Hemorrhoids

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Overview

We all have hemorrhoids. Hemorrhoids are normal “cushions” of tissue filled with blood vessels, found at the end of the rectum, just inside the anus. Together with a circular muscle called the anal sphincter, they help to control bowel movements. But when people talk about “having hemorrhoids,” they usually mean symptoms such as itching or bleeding caused by enlarged hemorrhoids. This condition is also known as “piles.”

Many people are ashamed of having enlarged hemorrhoids: They don’t like to talk about their symptoms, and might be reluctant to go to the doctor. Some might be afraid of having a physical examination or finding out that they have a serious illness. But seeing a doctor about your symptoms is important if you want to have the right treatment.

Symptoms

Hemorrhoid problems can cause various symptoms. These often include itching, mucus discharge or a burning sensation in the anus. Painless bleeding is common too. This can happen if hard stool damages the thin walls of the blood vessels in hemorrhoids. Bleeding from hemorrhoids is usually visible as bright red or red blood, on toilet paper or in the stool. If you have blood in your stool, it’s important to see a doctor rather than try to diagnose the problem yourself.


Swollen hemorrhoids might come out of the anus and can then be seen as soft lumps of tissue. This is called a protruding or prolapsed hemorrhoid. Sometimes hemorrhoids are confused with anal skin tags. These are small flaps of skin that grow around the anus and can cause similar symptoms.


Larger hemorrhoids generally lead to more severe symptoms. They can make it feel like something is pushing against the anus, or like there is something in that area, and sitting can be very uncomfortable. People might also feel like their bowel isn’t really empty, although they have just gone to the toilet. Mucus or stool might come out by accident too, particularly when passing wind. More severe hemorrhoids can be very painful.


Hemorrhoids can be classified according to how severe they are:


Grade 1: Slightly enlarged hemorrhoids that can’t be seen from outside the anus.

Grade 2: Larger hemorrhoids that sometimes come out of the anus, for example while passing stool or – less commonly – during other physical activities. They then go back inside again on their own.

Grade 3: Hemorrhoids that come out of the anus when you go to the toilet or do other physical activities, but don’t go back inside on their own. They can be pushed back inside, though.

Grade 4: Hemorrhoids that are always outside the anus and can no longer be pushed back inside. Usually, a small bit of the anal lining comes out of the anus too. This is also known as rectal prolapse.

Itching or irritation in your anal region.
Pain or discomfort.
Swelling around your anus.
Bleeding.

Causes

Increased pressure on the anal canal (the last section of the rectum) can cause hemorrhoids to become enlarged. Various factors might make this more likely. For example:


Being overweight

Chronic constipation

Frequent diarrhea

Regularly lifting heavy objects

Pregnancy and giving birth

The risk of enlarged hemorrhoids increases with age – probably because the tissue becomes weaker over time. And hemorrhoid problems are thought to run in families too.

Risk factors

Straining during bowel movements.

Sitting for long periods of time on the toilet.

Having chronic diarrhea or constipation.

Being obese.

Being pregnant.

Having anal intercourse.

Eating a low-fiber diet.

Regular heavy lifting.

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Complications

Anemia.

Blood clots in external hemorrhoids.

Infection.

Skin tags (flap of tissue that hangs off skin).

Strangulated hemorrhoids (muscles in the anus cut off blood flow to a prolapsed internal hemorrhoid).

Prevention

Eat high-fiber foods. Eat more fruits, vegetables and whole grains. ...

Drink plenty of fluids. ...

Consider fiber supplements. ...

Don't strain. ...

Go as soon as you feel the urge. ...

Exercise. ...

Avoid long periods of sitting.