Hemorrhoids are palpable swellings around or inside the anus, originating from veins. Hemorrhoids is a disease that can sometimes manifest itself with severe pain, bleeding, complicate people’s lives and sometimes create serious complications.
The rectum is the last part of the large intestine and opens outward with the anus. It is approximately 12-15 cm long, adjacent to vessels, nerves, prostate and bladder in men, and the posterior wall of the vagina and cervix in women. It is covered with a thin mucous membrane. It plays an important role in gas and stool output. There is a muscle structure called sphincter to prevent involuntary outflows. It has an important place in the diagnosis and treatment of prostate diseases. In addition, the rectum is used to reach some adjacent spaces in the diagnosis and treatment of intra-abdominal bleeding or fluid accumulations. It is the entry point for the endoscopy procedure used in the diagnosis of intestinal diseases.
The rectum is one of the parts of the body that has plenty of blood. For some reasons, the vascular structure here is known as hemorrhoids. Clarification of the veins may be caused by the weakening of the vascular structure over time, the reverse blood circulation between the arteries and veins in the rectum due to increased intra-abdominal pressure, or the relaxation in the sphincter structure for various reasons. In particular, internal hemorrhoids can be caused by the joint influence of these factors.
Hemorrhoids is a common disease in societies. Its incidence is affected by many factors, such as the physical activity status of the populations and nutritional habits. The fact that the disease is in a more specific region may delay diagnosis and treatment.
Table of contents
Causes of hemorrhoids:
Some of the causes that trigger the formation of hemorrhoids are:
- Dietary habits: Especially low-fiber foods cause hardening of the stool. It can cause more straining to remove hard stool and damage to the rectal structure.
- Constipation or diarrhea: Constipation also causes stool to stay in the intestine for a long time and harden. In addition, diarrhea can be the cause of hemorrhoids due to frequent straining, constant pressure on the rectal vessels.
- Toilet habits: Sitting on the toilet for a long time can cause the development of hemorrhoids.
- Familial habits: The nutrition and toilet habits children receive from their parents may also pave the way for the development of hemorrhoids in later ages.
- Pregnancy: The pressure created by the fetus in the abdomen during pregnancy may cause enlargement of the rectal vessels.
- Advanced age: Changes in the structure of the rectum with age, weakening of the vascular structures may accelerate the formation of hemorrhoids.
- Diseases: Diseases that increase intra-abdominal pressure and conditions that cause increased pressure in the veins may also be factors for hemorrhoids.
- Occupations that require sitting for a long time (officer, driver, etc.),
- heavy lifting,
- standing for a long time,
- lack of physical activity,
- Chronic cough.
Types of hemorrhoids:
Hemorrhoids can be evaluated in three groups:
- Internal hemorrhoids: It is a type of hemorrhoid that cannot be noticed from the outside, located inside the anal canal. It is evaluated in four stages according to the situation of coming out of the anal canal:
- Stage 1: It is in the anal canal, it does not go out of the anus, it gives a feeling of discomfort, there is no pain, there may be bleeding.
- Stage 2: It goes out of the anus during straining, coughing, defecation, and goes inside by itself when this process is over. Bleeding happens. There may be discharge from the anus.
- Stage 3: There is a hemorrhoid protruding from the anus, it does not go in by itself, it is necessary to insert it manually. Bleeding causes itching around the anus.
- Stage 4: There is hemorrhoids protruding from the anus. It does not go in by itself, nor can it be inserted by hand. There is bleeding, itching and painful mass around the anus.
- External hemorrhoids: It is a type of hemorrhoid located on the outside of the anal canal and can be noticed from the outside. It can be painful, itching, bleeding. It does not enter by itself, and it cannot be inserted into the anal canal by hand.
- Mixed type: There are hemorrhoids both inside and outside of the anal canal. It can be noticed from the outside.
Symptoms of hemorrhoids:
- Bleeding: Bleeding may occur during or after stool. It comes in the form of fresh, red blood. There may be bleeding in the form of drops after stool, and there may be bleeding in the form of spurts, rarely. It is often the reason for applying to a health institution.
- Pain: Pain is not common in internal hemorrhoids. In external hemorrhoids, there may be pain during or after stool.
- Palpable mass: In internal hemorrhoids, a palpable mass is seen especially during straining, coughing, standing for a long time, heavy exercise, stool removal, etc., while there is a mass in most external hemorrhoids.
- Itching: Itching, irritation and thickening of the skin may occur, especially in hemorrhoids protruding from the anus.
- Inability to relax after stool,
- Thrombosis: In cases where the hemorrhoid stays outside the anus for a long time, sometimes there is vascular occlusion as a result of clot, swelling increases, and severe pain occurs. There is a risk of ulcer and gangrene due to lack of blood supply.
Diagnosis of hemorrhoids:
Correct diagnosis is important for appropriate treatment. The most important step in diagnosis is to take a complete anamnesis. If there is bleeding, its color and time of occurrence are questioned. Possible complications such as thrombosis are questioned.
In the examination, the palpable mass is investigated. Rectal examination is important in diagnosis. In the rectal examination, the patient is asked to take the knee-elbow position. The hips are separated and applied to the rectal touch. In some patients, there may be internal hemorrhoids that are not noticed by rectal examination. In suspected cases, it can be viewed with an anoscope.
Hemorrhoids treatment:
Treatment depends on the severity of the hemorrhoid and whether there are complications or not.
Drug therapy can be applied in patients who do not develop thrombosis or other complications. Milder cases can also recover with home remedies. However, in severe or complicated cases, surgical treatment is preferred.
Recommendations for hemorrhoids:
- Regulation of dietary habits: Drinking plenty of water, consuming fibrous foods, avoiding spicy and bitter foods, not consuming caffeinated foods and beverages (tea, coffee, cola, etc.),
- Regulation of toilet habits: Not sitting on the toilet for a long time, intervening in case of constipation, preventing prolonged straining, wiping with moist toilet paper after stool, not wiping too hard,
- Sitting baths: It reduces itching and pain.
- Hygiene: If there is a palpable mass, keeping it clean and dry,
- Applying ice: If there is pain, ice packs wrapped in a towel or cloth can provide relief.
- Exercise: Regular exercise prevents the development of hemorrhoids, accelerates the healing of existing ones.
Drug treatment of hemorrhoids:
- If there is constipation, treatment is given ( oral laxative ),
- Local anesthetic creams : If there is itching or pain, local anesthetic creams containing lidocaine, tetracaine, amethocaine or pramoxine can be used. It is recommended not to be used longer than a few days.
- Corticosteroid: Local anesthetic can be applied locally in combination with antibacterials and corticosteroids.
- Vein regulating drugs: Phlebotrophic (vein regulating) drugs regulate the vein pressure, provide lymph drainage, and ensure that the blood circulates regularly and does not accumulate in one area.
Other treatments for hemorrhoids:
- Sclerotherapy: It is a method used in the treatment of hemorrhoids for many years. It is aimed to disrupt the blood supply by applying a sclerosing substance around the hemorrhoids. It is an effective treatment for early stage hemorrhoids.
- Rubber band ligation: A special rubber band is placed on the base of the protruding part called the hemorrhoid nozzle. In this way, the deterioration of the blood supply of that area is the prevention of nutrition. The hemorrhoid breast that can’t get blood will fall off after a week. Not recommended for people with suppressed immune system. There is a risk of pain, bleeding, necrosis and ulcers.
- Cryotherapy: With the application of liquid nitrogen, it is aimed to disrupt the blood supply of the hemorrhoid tissue. It is an expensive method and difficult to dose.
- Infrared coagulation: With this method, it is aimed to provide coagulation in hemorrhoids with the help of a special tool without damaging the surrounding tissues. Effective results can be obtained in early stage hemorrhoids.
- Laser coagulation and excision: It is a method that is applied with special devices and aims to reduce pain, bleeding and edema. It is especially used in advanced hemorrhoids. However, it is not superior to other treatments.
- Surgical treatment
Surgical hemorrhoidectomy:
Hemorrhoids are not usually a life-threatening disease. Therefore, a good planning can be done before surgery. Hemorrhoid area, type, size, medications used by the patient, and other diseases should be well investigated.
Surgical treatment can be performed under local, spinal or general anesthesia. Surgical hemorrhoidectomy can be done open or closed. Hemorrhoid tissue is taken by entering the anal canal in the appropriate position. Post-surgical complications such as bleeding or pain are not expected when necessary precautions are taken (tampons, painkillers, etc.). Stapler hemorrhoidopexy is one of the newer surgical techniques.