Hemorrhoid

What are Hemorrhoid? Causes, Symptoms, Treatment, Herbal Remedies, Lifestyle Changes, and Surgical Options

Introduction

Hemorrhoids, Just the word can make people cringe. If you’ve ever had them, you know how uncomfortable and downright painful they can be. Even if you haven’t experienced them yourself, you’ve likely heard the horror stories from friends or family members. Hemorrhoids are swollen veins in your lower rectum and anus, and they’re surprisingly common. They affect millions of people around the world, but despite this, they remain a somewhat taboo topic of conversation. This article aims to demystify hemorrhoids, providing you with a comprehensive guide that covers everything from what they are and their causes to symptoms, treatments, and even herbal remedies. So, whether you’re dealing with hemorrhoids yourself or just want to be better informed, read on to learn all about this common condition and how to manage it effectively.

Understanding Hemorrhoids

What are Hemorrhoids?

Hemorrhoids are essentially varicose veins that occur in the rectum and anus. Just like the varicose veins you might see on someone’s legs, hemorrhoids are veins that have become swollen and inflamed. They can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). Hemorrhoids can be quite uncomfortable and cause a variety of symptoms, including pain, itching, and bleeding during bowel movements. While they are rarely life-threatening, they can significantly impact a person’s quality of life.

Hemorrhoids occur when there is increased pressure in the lower rectum. This pressure causes the veins to stretch and swell, forming hemorrhoids. This condition can be compared to a balloon that gets too much air: eventually, the walls of the balloon (or veins) can’t hold the pressure and start to bulge.

Types of Hemorrhoids

Understanding the different types of hemorrhoids is crucial in determining the appropriate treatment. There are two main types of hemorrhoids: internal and external.

1. Internal Hemorrhoids: These hemorrhoids develop inside the rectum. Because there are few pain-sensing nerves in the rectum, internal hemorrhoids usually don’t cause discomfort. However, straining or irritation when passing stool can damage a hemorrhoid’s surface and cause it to bleed. Occasionally, an internal hemorrhoid may prolapse, which means it extends outside the anus. This can result in pain and irritation.
2. External Hemorrhoids: These hemorrhoids develop under the skin around the anus, where there are many more pain-sensing nerves, making them much more painful. When irritated, external hemorrhoids can itch, bleed, and cause significant discomfort. Sometimes, blood may pool in an external hemorrhoid and form a clot (thrombus), resulting in severe pain, swelling, and inflammation.
3. Prolapsed Hemorrhoids: These occur when internal hemorrhoids swell and slip outside of the anus. Prolapsed hemorrhoids can cause pain, discomfort, and bleeding. They are graded based on the degree of prolapse, from slight prolapse that can retract on its own to severe prolapse that cannot be manually pushed back.

Causes of Hemorrhoids

Common Causes

There are several common causes of hemorrhoids, many of which involve increased pressure in the lower rectum. This pressure can be due to:

• Straining during bowel movements: This is one of the most common causes. Straining puts extra pressure on the veins in the rectum and anus, which can cause them to swell and form hemorrhoids.
• Sitting for long periods on the toilet: Spending too much time on the toilet can increase the pressure on the veins in the anus.
• Chronic diarrhea or constipation: Both conditions can cause straining during bowel movements and increase the risk of developing hemorrhoids.
• Obesity: Being overweight can put extra pressure on the rectal and anal veins.
• Pregnancy: The weight of the fetus and hormonal changes can cause hemorrhoids in pregnant women.
• Anal intercourse: This can cause direct pressure and irritation to the rectal veins.
• Low-fiber diet: A diet lacking in fiber can lead to constipation and straining during bowel movements.

Risk Factors

Certain factors can increase your risk of developing hemorrhoids. These include:

• Age: Hemorrhoids are more common as you get older. This is because the tissues that support the veins in your rectum and anus can weaken and stretch with age.
• Family history: If your parents had hemorrhoids, you might be more likely to develop them as well. Genetic predisposition can affect the strength of vein walls and the likelihood of vein swelling.
• Pregnancy: Hemorrhoids are common during pregnancy due to the increased pressure in the abdominal area from the growing fetus. Hormonal changes also contribute to the development of hemorrhoids during pregnancy.
• Lifting heavy objects: Repeatedly lifting heavy objects can increase pressure in the lower rectum, leading to hemorrhoids.
• Prolonged sitting or standing: Both can put extra pressure on the veins in the rectal and anal area.
• Sedentary lifestyle: Lack of physical activity can contribute to the development of hemorrhoids due to poor circulation and increased pressure on the veins.

Symptoms of Hemorrhoids

Internal Hemorrhoid Symptoms

Internal hemorrhoids are typically painless, as there are fewer pain-sensing nerves in the rectum. However, they can cause other symptoms, including:

• Painless bleeding during bowel movements: You might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl. This is often the first sign of internal hemorrhoids.
• Prolapsed hemorrhoid: An internal hemorrhoid may prolapse, or extend outside the anus. This can result in pain, irritation, and sometimes the need for manual repositioning.
• Mucus discharge: Some individuals with internal hemorrhoids may experience a discharge of mucus, which can cause irritation and itching around the anus.
• Feeling of incomplete evacuation: Internal hemorrhoids can give you the sensation that you still need to have a bowel movement even after you’ve just gone.

External Hemorrhoid Symptoms

External hemorrhoids are usually more noticeable and can cause significant discomfort. Symptoms of external hemorrhoids include:

• Pain or discomfort: This is often the most troubling symptom. The pain can be constant or occur during activities such as sitting or passing stool.
• Swelling around the anus: External hemorrhoids can cause a visible lump around the anus. This lump may be tender to the touch.
• Itching or irritation in the anal region: External hemorrhoids can cause a persistent itching or irritation around the anus, which can be very uncomfortable.
• Bleeding: You might notice blood on the toilet paper after wiping or small amounts of blood in the toilet bowl. This bleeding is usually bright red.
• Thrombosed hemorrhoid: When blood pools in an external hemorrhoid and forms a clot, it becomes a thrombosed hemorrhoid. This can cause severe pain, swelling, and inflammation.

Diagnosis of Hemorrhoids

Physical Examination

Diagnosing hemorrhoids typically starts with a physical examination. Your doctor will:

• Inspect the area around your anus: This helps to identify any external hemorrhoids or other conditions that might cause similar symptoms.
• Digital rectal examination: The doctor may insert a gloved, lubricated finger into your rectum to feel for any abnormalities such as lumps or swellings. This examination can help identify internal hemorrhoids or other potential issues within the rectum.

Additional Tests

In some cases, additional tests might be necessary to diagnose hemorrhoids or rule out other conditions that cause similar symptoms. These tests include:

• Anoscopy: This involves using a short, lighted tube called an anoscope to examine the inside of your anus and lower rectum. An anoscopy can help identify internal hemorrhoids and other potential issues in the lower rectum.
• Sigmoidoscopy: This test uses a flexible, lighted tube called a sigmoidoscope to examine the lower part of your colon and rectum. It can help identify internal hemorrhoids, polyps, tumors, and other conditions.
• Colonoscopy: A colonoscopy is a more extensive examination that uses a long, flexible tube with a camera to examine the entire colon and rectum. This test is typically used to rule out more serious conditions such as colorectal cancer or inflammatory bowel disease.

Conventional Treatments for Hemorrhoids

Over-the-Counter Medications

For many people, over-the-counter (OTC) treatments can effectively manage hemorrhoid symptoms. These treatments include:

• Topical treatments: Creams, ointments, and suppositories containing hydrocortisone or witch hazel can reduce inflammation, itching, and discomfort. These are applied directly to the affected area.
• Pain relievers: Oral pain relievers, such as acetaminophen, ibuprofen, or aspirin, can help manage pain and discomfort. These medications can also reduce inflammation.
• Stool softeners: These can make bowel movements easier and reduce the strain that can exacerbate hemorrhoids. Common stool softeners include docusate sodium (Colace) and fiber supplements like psyllium husk (Metamucil).

Prescription Medications

If OTC treatments are not effective, your doctor might prescribe stronger medications, including:

• Topical steroids: These can reduce inflammation and pain more effectively than OTC treatments. Commonly prescribed topical steroids include hydrocortisone creams and suppositories.
• Oral medications: In some cases, your doctor may prescribe oral medications that help reduce swelling and improve symptoms. These medications might include flavonoids, which are plant compounds that can strengthen vein walls and improve circulation.
• Vasoconstrictors: These medications help constrict the blood vessels, reducing swelling and discomfort. Phenylephrine is a common vasoconstrictor used in hemorrhoid treatments.

Herbal Remedies for Hemorrhoids

Witch Hazel

Witch hazel is a natural astringent that can help reduce swelling and soothe hemorrhoid symptoms. It is often found in over-the-counter hemorrhoid treatments. Applying witch hazel directly to the affected area can provide relief from itching and discomfort.

• How to Use: Soak a cotton ball or pad with witch hazel and apply it to the hemorrhoids. You can also find witch hazel in pre-moistened pads specifically designed for hemorrhoid relief.

Aloe Vera

Aloe vera has anti-inflammatory properties and can help soothe and heal the skin. It has been used for centuries to treat a variety of skin conditions, including hemorrhoids.

• How to Use: Apply pure aloe vera gel directly to the affected area. Make sure to use aloe vera gel that is free from additives and fragrances, as these can cause irritation.

Horse Chestnut

Horse chestnut is often used to improve circulation and reduce swelling. It contains a compound called aescin, which has been shown to strengthen vein walls and reduce inflammation.

• How to Use: Horse chestnut can be taken as a supplement or applied topically as a cream. If taking supplements, follow the dosage instructions on the product label or consult with a healthcare professional.

Other Herbal Remedies

There are several other herbal remedies that might help with hemorrhoids, including:

• Butcher’s Broom (Ruscus aculeatus):
  • Properties: Contains saponins, which have anti-inflammatory and vasoconstrictive effects.
  • Benefits for Hemorrhoids: Helps reduce the swelling and inflammation associated with hemorrhoids by improving blood circulation and tightening blood vessels. This can reduce the size and discomfort of hemorrhoids, particularly those that are external.
• Psyllium Husk (Plantago ovata):
  • Properties: A natural source of soluble fiber.
  • Benefits for Hemorrhoids: By absorbing water and forming a gel-like substance, psyllium husk softens the stool and makes it easier to pass. This reduces straining during bowel movements, which is a common trigger for hemorrhoids. Regular use can help prevent the development of hemorrhoids and alleviate symptoms of existing ones.
• Calendula (Calendula officinalis):
  • Properties: Known for its anti-inflammatory, antimicrobial, and healing properties.
  • Benefits for Hemorrhoids: When applied topically, calendula can help reduce inflammation, soothe irritated skin, and promote healing of the affected area. It can be used in ointments or creams to relieve the discomfort of external hemorrhoids and support the repair of damaged tissue.
• Chamomile (Matricaria chamomilla):
  • Properties: Contains anti-inflammatory and soothing compounds such as chamazulene and bisabolol.
  • Benefits for Hemorrhoids: Chamomile can be used in sitz baths to relieve itching, burning, and swelling. Its soothing properties help calm irritated skin and reduce inflammation. Topical applications or compresses can also provide localized relief.

Lifestyle Changes to Manage Hemorrhoids

Dietary Adjustments

Making dietary adjustments can play a significant role in managing and preventing hemorrhoids. A high-fiber diet is essential to keep your stools soft and reduce the strain on hemorrhoids. Foods rich in fiber include:

• Fruits: Apples, pears, berries, and prunes are excellent sources of fiber.
• Vegetables: Leafy greens, broccoli, carrots, and Brussels sprouts are fiber-rich vegetables that can help prevent constipation.
• Whole grains: Oats, brown rice, whole wheat bread, and quinoa are great sources of dietary fiber.
• Legumes: Beans, lentils, chickpeas, and peas are high in fiber and can help improve bowel regularity.

Hydration

Staying well-hydrated is crucial for maintaining healthy bowel function. Drinking plenty of water can help prevent constipation and keep your stools soft, which can reduce the strain on hemorrhoids. Aim to drink at least eight glasses of water a day, and consider increasing your intake if you are physically active or live in a hot climate.

Exercise

Regular physical activity can help improve bowel function and reduce the risk of developing hemorrhoids. Exercise stimulates intestinal function and can help prevent constipation. Aim for at least 30 minutes of moderate exercise most days of the week. Activities like walking, jogging, swimming, and yoga can all be beneficial.

• Walking: A simple and effective way to improve bowel function and overall health.
• Yoga: Certain yoga poses can help improve circulation and reduce pressure on the rectal veins.
• Pelvic floor exercises: Strengthening the muscles of the pelvic floor can help prevent hemorrhoids and improve bowel function.

Minimally Invasive Treatments for Hemorrhoids

When lifestyle changes and medications are not enough, minimally invasive procedures can provide effective relief from hemorrhoid symptoms. These treatments are usually performed in a doctor’s office or outpatient setting and involve less pain and a quicker recovery time compared to surgery.

Rubber Band Ligation

Rubber band ligation is one of the most common minimally invasive treatments for internal hemorrhoids. In this procedure, a small rubber band is placed around the base of the hemorrhoid to cut off its blood supply. The hemorrhoid will wither and fall off within a week.

• Procedure: The doctor uses a special instrument to place the rubber band around the base of the hemorrhoid. This procedure is usually performed without anesthesia and causes minimal discomfort.
• Recovery: Patients can typically return to normal activities the same day. Some mild discomfort and bleeding may occur as the hemorrhoid falls off.

Sclerotherapy

Sclerotherapy involves injecting a chemical solution into the hemorrhoid tissue to shrink it. This is a quick and relatively painless procedure.

• Procedure: The doctor injects a sclerosing agent directly into the hemorrhoid, causing it to shrink and eventually be reabsorbed by the body.
• Recovery: Patients can usually return to normal activities immediately. Mild discomfort and bleeding may occur after the procedure.

Infrared Coagulation

Infrared coagulation uses infrared light to create scar tissue, cutting off the blood supply to the hemorrhoid. This procedure is typically used for smaller hemorrhoids.

• Procedure: The doctor uses a special device to apply infrared light to the hemorrhoid. This causes the hemorrhoid tissue to coagulate and form scar tissue, which cuts off the blood supply.
• Recovery: Patients can typically return to normal activities immediately. Mild discomfort and bleeding may occur after the procedure.

Surgical Treatments for Hemorrhoids

For severe or persistent hemorrhoids that do not respond to other treatments, surgery may be necessary. Surgical treatments for hemorrhoids include hemorrhoidectomy, hemorrhoid stapler procedure, and laser surgery. These procedures are more invasive but can provide long-lasting relief.

Hemorrhoidectomy

A hemorrhoidectomy is a surgical procedure to remove large external hemorrhoids or prolapsed internal hemorrhoids. This procedure is effective but can be painful, and recovery may take a few weeks.

• Procedure: The surgeon removes the hemorrhoid tissue using a scalpel, laser, or electrocautery. The area is then sutured or left open to heal.
• Recovery: Patients may experience pain and discomfort for a few weeks after the surgery. Pain relievers and sitz baths can help manage the discomfort.

Hemorrhoid Stapler Procedure

Also known as stapled hemorrhoidopexy, this procedure involves using a special stapling device to remove a portion of the hemorrhoid tissue and pull the remaining tissue back into place. It is less painful than a hemorrhoidectomy and has a shorter recovery time.

• Procedure: The surgeon uses a circular stapling device to remove a ring of tissue above the hemorrhoid. This pulls the hemorrhoid back into place and cuts off its blood supply.
• Recovery: Patients typically experience less pain and a quicker recovery compared to a hemorrhoidectomy. Most can return to normal activities within a week.

Laser Surgery

Laser surgery uses a laser to remove or shrink hemorrhoids. This procedure is minimally invasive, causes less pain, and has a quicker recovery time compared to traditional surgery.

• Procedure: The surgeon uses a laser to precisely target and remove the hemorrhoid tissue. The laser cauterizes the tissue, reducing bleeding and promoting faster healing.
• Recovery: Patients usually experience minimal pain and a quick recovery. Most can return to normal activities within a few days.

Choosing the Best Surgical Option

Choosing the best surgical option for hemorrhoids depends on several factors, including the severity of your condition, your overall health, and your personal preferences. Discussing your options with a healthcare professional can help you make an informed decision.

Factors to Consider

When deciding on a surgical treatment, consider the following factors:

• Severity of hemorrhoids: Larger and more severe hemorrhoids may require more invasive procedures, such as hemorrhoidectomy.
• Pain tolerance: Some procedures, like hemorrhoidectomy, are more painful and require a longer recovery time, while others, like stapled hemorrhoidopexy and laser surgery, are less painful with quicker recovery.
• Overall health: Your overall health and any underlying medical conditions may influence your choice of treatment. Some procedures may not be suitable for individuals with certain health conditions.
• Personal preferences: Your lifestyle, pain tolerance, and recovery expectations can all influence your decision. Discussing your preferences with your doctor can help you choose the best option for your needs.

Pros and Cons of Each Surgery

Each surgical option has its pros and cons. Here’s a summary to help you decide:

• Hemorrhoidectomy:
  • Pros: Highly effective for large or severe hemorrhoids, long-lasting results.
  • Cons: More painful, longer recovery time, higher risk of complications.
• Hemorrhoid Stapler Procedure:
  • Pros: Less painful, quicker recovery time, effective for prolapsed hemorrhoids.
  • Cons: Higher recurrence rate compared to hemorrhoidectomy, may not be suitable for all types of hemorrhoids.
• Laser Surgery:
  • Pros: Minimally invasive, less pain, quicker recovery time, reduced bleeding.
  • Cons: May not be as effective for large or severe hemorrhoids, higher cost.

Post-Treatment Care and Recovery

Proper post-treatment care and recovery are crucial for ensuring a smooth healing process and preventing the recurrence of hemorrhoids. Follow your doctor’s instructions carefully and make necessary lifestyle changes to support your recovery.

Immediate Aftercare

After undergoing treatment for hemorrhoids, follow these immediate aftercare tips:

• Pain management: Take prescribed pain relievers as directed by your doctor. Over-the-counter pain medications like acetaminophen or ibuprofen can also help manage discomfort.
• Sitz baths: Soaking in a warm sitz bath for 15-20 minutes several times a day can help reduce pain and swelling. Make sure to dry the anal area gently afterward.
• Topical treatments: Apply prescribed or recommended creams and ointments to the affected area to reduce pain and promote healing.
• Avoid straining: Avoid straining during bowel movements. Use a stool softener if necessary to make passing stool easier.
• Hygiene: Keep the anal area clean and dry. Use moist towelettes or gentle wipes instead of rough toilet paper to avoid irritation.

Long-term Recovery Tips

To ensure a smooth recovery and prevent the recurrence of hemorrhoids, follow these long-term recovery tips:

• Maintain a high-fiber diet: Eat plenty of fruits, vegetables, whole grains, and legumes to keep your stools soft and reduce the strain on hemorrhoids.
• Stay hydrated: Drink plenty of water throughout the day to prevent constipation and keep your stools soft.
• Exercise regularly: Regular physical activity can help improve bowel function and prevent constipation.
• Avoid prolonged sitting or standing: Take breaks to move around if you have to sit or stand for long periods.
• Follow-up appointments: Attend follow-up appointments with your healthcare provider to monitor your recovery and address any concerns.

Preventing Hemorrhoids

Preventing hemorrhoids involves adopting healthy habits that reduce the strain on your rectal and anal veins. By making some simple lifestyle changes, you can significantly reduce your risk of developing hemorrhoids.

Healthy Bowel Habits

Healthy bowel habits can help prevent hemorrhoids and other digestive issues. Follow these tips to maintain healthy bowel function:

• Don’t delay bowel movements: Go to the bathroom as soon as you feel the urge. Delaying bowel movements can cause constipation and straining.
• Avoid straining: Don’t strain during bowel movements. Take your time and relax.
• Use a footstool: Elevate your feet with a footstool while sitting on the toilet. This can help change the position of your rectum and make bowel movements easier.

Long-term Lifestyle Changes

Making long-term lifestyle changes can help prevent hemorrhoids from recurring. Consider the following tips:

• Maintain a healthy weight: Excess weight can put extra pressure on the veins in your rectum and anus. Losing weight through a healthy diet and regular exercise can help reduce this pressure.
• Exercise regularly: Regular physical activity can improve bowel function and overall health. Aim for at least 30 minutes of moderate exercise most days of the week.
• Eat a balanced diet: A diet rich in fiber can help prevent constipation and straining during bowel movements. Include plenty of fruits, vegetables, whole grains, and legumes in your diet.
• Stay hydrated: Drink plenty of water throughout the day to keep your stools soft and prevent constipation.
• Avoid prolonged sitting or standing: Take breaks to move around if you have to sit or stand for long periods.

Conclusion

Hemorrhoids can be a painful and inconvenient condition, but with the right treatment and lifestyle changes, you can manage and even prevent them. Whether you opt for conventional treatments, herbal remedies, or surgical options, it’s important to discuss your symptoms and preferences with a healthcare professional to determine the best course of action for your needs. By adopting healthy habits and making necessary lifestyle changes, you can reduce your risk of developing hemorrhoids and improve your overall quality of life.

FAQs

Can hemorrhoids go away on their own?

Yes, mild cases of hemorrhoids can resolve on their own with home care and lifestyle changes. However, more severe cases might require medical treatment.

How long do hemorrhoid treatments take to work?

The duration of treatment varies depending on the severity of the hemorrhoids and the type of treatment used. Over-the-counter treatments and lifestyle changes might take a few weeks to show improvement, while surgical options can provide more immediate relief.

Are herbal remedies effective for treating hemorrhoids?

Herbal remedies can be effective in managing symptoms and providing relief. However, their effectiveness may vary from person to person, and they are often best used in conjunction with other treatments.

What is the best surgical option for severe hemorrhoids?

The best surgical option depends on the individual case. Hemorrhoidectomy is highly effective for severe hemorrhoids, while stapling and laser surgery offer less painful alternatives with shorter recovery times.

How can I prevent hemorrhoids from recurring?

To prevent hemorrhoids from recurring, maintain a high-fiber diet, stay hydrated, exercise regularly, and adopt healthy bowel habits. Avoid straining during bowel movements and limit prolonged sitting or standing.

Note:”This article is based on my own knowledge, research, and opinion. Others may have different perspectives, so I encourage you to conduct your own research.”

Author

Dr. Asad (Pharmacist)

10 years experience in Herbal and Nutraceutical