Hemorrhoids: definition, symptoms, causes and treatment

By Cristiano Antonino On Apr 27, 2023

The term hemorrhoids commonly indicates a prolapse of the three cushions located in the anal canal, accompanied by venous congestion

In reality, hemorrhoids are anatomical structures that all people have: in the presence of this prolapse, one should more correctly speak of hemorrhoidal disease.

Congestion can develop either inside the rectum (called internal hemorrhoids) or under the skin around the anus (called external hemorrhoids).

This problem is very common and often the cause is unknown.

Fortunately, effective options are available to treat it when needed.

Hemorrhoids

As anticipated, although the term hemorrhoids is used to identify an annoying and widespread disorder, in reality hemorrhoids (also called haemorrhoids) are anatomical structures that all people have.

More precisely, these are three bearings located in the anal canal: usually two on the right and one on the left.

They are formed by a set of veins and are attached to the anal wall by some fibrous ligaments.

In medical terms, the disorder commonly identified with the term “hemorrhoids” is called hemorrhoidal disease.

It occurs when the fibrous ligaments that anchor the hemorrhoids to the anus break, and the pads prolapse, i.e. they protrude outwards, causing venous congestion.

External hemorrhoids

Why are we talking about external hemorrhoids? Because hemorrhoidal disease can be of two types.

It is internal if the prolapsed hemorrhoids are positioned above the “dentate line”, a sort of border that separates the skin of the anus from the mucosa that lines the intestine internally.

It is external if the hemorrhoids are positioned below the dentate line.

Hemorrhoidal disease is grade I and II when it is asymptomatic or characterized by mild symptoms, such as pain and itching.

It is of III and IV degree, instead, when it causes the prolapse of the bearings: in the first case, the prolapse is temporary, in the sense that the gavoccioli re-enter spontaneously, in the second it is definitive.

The causes of hemorrhoids

The underlying causes of hemorrhoidal disease are not always known.

It is certain, however, that the disorder almost always depends on a set of factors.

There seems to be a basic predisposition, which is combined with other elements.

Of course, the veins around the anus tend to stretch and swell when under pressure.

Increased pressure in the rectum may be due to:

straining during bowel movements and defecation;
constipation;
sitting position on the toilet maintained for a long time;
chronic diarrhea or constipation;
overweight or obesity;
pregnancy (the baby’s weight puts pressure on the anal region);
sedentary lifestyle;
low-fiber diet;
regular lifting of weights;
stress and anxiety.

It should also be kept in mind that with advancing age, the risk of hemorrhoids increases.

This is because the tissues that support the veins in the rectum and anus can weaken and stretch.

Symptoms of hemorrhoids

Hemorrhoidal disease does not always cause discomfort and even when it occurs it can alternate between remission and acute phases.

Typically, the signs and symptoms depend on the type of hemorrhoid.

External hemorrhoids can manifest as: itching or irritation in the anal region; local pain or discomfort; swelling around the anus; bleeding.

Internal hemorrhoids usually cannot be seen or felt.

They rarely cause discomfort.

However, straining or irritation while passing stool can cause painless bleeding during bowel movements and bowel movements.

You might also notice small amounts of bright red blood on toilet paper or in the toilet bowl.

A hemorrhoid that pushes through the anal opening (prolapsed or protruding hemorrhoid) can cause pain and irritation.

If blood collects in an external hemorrhoid and forms a clot (thrombus), it can cause: severe pain; swelling; inflammation; a hard lump near the anus.

Hemorrhoids remedies

When the hemorrhoidal disease is not symptomatic and does not cause particular discomfort, it is not necessary to treat it.

When the symptoms are mild, it is useful to follow a diet richer in fiber, to facilitate evacuation.

You can then try over-the-counter ointments, which may provide relief, but which do not guarantee long-term effects.

Warning: they can cause allergic reactions, often more difficult to cure than the hemorrhoidal disease itself.

Do not apply ice, which causes a spasm of the sphincter (muscle surrounding the anal orifice), strangling the hemorrhoids and aggravating the situation.

Better to apply warm water which facilitates venous outflow and gives relief.

During acute crises, the doctor may prescribe cortisone or nonsteroidal anti-inflammatory drugs, which treat edema and inflammation.

When is the intervention needed?

Grade III and IV hemorrhoids usually require surgery.

There are also minimally invasive techniques for the treatment of this problem, such as rubber band ligation, bandage, sclerotherapy, thd.

The choice of the technique to be used in the different cases must be made by the doctor, after evaluating the situation and analyzing all the pros and cons.

The rules of prevention

The best way to prevent the disorder is to keep the stools soft so they pass easily.

Here’s why it’s useful:

eat foods high in fiber, such as fruits, vegetables and whole grains. In this way, in addition to softening the stool, it increases its mass, which will help avoid straining which can cause hemorrhoids. It is advisable to add fiber to the diet slowly to avoid meteorism problems;
drink plenty of fluids, to keep the stools soft;
not straining when passing stools: straining and holding your breath when trying to pass stools creates increased pressure in the veins in the lower rectum;
go to the bathroom as soon as you feel the need: if you wait to evacuate and the urge disappears, the feces could dry out and be more difficult to evacuate;
move and exercise: an active lifestyle helps prevent constipation and reduce the pressure on the veins that can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that could be contributing to hemorrhoids;
do not sit for a long time, especially on the toilet, so as not to increase the pressure on the veins in the anus.

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