Hemorrhoids

summary hemorrhoids

Hemorrhoids are existing veins in the anal area and nerve endings of digestive organs, we all have them. In some cases there is an abnormal dilation or swelling of the veins of the rectum (end of the intestine), this is what we call a hemorrhoidal crisis, but which is popularly called hemorrhoids.
Hemorrhoids can be internal, when the prolapses are in the lower rectum, or external, when the prolapses are around the anus. These two forms often coexist.
The hemorrhoidal crisis is the main cause of anal bleeding, but it is not possible to specify the number of people affected due to the large number of people who self-medicate, not looking for a doctor, and due to the numerous diseases with similar symptoms. Despite this, it is estimated that approximately 4% of the world’s population suffer from this condition.

The causes are not yet fully understood, but some factors have already been related: heredity, constipation , excessive effort when defecating, pregnancy, overweight , among others.

The main symptoms are: formation of prolapses (internal or external), pain, itching, irritation and bleeding.

Although rare, hemorrhoidal crises can lead to serious complications such as strangulation of hemorrhoids and hemorrhoidal thrombosis  .

The diagnosis is made through clinical examination and knowledge of the person’s history, in some cases a palpation examination or anoscopy may be necessary.

The first symptoms of the hemorrhoidal crisis can be treated initially with analgesics (eg paracetamol) to relieve pain and local application of anesthetic (eg lidocaine) through creams or suppositories. A sitz bath with hot water, with or without a medicinal plant (eg witch hazel), can also be used.

To reduce bleeding, the main thing is to avoid constipation, one of the ways is to maintain a fiber-rich diet. Medications based on flavonoids also help to reduce bleeding.

Among the natural alternatives, we have the following plants that can be used in different ways (ointments, creams, gels, suppositories, pills, capsules, sitz bath, wet wipes, sitz bath) in cases of hemorrhoidal crises: witch hazel , chamomile , horse chestnut , tea tree .

Another alternative to conventional treatment is the use of homeopathy, see a homeopath.

If there is no improvement after 3 or 4 days, if there is severe pain or bleeding when having a bowel movement, it is advisable to consult a doctor.

When treatment with medication and natural alternatives are not working, it is possible to resort to minimally invasive treatments (elastic ligation, laser, infrared, bipolar coagulation, sclerotherapy) or even surgical treatments.

The main good advices are: treat constipation by eating a lot of fiber, avoid eating too much pepper and practice exercises or sports.

Also Read: 8 Ways to Prevent Hemorrhoids – Tips from an Expert

Definition

The hemorrhoidal crisis comes from an abnormal dilation or swelling of the veins around the lower rectum (end of the intestine), internal hemorrhoids , or in the anus itself, external hemorrhoids. Hemorrhoids are common in adults, from the age of 50, about one in two people are affected during their lifetime by hemorrhoids1 . When crises do not occur for a hereditary cause, they are often provoked by an increase in abdominal pressure that leads to a dilation of the veins at the anal level.
We observed that hemorrhoids are actually existing veins in the anal region and nerve endings of digestive organs. Therefore, it is somehow wrong to say that “a certain person has hemorrhoids”, since in the literal sense everyone has them. It is therefore more correct to speak of a hemorrhoidal crisis.

Internal hemorrhoidal crises can be classified according to the degree of prolapse in the anal canal:

– Grade I: Internal hemorrhoids are visible on anoscopy and there may be slight bulges, but they do not externalize.

– Grade II: the hemorrhoidal prolapse comes out of the anal canal with defecation or with effort, but it reduces spontaneously.

– Grade III: the hemorrhoidal prolapse comes out of the anal canal with defecation or with straining and requires the person to place them in the normal position.

– Grade IV: hemorrhoids are irreducible and can strangle, causing complications.

External hemorrhoidal crises have no classification.

Epidemiology

Although hemorrhoidal crisis is a common cause of anal bleeding and discomfort, the true numbers on this disease are still unknown. This is due to the large number of people who do not go to the doctor and do self-medication, in addition to having other diseases that can cause similar symptoms and confuse the diagnosis.

Children rarely suffer from hemorrhoids.

By the age of 50, about 1 in 2 people have suffered from hemorrhoids.

– In Brazil, there are no precise data, but according to experts, about 10 to 15% of the population are affected by the hemorrhoidal crisis.

– In the United States, it is estimated that around 10 million people suffer from hemorrhoids on a regular basis. A large study carried out in the United States and England demonstrated a prevalence of approximately 4%, with no differences between genders.

– In France, the number is 2 million people.

Causes

 

The causes of hemorrhoids (hemorrhoidal crisis) are still not completely known, but there are some theories: the first is related to the deterioration of the sphincter, the second is related to the thickening or hypertrophy of the sphincter and the third is related to the swelling of the plexus hemorrhoids (which everyone has).
Some factors can accentuate or trigger a hemorrhoidal crisis:

– Age: because the tissues around the hemorrhoids become weaker.

 Heredity (genetic causes)

– Constipation  (the number 1 cause of hemorrhoids), especially after a low-fiber diet (read about recommendations for discovering fiber-rich foods.

– Excessive effort when defecating

– Excessive consumption of irritating laxatives

– Spending too much time on the toilet

 Pregnancy (especially in the last trimester)

– Overweight _

– heart failure

 Lack of exercise (sedentary lifestyle)

– Anal sex

 Food very rich in spices or alcohol

– Chronic diarrhea

people at risk

The following people may more regularly suffer from hemorrhoids:

– People with a cold
– People with frequent diarrhea
– People who have a family history of hemorrhoids
– Pregnant women
– People who are obese
– People between 45 and 65 years old
– People over 60 years old. In fact, hemorrhoids are more common in the elderly, as the tissues that support the veins in the rectum and anus can weaken and relax with age.
– People suffering from heart or liver disease
– People with pelvic tumor
– People who practice anal sex

Symptoms

We call hemorrhoids located inside the rectum (end of the intestine) internal hemorrhoids and those located outside the anus external hemorrhoids. The most common symptoms are: bleeding, itching and pain.
Here are the symptoms of each:

Internal hemorrhoids (1st and 2nd degree)

In this case, hemorrhoids are, as their name implies, located inside the anus, in the rectum, and are generally not very painful and not very visible. Bleeding can be associated with this type of hemorrhoids. These are usually the first and second stages (1st and 2nd degree) of hemorrhoids (flares).

Internal (3rd and 4th degree) and external hemorrhoids

In more advanced stages (grades 3 and 4), hemorrhoids protrude outside the anus and become visible. Pains (rather severe) occur especially during defecation. Itching and irritation are also important signs of hemorrhoids. Bleeding (not abundant), bright red, may appear during defecation. It is also possible that there is leakage of feces or difficulty cleaning after a bowel movement. You can find these bleeds on toilet paper with traces of light red blood.

Attention if there is bleeding after defecation, despite hemorrhoids being the main cause of intestinal bleeding, it is necessary to undergo a medical examination to exclude a hypothetical risk of cancer ( intestinal cancer ,…). This diagnosis is luckily relatively rare, but it’s important to pay attention.

Diagnosis

The diagnosis of hemorrhoids is made by a doctor. In general, he will perform a clinical examination and anamnesis. One of the main difficulties is to exclude other more serious illnesses that could present similar symptoms (eg in case of blood in the stools). A palpation exam or anoscopy may also be necessary.

Complications

Hemorrhoids rarely cause serious complications, but sometimes strangulation of the hemorrhoids can occur at the level of the anus, which causes severe and lasting pain. In rare cases, a pool of clotted blood can form in the veins, then we speak of hemorrhagic thrombosis, which usually occurs suddenly with the appearance of a hardened nodule after exertion. In most of these cases, surgery is required to remove the problematic hemorrhoid.

When to see a doctor?

It is absolutely necessary to consult a doctor if there is blood in the stool, as this symptom could be the eventual sign of bowel cancer. In case of severe pain (signs of a possible clotting of blood), regular bleeding (risk of anemia), chronic itching, we also advise you to consult a doctor quickly.
Attention: non-exhaustive list, for every suspicious symptom please consult a doctor.

Treatments

Although hemorrhoids are uncomfortable or painful, they are not a serious condition.2.

Before starting specific treatments for hemorrhoids, you can start taking an analgesic, for example acetaminophen , to calm the pain. This medicine is particularly effective and recommended in case of hemorrhoidal crisis. In addition, it is important to avoid constipation (dry or infrequent stools) as it can cause rectal/anal bleeding or fissures and increase the risk of developing new troublesome hemorrhoids.
Drug treatments do not lead to cure, but relief of symptoms. The cure of dilated hemorrhoids is only possible through a surgical process.

The treatment of symptoms of internal and external hemorrhoidal crisis are practically the same, what changes is the form of administration. Suppositories are used for internal hemorrhoids, while for external hemorrhoids creams, ointments, gels, medicinal wipes and sitz baths can be used. Pills, minimally invasive treatments and surgery can be used in both cases.

– anesthetics (eg lidocaine) or hydrocortisone in cream, ointment, gel or suppository form: help temporarily relieve pain, inflammation and itching. But hydrocortisone should not be used for more than 1 week in a row, unless under medical guidance.

– medicines based on flavonoids (diosmin and hespiridin): decreases the risk of bleeding and pain. In less than half of cases it also reduces itching and recurrence. To be taken during the hemorrhoidal crisis 6 times a day, for 3 to 4 days.

– Sitz baths with or without medicinal plants (eg witch hazel ). They must be done with hot water, for 10 to 15 minutes, 2 to 3 times a day.

Minimally invasive treatments

– rubber band ligation: used in cases of internal hemorrhoids, in 70 to 80% of patients it is successful. A bandage or ring is placed around the base of an internal hemorrhoid, restricting blood flow, causing the hemorrhoids to shrink and degenerate over several days.

– laser, infrared or bipolar coagulation: These methods use laser, infrared light or heat to destroy external hemorrhoids.

– sclerotherapy: a chemical solution is injected into the tissues of the hemorrhoid

We emphasize that there are also other treatment possibilities for hemorrhoids, especially for cases of external hemorrhoids that resist drug and minimally invasive treatments. These are mainly surgical treatments (operations). Talk to your doctor so that he can better inform you about the most appropriate treatment for your case.

According to proctologist Dr. Marcon, interviewed by Create health, the choice of an operative technique “is determined by a combination of factors such as: size and extent of hemorrhoids, location, local and health conditions, patient habits. In general, no technique is the IDEAL, after all, they all have rates of discomfort, pain or postoperative complications”. The Doctor. Marcon still recalls that external hemorrhoids in general have as their only treatment the resection (removal) of excess skin.

Surgical treatments often cause pain after surgery (postoperative). Non-invasive techniques have been around for a few years and offer less risk of complications and are much less painful, such as THD (Doppler-guided transanal hemorrhoidal dearterialization). This technique, however, does not apply to all patients. Consult your doctor.

Phytotherapy (medicinal plants)

The following medicinal plants have been shown to be effective against hemorrhoids:

– Witch hazel , to be taken generally in the form of ointments, suppositories, pills or in a sitz bath. You can also use a cotton swab and apply the preparation directly to the rectum.

– Chamomile , to be used generally in sitz baths or wet wipes.

– Horse chestnut , usually taken in capsule form.

– The tea tree , studies of this plant in gel form are ongoing.

– The mullein , usually in the form of a decoction (Add in phyto).

– Italian cypress, usually found in the form of a decoction or essential oil.

Sitz baths should be done in hot water for 10 to 15 minutes, 2 to 3 times a day. Bath seats can be found in pharmacies, but it is also possible to use bathtubs. Do not add soap, bath bubbles or other non-herbal additives. These sitting baths work by increasing blood flow and relaxing the musculature around the anus.

– Coconut oil . This oil has anti-inflammatory and calming effects and can be applied directly to hemorrhoids several times a day.

Tips – Prevention

– Adopt a diet rich in fiber , fresh vegetables or dried fruits. Foods rich in fiber are: soybeans, beans, corn, brown rice, whole grain bread and prunes. Eating fiber prevents constipation  (the main cause of hemorrhoids).
You can also buy fiber in the form of a food supplement.

– Avoid eating dishes with a lot of spices, very spicy and concentrated sweets.

– Do exercises or sports regularly, this favors the proper functioning of the body and reduces constipation (source of hemorrhoids).

– Go to the bathroom whenever you feel like it, don’t hold back.

– Clean the anal area regularly, for example, using medicated wipes (moistened) after each trip to the bathroom. Avoid toilet paper which irritates and increases inflammation. You can also use soaps (stone soap, for example). Some medical experts, however, advise against using baby wipes (or medicated wipes) as they often contain allergens and preservatives that can irritate the skin in the anus. An anus-level showerhead, bidet, and use of soft toilet paper are preferred.

– Drink plenty of water (1.5 to 2 liters per day), this measure helps prevent constipation.

– Avoid taking very powerful laxatives for a long time.

In fact, in cases of constipation, if possible, prefer non-irritating laxatives or dietary measures (drink plenty of fluids and eat fiber mainly).

– Gently clean the anal area with water, for example when taking a bath or shower. The use of soap is not necessary, as in some cases it can aggravate hemorrhoids.

– Against pain, you can apply cold or hot compresses (cold-hot packs). To relieve inflammation during hemorrhoids, cold (ice pack, cold packs) is most recommended3.

– As we saw in this file (read in Treatments and Phytotherapy ), a sitz bath helps to improve blood circulation and soothes irritation during hemorrhoids . To prepare a sitz bath, fill a bathtub with a bottom of 7 to 10 cm with hot water. Then dip your buttocks to the level of the anus for 15-20 minutes several times a day. When you get out of the shower, wipe gently with a towel. There are also special bathtubs to perform sitz baths, available in specialized stores.

– Do not wear clothes that are too tight.

Also Read: 8 Ways to Prevent Hemorrhoids – Tips from an Expert

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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