Hemorrhoids Causes and Prevention

What is Hemorrhoids?

Hemorrhoids (often called piles or haemorrhoids) are swollen and inflamed veins in the anus and rectum.

Hemorrhoids are an especially common disorder. By age 50, about half of adults deal with the itching, bleeding and pain that often signal the presence of this condition. Men are more likely than women to suffer from hemorrhoids that require professional medical treatment. Hemorrhoids usually are not dangerous or life threatening, often go unnoticed and usually clear up after a few days, but can cause long-lasting discomfort, bleeding and be excruciatingly painful.

Symptoms of hemorrhoids include: anal itching, anal ache or pain, especially while sitting, bright red blood on toilet tissue, stool, or in the toilet bowl; pain during bowel movements; one or more hard tender lumps near the anus. Hemorrhoids can mask a more serious disorder and, therefore, must be evaluated and diagnosed properly by a physician. People with hemorrhoids who work closely with their physician are usually assured a good outcome and relief from this common disorder.




Types of Hemorrhoids

Hemorrhoids can develop inside the anal canal (internal) or near the anal opening (external). Both types can occur at the same time.

Internal hemorrhoids lie inside the anus or lower rectum, beneath the anal or rectal lining. They usually don't hurt but they may bleed painlessly. Rectal bleeding is the most common symptom of internal hemorrhoids. You may notice bright red streaks of blood on toilet paper or bright red blood in the toilet bowl after having a normal bowel movement.

When hemorrhoids remain inside the anus they are almost never painful, but they can prolapse (protrude outside the anus) and become irritated and sore. Sometimes prolapsed hemorrhoids move back into the anal canal on their own or can be pushed back in, but at other times they remain permanently outside the anus until treated by a doctor. These can be very painful.

Internal hemorrhoids are classified by degree of severity according to the extent of prolapse:

  • First degree: hemorrhoid does not prolapse from the anus.
  • Second degree: hemorrhoid prolapse from the anus during a bowel movement but returns to the anal canal afterward.
  • Third degree: hemorrhoid prolapse from the anus during a bowel movement, but can be pushed inside the anus manually.
  • Fourth degree: hemorrhoid is always outside the anus and cannot be pushed into the anal canal (incarcerated, irreducible prolapse).

External hemorrhoids lie outside the anal opening below the pectinate line. External hemorrhoids are masses of veins located underneath the skin at the anus. These are different than internal hemorrhoids, which are veins located beneath the lining of the rectum, just above the anus.

External piles seldom produce symptoms unless thrombosis occurs. External hemorrhoids can cause itching, burning, and irritation. You might notice streaks of bright red blood on toilet paper after straining to have a bowel movement, and it may be difficult to clean the anal area. When a blood clot forms in an external hemorrhoid (creating a thrombosed hemorrhoid), the skin around the anus becomes inflamed and a very painful lump develops. On rare occasions the clot will begin to bleed after a few days and leave blood on the underwear. A thrombosed hemorrhoid will not cause an embolism.

Hemorrhoids symptoms

Common symptoms of hemorrhoids include:

  • Anal itching
  • Anal ache or pain
  • Painless bleeding
  • Bright red blood on toilet tissue, stool, or in the toilet bowl
  • Pain during bowel movements
  • One or more hard tender lumps near the anus

Hemorrhoids causes and risk factors

Precisely why hemorrhoids develop is unknown. The major contributing factor appears to be too much pressure on the veins in the rectum. If the pressure continues, the veins become enlarged and protrude.

Common causes and risk factors of hemorrhoids include:

  • Constipation is one of the main causes of hemorrhoids. This is because constipated individuals tend to consistently strain to evacuate their bowels, increasing pressure in the rectum.
  • Diarrhea. Frequent diarrhea can be caused by illness, diet, disease, and the misuse of laxatives.
  • Genetic predisposition (heredity). Because the tendency to develop hemorrhoids seems to run in families, doctors believe that at least part of the risk for hemorrhoids is genetic (inherited).
  • Overuse of laxatives. Frequent use of laxative may result in diarrhea, and increase your likelihood of getting hemorrhoids.
  • Pregnancy and labor. Hemorrhoids are a common, usually temporary problem among pregnant women caused by hormonal changes and increased pressure by the growing fetus which forces the veins to work harder to pump blood. During labor, hemorrhoids may develop because of the intense pressure on the anal area while pushing to deliver the baby.
  • Chronic venous insufficiency. Hemorrhoids can be a sign of general weakness in the veins. Contributing factors are standing or sitting for long periods, being overweight, not exercising enough, and smoking.
  • Inflammatory bowel disease. Ulcerative colitis or Crohn's disease may be the underlying cause of hemorrhoids.
  • Portal hypertension. Increased pressure within the portal vein blood from the intestines to the liver. Liver cirrhosis (scarring) is the most common cause.
  • Aging. Starting in the thirties, there is a progressive weakening of the support structures in the area. Half of people who are older than 50 seek treatment for hemorrhoids.
  • Excessive pressure on the veins in the pelvic and rectal area causes hemorrhoids. As pressure increases, blood pools in veins and causes them to swell, stretching the surrounding tissue and forming hemorrhoids.
  • Excess weight, especially in the abdomen and pelvis, may increase pressure on pelvic veins.
  • Spending long periods of time on the toilet (like reading).
  • Prolonged sitting or standing. This may cause blood to pool in the anal area and increase pressure on the veins.
  • Frequent heavy lifting. This can cause a sudden increase of pressure in blood vessels
  • Sedentary lifestyle.
  • Lack of fiber.
  • Low daily intake of fluids.
  • Depression[1]
  • Anal intercourse

However, some people will have none of these conditions and still develop hemorrhoids. Humans are prone to hemorrhoids because erect posture puts a lot of pressure on the veins in the anal region.

Hemorrhoids home-based remedies

Home treatment is the first step in treating hemorrhoids. Hemorrhoids can often be effectively dealt with by dietary and lifestyle changes. Home treatment includes adjusting your diet to avoid constipation, using a stool softener, or using ointments to relieve symptoms.

  • Sitz baths. A sitz bath is a warm water bath for the buttocks and hips (the name comes from the German "sitzen," meaning "to sit"). It can relieve itching, irritation, and spasms of the sphincter muscle. Most experts recommend a 20-minute sitz bath after each bowel movement and two or three times a day in addition. Take care to gently pat the anal area dry afterward; do not rub or wipe hard.
  • Ice packs. Putting cold packs on the anus for short durations help reduce swelling and pain. It can also provide relief from the itching and burning experienced even if it is only temporary.
  • Medications. Hemorrhoidal creams or suppositories can relieve pain, reduce swelling, protect skin and/or reduce bleeding. Creams that contain hydrocortisone can be used for itching or pain.
  • Stool softeners may be used to avoid straining and constipation and are helpful for prolapsed and strangulated hemorrhoids[2].
  • Fiber shows a consistent beneficial effect for relieving hemorrhoid symptoms and bleeding. It softens the stool and increases its bulk, which will help lessen the straining that can cause hemorrhoids. Fruit, leafy vegetables, and whole-grain breads and cereals are good sources of fiber. Another fiber source is Metamucil, which can take up to a week to work. Fiber and bran retain water in the stool, producing soft, bulky stools which are easier to pass and reduce the tendency to develop hemorrhoids.
  • Fluids. Drink 6 to 8 eight ounce glasses of water each day to help keep stools soft.
  • Bioflavonoids are a type of plant compound that stabilizes and strengthens blood vessel walls and decreases inflammation. They have been found to reduce anal discomfort, pain, and anal discharge during an acute hemorrhoid attack
  • Keep the anus and hemorrhoids as dry as possible, using talcum powder and a pad of soft tissue to absorb moisture.
  • Do not strain during bowel movements. Trying to force a bowel movement can make hemorrhoids worse and straining for more than 5 minutes can be harmful. Try not to stay on the toilet any longer than necessary.
  • Don't scratch. While scratching can make a hemorrhoid feel temporarily better, scratching can damage the walls of the veins and create more problems.
  • After each bowel movement, wiping with a moistened tissue or pad sold for that purpose helps lessen irritation.

When painful hemorrhoids do not respond to home-based remedies, professional medical treatment is necessary. See your doctor if hemorrhoids are extremely uncomfortable and bleed frequently. While hemorrhoids are not a serious or life-threatening condition, it is important to see a doctor for any type of rectal bleeding, which can be a sign of other, more serious desease.



Prevention of hemorrhoids

Prevention of hemorrhoids includes drinking more fluids, eating more fiber, exercising, practicing better posture, and reducing bowel movement strain and time.

The following practices can help:

  • Drink plenty of liquids. The exact amount of water and other fluids you should drink each day varies and depends on your age, sex, health, activity level and other factors. Avoid liquids that contain caffeine (such as coffee and tea) or alcohol. These liquids may cause dehydration, which can lead to constipation.
  • Consider fiber supplements. Over-the-counter products such as Metamucil and Citrucel can help keep stools soft and regular. Check with your doctor about using stool softeners. If you use fiber supplements, be sure to drink at least eight to 10 glasses of water or other fluids every day. Otherwise, fiber supplements can cause constipation or make constipation worse. Add the fiber gradually to avoid problems with gas.
  • Exercise. Stay active to reduce pressure on veins, which can occur with long periods of standing or sitting, and to help prevent constipation. Exercise can also help you lose excess weight.
  • Avoid long periods of standing or sitting. If you must sit for long periods, don't use an inflatable doughnut cushion to pad your chair. It can increase the pressure on the veins in the anus. Always stand and walk during your breaks at work and try to stand and walk at least 5 minutes every hour.
  • Avoid straining during bowel movements. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.
  • Avoid reading or spending excess time on the toilet. If it takes you more than 3-5 minutes to have a bowel movement, then something is wrong. Reading in the bathroom is considered a bad idea, because it adds to the time one spends on the toilet and may increase the strain placed on the anal and rectal veins.
  • Go as soon as you feel the urge. Do not delay or try to prevent a bowel movement when the urge is present. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.
  • Train your digestive tract to have regular bowel movements. Schedule a 10-minute period to sit on the toilet at approximately the same time each day. The best time to do this is usually right after a meal.
  • Avoid the overuse of laxatives, type of medication that affects the bowels, because they may cause diarrhea, which can irritate hemorrhoids. Use laxatives only when absolutely necessary.
  • Keep the area around the anus clean and dry.
  • Wipe gently. Blot the anus gently with white toilet paper moistened with water or a cleansing agent after bowel movements. Baby wipes or other premoistened towels are also useful for this purpose.
  • Avoid rubbing the anal area. You can rinse off in the shower or on a bidet instead of wiping yourself with toilet paper. Washing with cool water provides instant relief for nagging pains and discomfort. After cleansing, gently pat the anal area dry with a soft, absorbent towel or cloth.
  • Soap or toilet paper that is perfumed may irritate the anal area and should be avoided.

References:

  • 1. Lee JH, Kim HE, Kang JH, Shin JY, Song YM. Factors associated with hemorrhoids in korean adults: korean national health and nutrition examination survey. Korean J Fam Med. 2014 Sep;35(5):227-36 PubMed
  • 2. Fox A, Tietze PH, Ramakrishnan K. Anorectal conditions: hemorrhoids. FP Essent. 2014 Apr;419:11-9. PubMed

Created: August 18, 2006
Last updated: February 24, 2016



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