What are hemorrhoids?
Hemorrhoids are small blood vessels in the anal canal located between the anus and the rectum that help to control bowel movements. Hemorrhoids are a natural part of the human anatomy. When healthy, hemorrhoids act as a cushion that lines the anal sphincter and helps the passage of stool. When hemorrhoids are unhealthy, itching, bleeding and rectal pains occur. Inflamed internal hemorrhoids cause blood in the stool, called hematochezia. Hematochezia is usually painless and disappears in several days. External hemorrhoids, however, are painful and cause inflammation around the anus.
The hemorrhoids lining the lower 1/3 of the anal cavity are called external hemorrhoids. External hemorrhoids may develop varicose veins, which can lead to inflammation and blood clots, referred to as thrombosis. These hemorrhoids have more nerve endings and are susceptible to inflammation and infection that can cause considerable pain when passing stool.
Internal hemorrhoids occur above the dentate line, that is, in the 2/3 of the anal cavity farthest from the anus. This area lacks pain receptors and thereby serious complications such as prolapsed and strangulated hemorrhoids often occur without warning. Prolapsed hemorrhoids are hemorrhoids that push through the anus. When a prolapsed hemorrhoid experiences a blood clot, it is called a strangulated hemorrhoid.
What causes hemorrhoids?
Aging, constipation, diarrhea, pregnancy, a diet lacking in fiber, and genetic predispositions can all lead to hemorrhoids. Increased stress on the anal cavity such as sitting for prolonged periods of time and obesity will increase the chance of hemorrhoids. Certain gastrointestinal diseases that cause diarrhea and abnormal bowel movements such as Crohn’s disease and irritable bowel syndrome lead to inflamed hemorrhoids. Cancers located in the anal cavity such as colorectal cancer can cause a chronic inflammation and prolapsed hemorrhoids.
What are the treatments for hemorrhoids?
A change in lifestyle can help prevent the onset of hemorrhoids. Fiber supplements decrease the likelihood of diarrhea and irregular bowel movements, thereby relieving stress to the anal cavity. To decrease discomfort and itching caused by external hemorrhoids, zinc oxide and petroleum can be applied to the anus.
For more serious cases, such as prolapsed hemorrhoids, rubber band ligation is used to cut off blood supply just above the dentate line, causing the hemorrhoids to fall off. Sclerotherapy causes the vein walls of the prolapsed hemorrhoids to break down, causing them to wither and fall off. This therapy has a success rate of 70%. Hemorrhoid cauterization of is performed with lasers, radiation, electrocautery, or cryosurgery (freezing).
Surgical techniques are used if other medical options have been exhausted and if the hemorrhoids are causing other medical problems. Certain types of cancer, including colorectal cancer, necessitate a hemorrhoidectomy: the removal of a part of the hemorrhoid. Transanal hemmorhoidal dearterialization is a procedure that uses an ultrasound to find a blood clot in a hemorrhoid, cut the artery and reattach the veins directly to an artery. Stapled hemorrhoidopexy is a procedure that removes a large portion of the enlarged hemorrhoid tissue, stretching then reattaching the remaining healthy sections. Stapled hemorrhoidopexy requires less recovery time and is considered less painful than hemorrhoidectomy.