Hemorrhoids & Treatment

Hemorrhoids & Treatment

Hemorrhoids & Treatment (causes, symptoms, treatment)

Hemorrhoids are small anatomical formations located at the end of the rectum. Their presence is important as they contain the vessels of the hemorrhoidal plexus which contribute to the protection of the anal canal and the control of bowel movements. However, very often these normal vascular “pads” can become inflamed, so they swell, and in fact many times to such an extent that it has serious effects on people’s health and everyday life at a social level, since most people hesitate to express the specific problem even to the doctor or to their relatives.

Dilation and inflammation of hemorrhoids predispose to prolapse, bleeding or thrombosis, that is, formation of blood clots inside them. In all these cases we speak of hemorrhoidal disease or hemorrhoidal disease.

In the early stages, haemorrhoids appear as painful lumps protruding from the anus, accompanied by a burning and itching sensation.

Various factors can contribute to the inflammation of hemorrhoids. Among them are chronic constipation, excessive pressure to defecate, prolonged stay on the toilet, unbalanced diet and often appear during pregnancy.

Hemorrhoidal disease should not be neglected, after all, it is a condition that can be easily treated. In fact, milder cases can be treated with a series of changes in diet and hygiene, combined with local application of drugs with a decongestant effect. However, worsening symptoms associated with hemorrhoids may require surgery.

Hemorrhoids & Treatment

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Internal and external hemorrhoids

From an anatomical point of view, hemorrhoids are divided into internal and external.

• Internal hemorrhoids remain located inside the anal canal, above the imaginary line, called the dentate line or pettinea, which divides the anal canal into two parts according to the mucous membrane that covers it. Internal hemorrhoids are not visible to the naked eye and are usually painless. During defecation they may protrude (prolapse) and then spontaneously return to the original position. Only when prolapse is complete or associated with fissures, internal hemorrhoids cause pain.
• External hemorrhoids are located lower, below the dentate line, at the edge of the anus. External hemorrhoids are visible to the naked eye, grow near the anus, come out easily and appear as hard, painful bumps.

Did you know…

An important difference between the two types of hemorrhoids is the sensitivity to pain. Internal hemorrhoids do not actually hurt, while there is a strong association of pain with external hemorrhoids.

Grades of Hemorrhoid Disease

There are several types of hemorrhoids, classified according to the severity of the clinical picture:

Grade 1 hemorrhoids: There is an increase in the volume of one or more hemorrhoidal pads, which protrude into the anal lumen, without prolapse outside the sphincter. Therefore, they are visible only with endoscopic examination. Grade 1 hemorrhoids cause discomfort, itching and possible bleeding during defecation, but without particular pain.

Grade 2 hemorrhoids: Initial hemorrhoidal prolapse (i.e., protrusion of hemorrhoids from the anal canal) is observed, but only after excessive exertion – for example during defecation or childbirth, with subsequent spontaneous return to the original position after the contraction stops. In this case, in addition to bleeding, there may also be itching and discharge.

Grade 3 Hemorrhoids: Hemorrhoidal prolapse is independent of pressure. Hemorrhoids can reenter the anal canal. In addition to the discomforts of the first and second degree, in the third degree the symptoms include pain and slight faecal incontinence, with the corresponding unpleasant consequences.

Grade 4 Hemorrhoids: In this stage there is total prolapse and the hemorrhoids cannot be repositioned inside the anus, so they always remain outside. Symptoms include pain, severe itching and faecal incontinence.

However, even quite severe pain can occur, at any stage of hemorrhoidal disease. Thrombosis, for example, is one of the most common acute complications that can affect both external and, more rarely, internal hemorrhoids. In this condition there is the formation of a thrombus (blood clot) within the inflamed varicose vein, which is associated with swelling, itching and severe pain. Recurrence of these episodes requires surgical removal of the hemorrhoids (hemorrhoidectomy).

Causes and Risk Factors

Hemorrhoids are anatomical structures formed by capillaries, arteries and, mainly, veins. When they are swollen, they cause pain and/or bleed and indicate the onset of hemorrhoidal disease.

Hemorrhoids: Why they develop?

The development of hemorrhoidal disease occurs, in any case, with an accumulation of blood which expands the hemorrhoids and causes them to slide down. This phenomenon causes on the one hand the damage of the walls of the vessels and on the other hand tends to exhaust the tissues of the anal region, which are forced to support a greater weight given by the accumulated blood. As a result, the hemorrhoidal veins tend to protrude beyond the anal sphincter and then drag along the mucous membrane that covers them.

What are the causes οf hemorrhoids?

Inflammation of hemorrhoids can affect men and women of different ages.

Hemorrhoidal disease is multifactorial, so it is caused by a combination of many causes, such as:

• Chronic constipation: During defecation, increased effort and prolonged sitting on the toilet favors the irritation of hemorrhoids.
• Pregnancy: During pregnancy, women become more vulnerable to hemorrhoids. In particular, women may suffer from hemorrhoids during pregnancy or immediately after childbirth. This happens both because of the increase in pelvic pressure associated with the presence of the fetus and because of the hormonal changes associated with pregnancy itself.
• Lifestyle: Sedentary lifestyle, obesity, smoking and engaging in certain sports such as horse riding or cycling.
• Medicines: Mainly contraceptives and laxatives are a cause for the development of hemorrhagic disease.
• Unbalanced and low fiber diet with low water intake
• Other concomitant pathologies, such as portal hypertension resulting from cirrhosis of the liver, certain pelvic neoplasms or prostatic hypertrophy.

Other factors that cause or contribute to hemorrhoids are:

• Maintaining an upright posture for extended periods of time.
• The habit many have of sitting on the toilet bowl for a long time, reading, for example.
• When defecation is too hasty or, on the contrary, postponed
• Personal and family predisposition to vascular fragility and tendency to varicose veins, even in other areas of the body.

Diet and hemorrhoids

If the diet is unbalanced and low in fiber, the intestine cannot function properly. The result is changes in the hive (constipation/diarrhea) that are irritating to the hemorrhoidal plexus. There are also foods that have an irritating effect on hemorrhoids – such as sausages, alcohol, chocolate, spices and spicy foods. These foods can cause venous dilatation and act as triggers for the appearance of hemorrhoids.

Which foods should I prefer and which should I avoid with hemorrhoids?

Recommended foods for people suffering from hemorrhoids: yogurt, beets, cabbage, potatoes and leeks.

Foods to avoid are: spicy, fatty, alcoholic, fried, chocolate, tea, coffee

The diet for hemorrhoids includes avoiding subjecting the intestine to any form of chemical-pharmacological stress, preventing irritation, inflammation and therefore vasodilation (which would contribute to the initiation or worsening of hemorrhoids). Spicy elements such as: capsaicin, piperine, gingerol, isothiocyanate and allicin (chili, pepper, horseradish, mustard, ginger, wasabi, radish, garlic, onion, shallot, etc.) should be avoided. In addition, nerve molecules such as: ethyl alcohol, caffeine, theine, theobromine (alcoholic drinks, fermented teas, coffee, cocoa, chocolate) are completely contraindicated.

Certain medications should also be limited (if necessary, consult the package insert or the pharmacist) and osmotic laxatives (lactulose, sorbitol, etc.) and/or irritants (anthraquinones, phenolphthalein, etc.).

The hemorrhoid diet also limits the intake of “foreign” or unnatural ingredients. Among them: sodium chloride and added sucrose (salt and sugar), food additives and preservatives, etc.

In case of constipation, all astringent foods should be avoided, such as fermented tea tannins, unripe persimmon, unripe banana, etc.

Who is most at risk?

Hemorrhoidal disease is a widespread problem that affects men and women of different ages. According to some estimates, about 5-10% of adults suffer from it, while 50% of the population has suffered, is suffering or will suffer from this disease at some point. Less common under the age of 30, inflamed hemorrhoids become quite common after the age of 40/50. In general, hemorrhoids are more common in industrialized countries, due to both lifestyle and dietary habits.

Symptoms and Complications

Hemorrhoids swell at the tip of the anus and are often visible even to the naked eye while being felt to the touch in the form of a lump like a “ball”. If they are subjected to some form of pressure, their presence is associated with tingling, pain and the sensation of a foreign body at the level of the anus. The size of hemorrhoids can be variable (small or large).

Other symptoms of hemorrhoid irritation include:

• Itching
• Burning sensation

Title: In more advanced stages, however, external hemorrhoids may include:

• Mucus loss associated with an uncomfortable feeling of wetness.
• Stimuli for repeated discharges.

Over time, hemorrhoidal pads may not only protrude from the anus but remain on the outside of the sphincter permanently, causing intense physical discomfort and pain, aggravated by contraction of the anal sphincter. Damage to external hemorrhoids by rubbing or excessive thinning of the structures that compose it predisposes to bleeding (proctoragia), which can even be continuous and relatively abundant.

Did you know…

Damage to external hemorrhoids by rubbing or excessive thinning of the structures that compose it predisposes to bleeding (proctoragia), which can even be continuous and relatively abundant.

How long do hemorrhoids last?

Hemorrhoids often tend to recur: patients experience an alternation between acute attacks and periods of relative relief that are shorter or longer.

Possible complications of hemorrhoids

Regardless of the degree, hemorrhoids can be associated with some complications.

The main problem is bleeding as a consequence of congestion and swelling, which lead to greater ease of injury to exposed tissues. When prolapsed outside the anal sphincter, hemorrhoids may even cause continuous and relatively profuse blood loss, as the prolapsed tissue is exposed in greater amounts. In the cases of patients who have had bleeding hemorrhoids for a long time, with either minor or major bleeding, the development of severe iron deficiency anemia – that is, there is a lack of iron leading to a low hematocrit – has been observed.

When to see your doctor and what to report

The characteristic symptoms of hemorrhoids are a source of worry and embarrassment for most patients. Patients often feel uncomfortable and have difficulties in reporting the symptoms even to the doctor.

For this reason, there is a general tendency to turn to a specialist only at an advanced stage, when the symptoms we feel are particularly severe. This is obviously wrong behavior, which can only worsen the situation further. Many of the characteristic symptoms of hemorrhoidal pathology are, for example, common to various diseases, some of them very serious and therefore can only be diagnosed through special tests.

For all these reasons, when the typical symptoms of hemorrhoids appear, it is necessary to overcome caution and taboos and contact your trusted doctor. Early intervention will help to recover from the disease and improve, many times, the quality of life.

The Surgical Intervention

Even today, many patients are afraid to go to the surgery for the decisive treatment of hemorrhoids. This is partly due to the subject of this particular part of the body, which is particularly intimate and delicate, and partly to a legacy of the past. Once upon a time, the operations were long and painful, but now, thanks to the giant strides made by surgery and medicine in general, the operation can be made extremely simpler, faster and painless.

First of all, it is an intervention that can be performed with local anesthesia. The entire procedure only takes a few minutes and by the end of the day you can be safely discharged home, just taking care to keep the surgical area sterile.

the old tampon that was used in the past and which could cause some discomfort, has been replaced nowadays with a simple gauze and with micro tampons that protect the wound and gradually dissolve by themselves. Once you return home from surgery, it is always recommended that you follow certain care measures to prevent infection and complications, such as the use of mild laxatives, proper anal hygiene, and a period of bed rest with the legs elevated to promote venous return and help resolve the clot.

Instead, analgesics and sedatives can be used to eliminate postoperative pain. Low-iron diets and douching are procedures that can be considered after an acute episode of hemorrhoids.