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Hemorrhoids symptoms, causes, treatment – Hemorrhoids

Hemorrhoids are swollen blood vessels in the lowest part of the rectum and anus. Here, you will learn what you need about this disorder. 

The estimation is that this disease affects 4.4% of the population worldwide. In the US alone, around 10 million people suffer from hemorrhoids, with about a third of them getting medical help. This condition is one of the most common causes of diseases in the anus, and both men and women can have them. The chances of getting them are higher as people age, with a peak in patients between 45-65.

Here you will find the answers to frequently asked questions about hemorrhoids, questions like what’s inside? Also, its causes, symptoms, and treatment, all briefly explained by a doctor. By the end of this reading, you’ll find yourself with the necessary knowledge about this condition. 

What are hemorrhoids? 

The first thing you should know is what hemorrhoids actually are. They are a cluster of vascular, connective, and muscular tissue that are a normal part of your anus and rectum. Vascular tissue is formed by tiny blood vessels called arterioles, venules, and the connections they make.

Most people think hemorrhoids are just swollen veins, but this is not true. In fact, doctors have found that hemorrhoidal bleeding comes from arteries, not from veins. These clusters or cushions are located in the anal canal, and they’re a completely normal part of your anatomy.

Depending on their location, they can be internal (internal hemorrhoid) or external (external hemorrhoid) and have different characteristics, which we’ll discuss later. Normal hemorrhoidal tissue forms about 20% of anal pressure and gives sensory information to differentiate between gas, liquid, and solid in the rectum. However, people usually refer to them to talk about when these cushions get inflamed, enlarged, or prolapse (protrude).

What do they look like? 

Normal and healthy hemorrhoidal tissue can’t be seen. It needs to be swollen or develop a clot inside to cause symptoms and become visible. In the case of external hemorrhoids, they are visible once they get inflamed.

On the other side, internal hemorrhoids can’t be seen unless they prolapse and get exposed outside the anus. The appearance of the hemorrhoids varies whether they are thrombosed or not. A thrombosed hemorrhoid usually looks like a lump that protrudes from the anus and is dark blue or purple. This is because there is a blood clot inside the swollen blood vessel. A hemorrhoid that is not thrombosed will look like a tender mass around your anus. Sometimes, many hemorrhoids can simultaneously swell so that you can see more than one lump in this area. Other visible findings include:

  • Anal fissure
  • Extra tissue around the anus
  • Signs of infection like redness and pus
File:Piles 4th deg 01.jpg
Piles of 4th degree

What is inside a hemorrhoid? 

Like we said before, they are not just varicose veins. A hemorrhoid is a structure that includes blood vessels, connective and muscular tissue. The blood vessels are both tiny arteries and veins, called arterioles and venules. Also, there are connections between these arterioles and venules. The connective and muscular tissue help these blood vessels to stay in place. Sometimes, hemorrhoids get thrombosed; that is to say, a blood clot inside the blood vessels causes the disease.

File:Blausen 0053 Artery NormalvsDiseasedVessel.png

What are the causes of hemorrhoid problems?

The leading cause for developing hemorrhoids is the dilation of blood vessels. This can happen as a result of straining while defecating and increased pressure. The most common causes of it include: 

  • Chronic constipation: Since it makes you strain harder to evacuate, chronic constipation is a significant risk factor for this disease.
  • Low fiber diet: It affects your bowel habit making you more prone to develop constipation and, therefore, hemorrhoids. 
  • Age: As you grow older, all tissues in your body lose elasticity and strength. So, it is common for older people to suffer more from prolapsed hemorrhoids. 
  • Sitting for a long time: It makes it harder for your blood to flow back towards your heart. This results in higher pressure of the blood vessels that form this disease. 

Other risk factors for hemorrhoids include: 

  • Obesity
  • Having previous rectal diseases.
  • Family history
  • Anal intercourse 

What are the different types of hemorrhoids? 

The classification of hemorrhoids considers the origin of the hemorrhoids and their position in the anal canal. In your anal canal, there is a structure called the dentate line. This structure is basically a line formed by the change of the rectum’s mucosal layer for the anus’ one. Hemorrhoids above the dentate line are internal hemorrhoids. On the other side, hemorrhoids that form below this line are external hemorrhoids.

File:Rectum anatomy en.svg
Rectum anatomy

You may also find expressions like thrombosed hemorrhoids or strangulated hemorrhoids. These are not considered types of hemorrhoids but complications that can be present in some cases. 

What are the symptoms?

Normally, hemorrhoids exist without causing any symptoms. They can cause symptoms once they become inflamed, enlarged, prolapsed, or thrombose. Symptoms may vary whether they are internal or external and if they are prolapsed or thrombose. The most common hemorrhoid symptoms include: 

  • Pain or discomfort: In the case of internal hemorrhoids, they don’t cause pain unless they are prolapsed. External hemorrhoids are more likely to cause pain since they are located outside of your lower rectum. It may be uncomfortable for you to sit or have a bowel movement. Typically, acute pain only develops if the hemorrhoid is thrombosed. 
  • Anal itching or burning: It is due to irritation of the area near your anus. 
  • Visible lumps near the anus: External or prolapsed hemorrhoids can be seen on the outside of your anus. Blue or purple color can indicate that it’s thrombosed too. 
  • Rectal bleeding: It is the most common symptom and the one that frightens patients the most. The main characteristic of the bleeding is the bright red blood. It can drip to your underwear, squirt into the toilet or appear in the toilet paper. 

What is the difference between internal, external, or thrombosed hemorrhoids?

As we mentioned before, the location of the hemorrhoids divides them into internal hemorrhoid or external hemorrhoid. 

Internal hemorrhoids appear above the dentate line and are not visible unless they prolapse. Because of their location, internal hemorrhoids don’t receive innervation from cutaneous nerves. This means that they can’t cause pain. However, they can still cause hemorrhoid symptoms like bleeding and prolapsing. Once they prolapse and get to the exterior, internal hemorrhoids can get strangulated due to sphincter spasms.

The sphincter is a muscular ring that opens and closes; in this case, it’s the anus. When the sphincter spasms, it can cut the blood flow to hemorrhoids, causing acute pain. The most common symptom of internal hemorrhoids is painless bleeding with bowel movements. This bleeding can be accompanied by mucus release into the area near the anus, causing itching and irritation. 

On the other side, external hemorrhoids appear under the dentate line and are visible once they have swollen. The most common way in which they cause symptoms is due to thrombosis (presence of blood clots). Thrombosed external hemorrhoids happen as the result of a specific event. Straining, physical exercise, and changes in diet or bowel habits can result in thrombosed hemorrhoids.

In this case, external hemorrhoids receive innervation from cutaneous nerves, causing cutaneous pain. The quick stretching of the skin that covers it causes pain. The pain usually lasts between 7 to 14 days until the inflammation (swelling) has passed. 

A thrombosed hemorrhoid occurs when a blood clot is contained in it. Blood clots are the main reason why the hemorrhoidal tissue swells. Essentially, a thrombosed hemorrhoid is a complication that can be present in both internal and external hemorrhoids. A blood clot can cut the blood supply in them, so you should get treatment as soon as possible. 

What are the complications?

Unlike other diseases, complications of this ailment are not lethal. The most common complications of hemorrhoids are: 

  • Strangulation: Interrupted blood flow towards the hemorrhoids that can result in strangulated hemorrhoid and acute pain. 
  • Thrombosis: or blood clots. They can also cause acute pain and make the lining more fragile. This results in a higher chance of bleeding. 
  • Prolapse: Seen in internal hemorrhoids. Once they get to the exterior, a prolapsed hemorrhoid can easily become strangulated. They cause constant discomfort and pain. 
  • Infections: This disease makes the cleansing of the anus area a little more difficult. This can be a risk factor for infection and abscesses. 

How do you know if you have hemorrhoids?

If you experience symptoms like rectal bleeding, pain around your anus, or feel a lump in that area, suspect hemorrhoids. However, it is important that you still go to a doctor since there are many rectal bleeding causes. Colorectal cancer is another common cause of bleeding, so you’ll need to rule out first any other serious conditions.

When at the doctor, they’ll ask about the symptoms you are having and any risk factors. After the interrogatory, your doctor will perform a physical examination. This includes the inspection of the perianal area and digital rectal examination. Yes, your doctor may need to use their fingers to know what is going on. It can be uncomfortable, so your doctor can use topic anesthesia to avoid discomfort. This way, they can identify masses, ulcers, and bleeding. 

Usually, that’s all it takes to diagnose this disease. Nevertheless, in order to see internal hemorrhoids, doctors need to do an anoscopy. This is a procedure that helps visualize the inside of the anus and the anal canal. It uses a small tubular instrument to observe. Also, any cause of rectal bleeding should be studied, especially if the patient has risk factors for colon cancer. In these cases, your doctor may also perform a colonoscopy. This imaging study uses a tube with a camera to see your rectum and colon. It is very useful to diagnose other colon and rectum conditions. 

How are they treated?

This will depend on the type of hemorrhoid. Most of the patients will find relief for their symptoms with conservative measures. These include: 

  • Warm baths: They calm pain caused by spasms of the anus. One of the ways to do this was with a sitz bath. However, doctors don’t recommend it now. That’s because of the position of your body. Sitting for a long time can, in fact, worsen the disease. Choose instead of a bathtub. 
  • High fiber diet: Preventing constipation and straining is a smart way to prevent the disease. Consider taking a fiber supplement to help reach your fiber goal. 
  • Stool softeners: Their role is not as important, but a softer stool can help prevent straining that causes the disease. 
  • Topical agents: They can help alleviate local symptoms like itching, swelling and ease the pain. However, it is not useful to patients with severe pain or thrombosed hemorrhoids. 

There are also several non-surgical and surgical procedures to remove the disease; two of them are:

  • Rubber band ligation: It’s the most common non-surgical procedure. Rubber bands are inserted through an anoscope to ligate them. This way, the blood flow is stopped, and the tissue dies. Later, scar tissue will appear where the hemorrhoid was before. 
  • Surgical or stapled hemorrhoidectomy: It’s the most effective treatment. It can be done with a laser or the traditional way, and it is basically a removal of the swollen hemorrhoids. This procedure is recommended for patients with recurrence of the disease who didn’t get relief from conservative measures. 

Is it bad if you have hemorrhoids?

As we mentioned before, they are actually a normal part of your anatomy. Everybody has them. The detail is that you don’t notice them unless they get swollen and start to cause symptoms. And even if you happen to have swollen or thrombosed hemorrhoids, it wouldn’t be considered as “bad.” They are just another condition that needs to get treated in order for the patient to get better. Even without treatment, sometimes they can get better on their own.

The real problem with them is the symptoms they cause once they have swollen. Symptoms like rectal bleeding and acute severe pain in the anus tend to worry patients. Nonetheless, they are straightforward to treat most often than not, and you should not worry much about them; just seek treatment.

What’s the prognosis of a person with this disease? 

Remember, hemorrhoids are normal. The prognosis of hemorrhoidal disease is excellent. In fact, most cases can resolve spontaneously or just with medical treatment. However, like any other condition, it can have its complications. After getting non-surgical treatment, patients have a chance of recurrence around 10-50%. This means that they can experience symptomatic hemorrhoids again. On the other side, patients who get surgery have less chance of recurrence, as little as 5%.

Patients who undergo surgery have around a 5% chance of developing some complication concerning the surgical treatment. This depends on the patient but also depends on the surgeon that operates. The most common complications of the procedure include infections, bleeding, recurrence, and wounds that don’t heal. 

Do hemorrhoid bumps go away? 

Actually, yes. Some patients will experience a spontaneous resolution of their disease. Some other patients will need medical treatment to assess their problems. The point is that hemorrhoid bumps are not forever.

Some patients can experience recurrent episodes of the disease, which can be really uncomfortable. The best technique for preventing this is changing the habits that make you prone to have them. Factors like constipation, a low-fiber diet, sitting for a long time, and obesity are risk factors in developing the condition. Even if you happen to have recurrent episodes of enlarged hemorrhoids, they can go away with hemorrhoid surgery. 

Do you have symptoms compatible with this condition?

This tool is a Hemorrhoids Symptoms Checker. It gathers the most important signs, symptoms, and risk factors of this ailment. Therefore, the tool will tell anybody who uses it the likelihood of their symptoms because of hemorrhoids. Using the tool is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.


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