cause blood with wiping, or in the toilet water, sometimes seen as dripping from the anal area. Blood can at times be mixed with the stools, particularly if the hemorrhoids are internal hemorrhoids. People can experience itching and discomfort around the anal area with hemorrhoids, but as mentioned, the primary symptom of hemorrhoids is bleeding.

How are Hemorrhoids Diagnosed?

External hemorrhoids can often be seen by visually inspecting the area. Internal hemorrhoids can sometimes be palpated with a rectal examination with the examining finger and often require examination with an anoscope or fiberoptic scope (flexible sigmoidoscopy or colonoscopy) to directly visualize the area. At that time other sources of bleeding and problems can also be looked for.

What is the Treatment for Hemorrhoids?

Minimizing straining with bowel movements is a primary goal for treating hemorrhoids. This reduces the pressure placed on them. Increasing bulk and fiber in the diet and taking in plenty of fluids are important. The daily use of a bulk fiber agent, such as Metamucil, Citrucel, Konsyl (and others) can also be helpful to assure sufficient daily fiber intake. If the hemorrhoids are inflamed or tender, warm Sitz bathes several times daily can be helpful. The application of a hemorrhoidal cream or suppository is often used. To remove hemorrhoids there are various techniques available. Infrared coagulation of hemorrhoids can be done using a coagulator that burns the base of the hemorrhoids and cause them to shrink up. In some cases, hemorrhoids may be treated surgically by removing them with various techniques, such as rubber-band ligation, or sclero-therapy, or excision (removal).

What is Anal Cryptitis and Anal Fissure?

Anal cryptitis is an inflammation of the anal canal. The primary symptom is rectal bleeding, usually seen with wiping or on the bowel movement. 

Anal fissure is similar to having a tear in the anal canal. It usually causes rectal bleeding and pain with bowel movements.

Treatment involves stool softeners to avoid straining, and an agent such as hemorrhoidal-type suppository to reduce the inflammation associated with cryptitis and fissure.