Hemorrhoids, often known as piles, are enlarged veins in the lower rectum and anus. Internal hemorrhoids, which appear beneath the skin surrounding the anus, are hemorrhoids that form within the rectum (external type).

Nearly three out of every four people will get hemorrhoids sometimes. There are several causes of hemorrhoids, however sometimes the reason is not identified.

It may be uncomfortable sometimes, although they often go away on their own. Increased fiber consumption and regular exercise may aid with symptom relief and reduce the likelihood of developing its in the future.

Symptoms

  • Bleeding in the anal region, 
  • itching, or irritation
  • Discomfort, pain, or soreness around the anus lumps, 
  • swelling in the anal area, and 
  • dilatation or bulging of a vein that
  • Although symptoms may be unpleasant or concerning, they often get better on their own within a few days.

Causes

  • Pregnancy: During pregnancy, hormones cause veins to relax and expand. Rectal tissues also weaken. Up to 35% of pregnant women may have it 
  • Age: Adults over the age of 50 are more likely to also have it
  •  However, children and younger adults may also have them.
  • Diarrhea: It may develop after episodes of persistent diarrhea.
  • Chronic constipation: Struggling to pass feces puts extra strain on the blood vessel walls, which may lead to it.
  • Too much time spent sitting down, particularly when using the restroom, might result in this condition.
  • Diet: Consuming meals deficient in fiber may make them more likely.
  • It may develop by repeatedly lifting large objects.
  • Anal sex: This might result in new ones or make existing ones worse.
  • Weight: has shown an increased risk of it to being overweight. This can be the consequence of elevated abdominal pressure.
  • Genetics: they are a condition that certain individuals are predisposed to.

Treatments

Simple treatments will often relieve symptoms while they cure on their own. However, in certain circumstances, treatment with drugs or surgery may be required.

Hemorrhoids
Hemorrhoids, Pile

Home remedies

  • The following at-home remedies might aid in reducing its’ signs and symptoms:
  • Topical creams and ointments: OTC treatments for external ones may aid in reducing swelling, itching, and irritation.
  • Fiber supplements may aid with it and relieve constipation. Examples include methylcellulose (Citrucel) and psyllium (Metamucil).
  • Applying cold compresses and ice packs to the injured region may help reduce discomfort.
  • Sit in a warm, shallow tub of water while taking a sitz bath. One taken many times day could help lessen its discomfort.
  • Analgesics: Painkillers such acetaminophen, aspirin, and ibuprofen may help reduce the discomfort associated with it.

Medications

There are several different types of treatments, including suppositories, ointments, and pads. Typically, one may get them from a store.

Several typical drugs consist of:

  • Creams with zinc oxide may be useful in treating inflammation. One cream, Calmoseptine, mixes menthol and zinc oxide. It could be useful for treating anal irritation, which can be associated to it.
  • Astringents like witch hazel, according to experts, may provide temporary relief.
  • They are often treated with steroid cream, which contains corticosteroids like hydrocortisone. They may aid in reducing inflammation, but prolonged usage might result in skin damage.
  • As a local anesthetic, lidocaine works. According to Research, creams or suppositories that include lidocaine and the anti-inflammatory tribenoside may help alleviate the sensations of discomfort and itching.

If symptoms persist after taking these drugs for a week, the person should see a doctor.

Non-surgical therapy

If at-home treatments are ineffective, more medical intervention may be required. 

Nonsurgical alternatives include 

  • Rubber band ligation: 
  • Sclerotherapy,
  • Infrared photocoagulation
  • Electrocoagulation 

These operations are often performed by a doctor while the patient is sedated with local anesthetic.

Surgical Treatments:

Both prolapsed internal and external hemorrhoids may be completely removed during surgery. Hemorrhoidectomy is the medical term for this treatment.

An alternative is to staple a prolapsed one back into the anus by a doctor.

Anesthesia will be given to the patient throughout these operations. This is usually a day case.

Types

There are two types

Internal and 

External. 

Internal ones are graded by how much they protrude from the anus or stay within the rectum by medical specialists.

Internal hemorrhoids

Internal ones are internal and cannot be seen from the exterior of the rectum. They normally cause little discomfort. Rectal bleeding is often the first symptom of the internal type

A prolapsed hemorrhoid is a term used to describe an internal hemorrhoids that pushes through the anus. It may be unpleasant and may be brought on by a weakening of the muscles around the anus.

Internal types are rated by medical specialists from 1 to 4 according to the prolapse:

  • Grade 1 do not prolapse and stay in the rectum (protruding out of the anus).
  • When a person passes stool, grade 2 prolapse and then retract on their own.
  • Grade 3 that have prolapsed need to be pulled back in.
  • Grade 4 have prolapsed and are unable to be pulled back in.

External Hemorrhoids 

The skin surrounding the anus is where external ones develop, making them apparent.

The external type may be excruciatingly painful since the nerves in this area of the body are more sensitive. Either internal or external, may bleed when you strain during passing stool.

Diagnosis

To check for Them, a doctor would probably inquire about a patient’s medical history, do a physical exam, and order further testing. In order to check for external ones in the region around the anus, the following will be looked for:

  • lumps
  • Slight anal tears
  • Inflamed skin
  • Prolapsed internal hemorrhoids

To identify internal ones, they could also do a digital rectal examination. This entails manually examining the anus to look for blood, sensitivity, and lumps using a gloved, lubricated finger.

A little instrument called an anoscope may be used by a clinician to examine the anal and rectal walls if a digital rectal exam fails to detect internal hemorrhoids. Through the device, they might be able to see internal hemorrhoids as bulges.

Prevention

Hemorrhoids may be prevented with certain lifestyle modifications. 

These consist of:

A healthy diet – should include lots of fiber-rich foods including fruits, vegetables, and whole grains to keep stools soft. 

Constipation may also be relieved by using over-the-counter fiber supplements and keeping hydrated.

Avoiding straining: When using the restroom, one should make an effort to avoid straining. The lower rectum’s veins are pressed upon as you strain.

Using the restroom when needed: It is important to avoid keeping someone waiting while you use the restroom. The stools will get drier the more time someone waits.

Regular physical activity: Exercise encourages stool transit through the gut, promoting more regular bowel movements.

Maintaining a healthy weight: Having hemorrhoids is more likely if you are overweight.

With conservative care, hemorrhoid symptoms often go away on their own, but there is a 10–50% risk they will come back. After surgery, there is a fewer than 5% risk that hemorrhoids would recur.

Complications includes:

Bleeding: Whether or whether there is pain, anybody who is bleeding heavily or persistently needs to get emergency medical attention.

Hemorrhoids that have been strangulated might have their blood supply cut off by the muscles around the anus. Significant pain may result from this.

Anemia: Hemorrhoids may cause significant, ongoing blood loss. This happens when the body’s circulation of red blood cells is insufficient.

Blood clots: Hemorrhoids can experience blood clotting. It may be very painful if the hemorrhage is external. The blood clot may need to be removed by a surgeon.

Infection: Following therapy, ulceration and infection are possible.

Urinary retention: After surgery for internal hemorrhoids, around 15% of patients report having trouble passing urine. Urinary retention will affect 30 to 50 percent of persons after surgery for external hemorrhoids.

If hemorrhoids do not go away after a week or if new hemorrhoids continue to develop, it is crucial to see a doctor.

Additionally, severe anal discomfort, considerable rectal bleeding, or fever may need medical treatment. In addition to hemorrhoids, illnesses including colorectal and anal malignancies may result in rectal bleeding.

References:

https://www.medicalnewstoday.com/articles/73938

https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268#:~:text=Hemorrhoids%20are%20swollen%20veins%20in,rectum%2C%20similar%20to%20varicose%20veins.