Understanding Hemorrhoids: Causes, Symptoms, and Treatment Options for Piles

Hemorrhoids or piles are locally known as “bawaseer” in South Asian countries India and Pakistan. They form in the last and the second last part, the anus and the rectum of our digestive system. Sometimes, pressure exertion on small blood vessels (veins) of the rectum and the anus causes painful swelling. Bleeding may also occur in some cases. This condition is called piles or hemorrhoids. Approximately 75% of Indians complain of hemorrhoids, while their exact percentage is unknown in Pakistan. Similarly, 10 million people in the United States of America are hemorrhoid positive.

Highlights

• Hemorrhoids or piles are swollen veins inside and outside the rectum and the anus. The swollen veins enlarge, become painful, and may cause bleeding in some patients.
• Hemorrhoids affect people irrespective of gender, age, ethnicity, and race. One in every 20 Americans is a victim of symptomatic hemorrhoids.
• Hemorrhoids form due to pressure exertion on the rectum and the anus region due to labor work, pregnancy, constipation, etc.
• Doctors order digital rectal exams, anoscopy tests, and sigmoidoscopy to diagnose hemorrhoids or piles.
• Doctors recommend warm baths, non-steroidal anti-inflammatory drugs (NSAIDs), and a high-fiber diet to treat hemorrhoids.
• Other treatment options for hemorrhoids include rubber band ligation, electrocoagulation, infrared coagulation, sclerotherapy and hemorrhoidectomy surgery.

What are hemorrhoids?

Hemorrhoids or piles are swollen veins inside and outside the rectum and the anus. The swollen veins enlarge, become painful, and may cause bleeding in some patients. Hemorrhoids are a common condition we are all born with, but they usually do not bother us or cause any problems. However, they are painful and irritating when they swell and enlarge. Hemorrhoids affect people irrespective of gender, age, ethnicity, and race. One in every 20 Americans is a victim of symptomatic hemorrhoids.

Types of hemorrhoids

Hemorrhoids have three types depending on where they form. Types (Figure 1) include:

1. Internal hemorrhoids: When hemorrhoids form due to swelling of veins inside the rectum. Internal hemorrhoids usually are not painful, but they may bleed.
2. External hemorrhoids: When hemorrhoids form due to swelling in anal veins. External hemorrhoids are not harmful but can be painful, irritating, and occasionally bleed.
3. Prolapsed hemorrhoids: If internal or external hemorrhoids stretch and form an outgrowth or bulge outside the anus. These hemorrhoids are called “prolapsed hemorrhoids”. They can cause bleed and pain.

Risk factors of hemorrhoids

Symptomatic hemorrhoids are very common; even teenagers can get hemorrhoids. However, children are less likely to develop hemorrhoids. The following are the risk factors of hemorrhoids:

• Being obese or overweight makes you more prone to get hemorrhoids.
• Low-fiber diet: You may get hemorrhoids if your diet is low in fiber.
• Pregnancy also increases your chances of developing hemorrhoids.
• Constipation or diarrhea: People with irregular bowel movements have a higher risk of getting hemorrhoids due to chronic diarrhea or constipation.
• Other risk factors of hemorrhoids include weightlifting and spending much time in the toilet.

Causes

Hemorrhoids form due to the exertion of pressure on our lower abdominal region, specifically the rectum and the anus. Many of our daily work activities cause exertion of pressure on our lower abdominal region. For example, labor work, weightlifting, pregnancy or constipation, etc. These works put extra pressure on the veins of the rectum and the anus region. This causes swelling, pain, and inflammation in these regions.

Further, the swollen veins enlarge, accumulate, swell and form an outgrowth or bulge. This condition is called hemorrhoids or piles. Sometimes, a bulge can grow only inside the rectum or outside the anus. However, a painful bulge may also affect the rectum and the anus.

Symptoms

Most people do not have pain or bleeding with hemorrhoids, so no symptoms appear. In contrast, hemorrhoids cause painful swelling and inflammation of the rectum and the anus in some people, which may cause bleeding.

Diagnosis

Doctors order digital rectal exams, anoscopy tests, and sigmoidoscopy to diagnose hemorrhoids or piles. The digital rectal examination involves analyzing the rectum and the anus by inserting a gloved finger inside the rectum. Anoscope is a 5-inch long, small-diameter hollow tube to examine the anal canal and the rectum. Similarly, sigmoidoscopy involves an examination of the lower colon region using a sigmoidoscope.

Treatment

Doctors recommend warm baths, non-steroidal anti-inflammatory drugs (NSAIDs), and a high-fiber diet to treat hemorrhoids. However, people having severe pain and swelling need complete removal of hemorrhoids using the following methods:

1. Rubber band ligation involves placing a rubber band around hemorrhoids to remove them.
2. Electrocoagulation and infrared coagulation use heating through an electric current or infrared probe to remove hemorrhoids.
3. Sclerotherapy involves injecting a specific chemical directly into the hemorrhoids to destroy them.

The above methods do not apply to removing large hemorrhoids. So, doctors remove large hemorrhoids using a surgical procedure called hemorrhoidectomy.