The topic of hemorrhoids is an uncomfortable conversation for many.
But did you know that this condition affects millions of people worldwide?
The truth is many people are dealing with this condition. However, many aren’t quite sure what they are.
If you suspect this is a condition you are dealing with, you’ve come to the right place.
In this article, we will discuss all things hemorrhoids: what they are, the many types, causes, treatment, and more.
What Are Hemorrhoids Made Of?
Let’s start with the basics.
Hemorrhoids are clusters of blood vessels, muscle fibers, and connective tissue located in the rectal and anal regions [1].
Believe it or not, hemorrhoids are actually a natural part of your anatomy. Hemorrhoidal cushions play an important role as they aid in controlling continence and keeping the stool [2].
But when people refer to “hemorrhoids,” they’re referring to the swelling and inflammation of these cushions. That’s where the problem begins.
So where does this inflammation come from? Read on to learn about the development of hemorrhoids.
How Hemorrhoids Develop
So, how do these rectal and anal cushions turn into what we call hemorrhoids? It’s all about pressure.
In the simplest terms, when extra pressure is placed on the pelvic and rectal area, this can lead to the blood vessels around the anus stretching and swelling.
This then results in the formation of hemorrhoids.
But it’s a little more complicated than that. Let’s dig even deeper into how hemorrhoids develop. It’s all about pressure, inflammation, and balance.
The Pressure Game: When Things Take a Turn
The increased pressure often stems from lifestyle choices. Eventually, this increased pressure starts affecting blood vessels and surrounding tissues.[3]
Pressure continues to mount, which then causes the blood vessels and supportive tissues located around the hemorrhoids to swell.
This swelling is a natural response. It’s your body’s way of dealing with the increased demand placed upon these tiny cushions.
But not all hemorrhoids are the same. In the next section, we will discuss 3 different types of hemorrhoids: internal hemorrhoids, external hemorrhoids, and prolapsed hemorrhoids.
Types of Hemorrhoids
As mentioned, there are 3 different types of hemorrhoids:
1. Internal Hemorrhoids
Internal hemorrhoids reside inside the rectum – hence the name – away from pain receptors[4]. As they are away from the pain receptors, these hemorrhoids often go unnoticed.
Gradual Development and Stages
Internal hemorrhoids develop gradually, progressing through different stages. In the early stages (Grade I and II), they might only cause a little discomfort.
You might not even be aware that you are experiencing this!
However, as they advance to Grades III and IV, protrusion and increased symptoms become much more apparent.
Symptoms
Identifying internal hemorrhoids can be tricky due to their silent nature, but they aren’t always symptomless. If you suffer from internal hemorrhoids, you might experience:
- Bleeding during bowel movements [5]
- A feeling of incomplete evacuation
- Occasional discomfort
If you are in tune with your body, you may be aware of the presence of internal hemorrhoids before symptoms worsen.
2. External Hemorrhoids
Unlike internal hemorrhoids, external hemorrhoids, as you may have guessed, develop outside the rectum – specifically around the anal opening [6].
Causes and Triggers
External hemorrhoids are often the result of external factors, such as:
- Straining during bowel movements
- Lifting heavy objects
- Prolonged sitting
Visible Signs and Symptoms
Unlike internal hemorrhoids, you’re much more likely to be aware of the symptoms of external hemorrhoids.
One of the key characteristics of external hemorrhoids is their visibility. You can often feel or see them around the anal opening. They may cause:
- Itching
- Discomfort
- Sometimes severe pain, especially during activities like sitting or walking
3. Prolapsed Hemorrhoids
Another type of hemorrhoids are prolapsed hemorrhoids. These can be either internal or external hemorrhoids, but they take things to the next level.
Hemorrhoids that protrude outside of the anal opening are identified as prolapsed hemorrhoids[7].
Varieties of Prolapsed Hemorrhoids
Prolapsed hemorrhoids come in a few different varieties, each with different characteristics:
- First-Degree Prolapse. The hemorrhoid protrudes into the anal canal during a bowel movement. However, it returns to its original position afterward.
- Second-Degree Prolapse. The hemorrhoid extends outside the anal opening during a bowel movement and retracts spontaneously.
- Third-Degree Prolapse. The hemorrhoid extends outside the anal opening during a bowel movement. It requires manual assistance to retract.
- Fourth-Degree Prolapse. The hemorrhoid is always prolapsed and cannot be pushed back inside. This is the most severe form.
Symptoms
The symptoms of prolapsed hemorrhoids are often more pronounced than their internal or external counterparts. These symptoms include [8]:
- Visible protrusion
- Increased discomfort
- Mucus discharge
Now you’re aware of all 3 different types – but how do these come about?
In the next section we will discuss the causes and risk factors of hemorrhoids.
Causes and Risk Factors
Now that you’re aware of the different kinds of hemorrhoids that exist, it’s time to learn about their causes.
There are a number of causes and risk factors that can lead to hemorrhoids of all kinds.
1. Straining During Bowel Movements
One of the main causes of hemorrhoid formation is straining during bowel movements [9]. When we force things a bit too much down there, and too often, the delicate blood vessels and tissues around the anal area take a bit of a hit. This leads to inflammation and swelling – which, as we mentioned earlier, is that combination that leads to hemorrhoids.
Solution: Cultivate Healthy Bowel Habits
The solution for this cause is a simple one: avoid excess straining. Listening to your body is key. Pay attention to your body’s signals and avoid rushing the process. Make sure you allow nature to take its course without unnecessary pressure.
2. Chronic Constipation or Diarrhea
Healthy bowel habits equal a healthy body. Did you know both chronic constipation [10] and persistent diarrhea can contribute to the development of hemorrhoids?
Solution: Fiber-Rich Diet and Hydration
Fiber is your friend. Maintaining a diet rich in fiber will help regulate bowel movements [11]. Make sure you include fruits, veggies, and whole grains in your diet. Staying hydrated is also essential to keep stools and easy to pass. Water reduces the risk of straining.
3. Pregnancy and Childbirth
Pregnancy comes with a whole set of challenges on the body, and this is one of many areas to pay attention to. The growing uterus increases the pressure on the pelvic region, which impacts blood flow and contributes to the development of hemorrhoids [12]. Childbirth also comes with its own set of risks that can potentially lead to hemorrhoids.
Solution: Manage Symptoms and Posture
While you can’t avoid the many physiological changes that come with pregnancy, you can practice certain behaviors to avoid and manage hemorrhoid symptoms. Simple measures can make a difference, such as:
- Using a cushion for sitting
- Maintaining good posture
- Consulting with your doctor
4. Obesity and Sedentary Lifestyle
Carrying excess weight, especially around the abdominal area, can increase pressure on the pelvic region.
If you combine that with a sedentary lifestyle, you greatly increase your chance of developing hemorrhoids[13]. Sitting for extended periods, especially on hard surfaces, exacerbates the issue.
Solution: Regular Exercise and Weight Management
Regular exercise in your routine helps with weight management and improves blood circulation. Even basic activities like walking can make a big difference, especially if you sit at an office all day.
Implementing good habits to maintain a healthy weight can lessen the strain on your hemorrhoidal blood vessels.
5. Genetics: The Family Connection to Hemorrhoids
Sometimes you can do everything right, but genetics has other plans for you.
If your family has a history of dealing with hemorrhoids, there’s a chance that you might be genetically predisposed to this condition [14].
Solution: Proactive Lifestyle Choices
You can’t change your genetic makeup. But knowledge is power. Knowing your family history means you can make proactive lifestyle choices that lead to better health, such as monitoring of your bowel habits and aiming to maintain a healthy lifestyle.
Now that you’ve learned about the types, causes, and symptoms of hemorrhoids, you might be curious about diagnosis. In the next section, we will talk about the steps you need to take to receive a diagnosis.
Diagnosis
Hemorrhoids can be an uncomfortable thing to talk about, and even more uncomfortable to diagnose.
But, as we mentioned, this is a condition that millions of people deal with. Your doctor is here to help provide an accurate diagnosis and ensure you receive the best treatment for you and your condition.
Here is what you may experience to reach a hemorrhoids diagnosis:
1. Physical Examination: The First Step to Understanding
First things first is the physical examination. [15]. While it might seem a bit uncomfortable at first, it’s an essential step for your healthcare provider to get a clear picture of what’s going on.
When performing the exam, your doctor will examine the external area for any visible signs of hemorrhoids. They may gently insert a gloved and lubricated finger into the rectum for an internal examination.
Understanding the Importance
This examination is vital for grading the severity of hemorrhoids. It helps your doctor determine the type of hemorrhoids you have and assess the health of the region.
2. Anoscopy and Sigmoidoscopy: Peeking Inside for a Closer Look
For a more detailed examination, your doctor might recommend an anoscopy or sigmoidoscopy.
An anoscope is a small, tubular instrument used to examine the lower rectum [16]. A sigmoidoscope allows a more extensive view, reaching up into the sigmoid colon [17].
Addressing Potential Concerns
These procedures might sound intimidating. However, they are incredibly valuable tools for identifying the location, size, and severity of hemorrhoids.
Your doctor will carefully guide these instruments to get a closer look at the inner workings of your lower gastrointestinal tract.
3. Hemorrhoid Grading: Understanding the Severity
After performing the examinations, your doctor will likely grade your hemorrhoids [18]. This grading system helps determine the severity of the condition, ranging from Grade I (mild) to Grade IV (severe).
This information is crucial in tailoring an appropriate treatment plan. Keep reading to learn more about the different types of treatments available.
Treating Hemorrhoids
Now, whether you’ve received a hemorrhoids diagnosis, or simply want to learn more about treatment options, let’s discuss what one can do to treat hemorrhoids:
1. Lifestyle Modifications
When it comes to managing hemorrhoids, lifestyle modifications are one of the simpler steps you can take to ease symptoms and prevent further irritation.
Dietary Adjustments. As we mentioned earlier, incorporating a high-fiber diet is key to softening stools and promoting regular bowel movements. Include fruits, vegetables, and whole grains into your meals, and make sure to stay hydrated!
Good Bowel Habits. Taking your time in the bathroom can significantly reduce the pressure on the anal area, which should reduce or prevent irritation.
Topical Treatments. There are a number of over-the-counter creams, ointments, and medicated wipes that can provide relief from itching and discomfort. These topical treatments often contain ingredients like witch hazel or hydrocortisone [19]. Check out your local pharmacy for different options.
2. Medical Procedures
Sometimes lifestyle modifications alone aren’t enough, particularly with more severe hemorrhoids.
In that instance, it may be best to turn to medical procedures. These treatments target the root causes of hemorrhoid discomfort to provide relief.
Rubber Band Ligation. This is a common outpatient procedure that involves placing a rubber band around the base of the hemorrhoid [20]. This band cuts off the hemorrhoid blood supply. The hemorrhoid then withers away and falls off within a few days.
Sclerotherapy. In this process, a chemical solution is injected into the hemorrhoid, which causes it to shrink [21]. This outpatient procedure is particularly effective for treating small hemorrhoids.
Infrared Coagulation (IRC). IRC uses heat to clot the blood vessels within the hemorrhoid. This leads to scar tissue formation and subsequent shrinkage [22]. This procedure is quick and often well-tolerated.
Hemorrhoidectomy. When dealing with severe or persistent hemorrhoids, surgical removal may be recommended. A hemorrhoidectomy involves the removal of the hemorrhoidal tissue. It provides a more permanent solution [23].
3. Interventional Radiology
For certain types of hemorrhoids, the best treatment plan might be interventional radiology, which is a specialized field that treats certain types of hemorrhoids. It is particularly useful in hemorrhoid cases with excessive blood flow.
Transarterial Embolization. This minimally invasive procedure involves injecting particles or coils into the blood vessels feeding the hemorrhoids. This reduces blood flow and causes them to shrink [24].
When Should You Consider Interventional Radiology?
Interventional radiology is useful for cases where:
- Traditional treatments may not be effective
- When the patient has a specific vascular issue contributing to hemorrhoidal enlargement
Post-Treatment Care: Ensuring Long-Term Relief
Once you’ve received any sort of treatment for hemorrhoids, it’s time to focus on post-treatment care.
Post-treatment care is crucial for ensuring long-term relief. It also prevents the recurrence of hemorrhoids.
Healthy Lifestyle Maintenance. Continue having a high-fiber diet and stay hydrated to maintain good bowel habits [25]. These are essential for preventing the reappearance of hemorrhoids.
Regular Follow-ups. Regular check-ups with your doctor allow for the monitoring of your hemorrhoidal health. This also ensures that you will receive prompt intervention if any issues were to arise.
Myths and Facts
As this condition is often untalked about, there are a number of myths out there about hemorrhoids and their symptoms and treatment.
In this section we’ll talk about fact versus fiction when it comes to hemorrhoids:
Myth: Only Older Adults Get Hemorrhoids
Fact: People of all ages can suffer from hemorrhoids.
While it is rumored that hemorrhoids only affect the elderly, they can actually be an issue for individuals of any age [26].
The following factors can contribute to the development of hemorrhoids in younger people:
- Lifestyle factors
- Genetics
- Various health conditions
Myth: Surgery Is the Only Solution for Hemorrhoids
Fact: There are numerous treatment options for hemorrhoids.
As we mentioned earlier in this article, surgical procedures like hemorrhoidectomy exist. However, they are not the only solutions [27]. Many cases of hemorrhoids will respond well to:
- Lifestyle changes and other more conservative measurements
- Over-the-counter treatments
- Medical procedures, such as rubber band ligation or transarterial embolization.
Surgical intervention is typically reserved for persistent or severe cases.
Myth: Hemorrhoids Are Always Painful
Fact: Sometimes hemorrhoids are not painful.
While hemorrhoids can cause discomfort, itching, and pain, they aren’t always painful [28]. Internal hemorrhoids, in particular, may even go unnoticed as they lack pain receptors. Some primary indicators that may come without significant pain are the following:
- Bleeding during bowel movements
- A sensation of fullness
Myth: Hemorrhoids Are an Outcome of Poor Hygiene
Fact: Cleanliness matters, but it is not the sole culprit.
Maintaining good hygiene is important, but poor cleanliness alone won’t cause hemorrhoids. Hemorrhoids are a result of increased pressure on the rectal veins, leading to inflammation. Good hygiene practices can, however, help alleviate symptoms and prevent further irritation [29].
Myth: Hemorrhoids Are an Irreversible Condition
Fact: Hemorrhoids are treatable and manageable!
While hemorrhoids may be persistent, they are not irreversible. Many cases respond well to:
- Lifestyle modifications
- Over-the-counter treatments
- Minimally medical procedures [30]
Surgical interventions are also an option to remove hemorrhoids, though they are typically reserved for the most severe cases.
Conclusion
Hemorrhoids can be more than just uncomfortable to talk about. In moderate to severe cases they can be incredibly irritating!
As this ailment is incredibly common, it is important to understand the causes, symptoms, diagnosis, and treatment options for this condition. This can easily affect you or a loved one.
Understanding what hemorrhoids are and how to manage them is a journey toward better health. You can navigate the challenges of hemorrhoids with confidence by seeking timely medical advice. Remember, you’re not alone on this journey. There is support available to help you every step of the way.
If you suspect that you’re dealing with moderate to severe hemorrhoids, interventional radiology may be a solution for you. At Imaging and Interventional Radiology, our team of dedicated experts maintains a patient-focused approach, providing high-quality care with compassion and expertise.
You shouldn’t have to suffer. Take the first step towards relief and improving your everyday well-being. Contact Imaging and Interventional Radiology today!
Resources
1. https://www.sciencedirect.com/science/article/abs/pii/S1043148907000292
3. https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268
4. https://www.ncbi.nlm.nih.gov/books/NBK537182/
5. https://pubmed.ncbi.nlm.nih.gov/15667500/
6. https://www.ncbi.nlm.nih.gov/books/NBK500009/
7. https://www.healthline.com/health/prolapsed-hemorrhoid#causes
8. Sun Z, Migaly J. Review of Hemorrhoid Disease: Presentation and Management. Clin Colon Rectal Surg. 2016 Mar;29(1):22-9. doi: 10.1055/s-0035-1568144. PMID: 26929748; PMCID: PMC4755769.
9. Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist’s view. World J Gastroenterol. 2015 Aug 21;21(31):9245-52. doi: 10.3748/wjg.v21.i31.9245. PMID: 26309351; PMCID: PMC4541377.
10. Oberi IA, Omar Y, Alfaifi AJ, Ayoub RA, Ajeebi Y, Moafa SH, Elhilu AH, Ayoub AH, Gosadi IM. Prevalence of Hemorrhoids and Their Risk Factors Among the Adult Population in Jazan, Saudi Arabia. Cureus. 2023 Sep 25;15(9):e45919. doi: 10.7759/cureus.45919. PMID: 37885500; PMCID: PMC10599269.
11. Forootan M, Bagheri N, Darvishi M. Chronic constipation: A review of literature. Medicine (Baltimore). 2018 May;97(20):e10631. doi: 10.1097/MD.0000000000010631. PMID: 29768326; PMCID: PMC5976340.
12. https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/piles/
13. Hong YS, Jung KU, Rampal S, Zhao D, Guallar E, Ryu S, Chang Y, Kim HO, Kim H, Chun HK, Sohn CI, Shin H, Cho J. Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults. Sci Rep. 2022 Jan 7;12(1):129. doi: 10.1038/s41598-021-03838-z. PMID: 34996957; PMCID: PMC8741788.
14. Villalba H, Abbas MA. Hemorrhoids: modern remedies for an ancient disease. Perm J. 2007 Spring;11(2):74-6. doi: 10.7812/tpp/06-156. PMID: 21461099; PMCID: PMC3057743.
15. https://www.aafp.org/pubs/afp/issues/2018/0201/p172.html
16. https://medlineplus.gov/lab-tests/anoscopy/
17. https://www.mayoclinic.org/tests-procedures/flexible-sigmoidoscopy/about/pac-20394189
19. Mott T, Latimer K, Edwards C. Hemorrhoids: Diagnosis and Treatment Options. Am Fam Physician. 2018 Feb 1;97(3):172-179. PMID: 29431977.
20. Albuquerque A. Rubber band ligation of hemorrhoids: A guide for complications. World J Gastrointest Surg. 2016 Sep 27;8(9):614-620. doi: 10.4240/wjgs.v8.i9.614. PMID: 27721924; PMCID: PMC5037334.
21. He A, Chen M. Sclerotherapy in Hemorrhoids. Indian J Surg. 2023 Apr;85(2):228-232. doi: 10.1007/s12262-022-03414-3. Epub 2022 Apr 20. PMID: 35469212; PMCID: PMC9022405.
22. Marques CF, Nahas SC, Nahas CS, Sobrado CW Jr, Habr-Gama A, Kiss DR. Early results of the treatment of internal hemorrhoid disease by infrared coagulation and elastic banding: a prospective randomized cross-over trial. Tech Coloproctol. 2006 Dec;10(4):312-7. doi: 10.1007/s10151-006-0299-5. Epub 2006 Nov 27. Erratum in: Tech Coloproctol. 2009 Mar;13(1):103. PMID: 17115317.
23. https://www.ncbi.nlm.nih.gov/books/NBK549864/
24. Bagla S, Pavidapha A, Lerner J, Kasimcan MO, Piechowiak R, Josovitz K, Marathe A, Isaacson A, Sajan A. Outcomes of Hemorrhoidal Artery Embolization from a Multidisciplinary Outpatient Interventional Center. J Vasc Interv Radiol. 2023 May;34(5):745-749. doi: 10.1016/j.jvir.2023.01.023. Epub 2023 Feb 1. PMID: 36736822.
25. https://www.nhs.uk/conditions/piles-haemorrhoids/
26. Yildiz T, Aydin DB, Ilce Z, Yucak A, Karaaslan E. External hemorrhoidal disease in child and teenage: Clinical presentations and risk factors. Pak J Med Sci. 2019;35(3):696-700. doi: 10.12669/pjms.35.3.442. PMID: 31258578; PMCID: PMC6572969.
27. https://www.mayoclinic.org/diseases-conditions/hemorrhoids/diagnosis-treatment/drc-20360280
28.https://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them
29. https://www.proctologyinstitute.com/2017/04/14/anal-hygiene-how-to-cleanup-down-there/