Hemorrhoids, also known as piles, can resolve on their own in the early stages. However, if left untreated, they can lead to various complications. Let's discuss this further.
Hemorrhoids, commonly known as piles, are medically known as hemorrhoids. This condition occurs due to swelling or dilation of the veins around the anus and rectum, causing them to appear as lumps. Based on their location, hemorrhoids can be classified into two types: internal hemorrhoids and external hemorrhoids. External hemorrhoids, often referred to as external hemorrhoids, are usually easier to identify because they are located around the anus.
Meanwhile, internal hemorrhoids, often referred to as internal piles, usually require further examination to confirm the diagnosis and determine the degree.
Internal hemorrhoids can be classified into several grades:
- Grade 1: Does not protrude from the anus.
- Grade 2: Protrudes from the anus when pressure is applied, such as during a hard bowel movement, but can be pushed back in on its own.
- Grade 3: Protrudes from the anus and must be pushed in manually.
- Grade 4: Protrudes and cannot be pushed back in manually.
Causes of Hemorrhoids
Many things can cause hemorrhoids. One of the most common causes of hemorrhoids is constipation. This condition is often caused by insufficient fiber consumption, which causes excessive pressure during bowel movements, leading to hemorrhoids. A similar situation can also occur if you sit too long on the toilet during a bowel movement. Furthermore, the position you use during bowel movements can also cause hemorrhoids. Generally, squatting makes it easier to defecate.
Sitting on the toilet for too long and in an unhealthy position for defecation can increase the risk of hemorrhoids because the pressure on the area is too great and prolonged, causing the blood vessels to dilate, forming hemorrhoids. During pregnancy, pressure on the abdominal cavity can increase due to the presence of the fetus. This is especially true in the final trimester, when the baby is already quite large, this can cause a significant increase in pressure and cause dilation or swelling of the blood vessels in the rectum. As you get older, the supporting tissues around the rectum and anus begin to weaken, so even a small increase in pressure in this area can still increase the risk of hemorrhoids.
Symptom
Hemorrhoid symptoms vary widely and depend on the type (internal or external) and the severity. In early cases, such as grade 1 internal hemorrhoids, they may not cause any symptoms and are discovered during routine screening or regular examinations. However, if they become large enough, internal hemorrhoids can cause symptoms such as bloody stools. The blood may appear as streaks in the stool or drip at the end of a bowel movement. The blood is usually bright red. Another common symptom of hemorrhoids is a lump around the anus. This condition can occur in both external and internal hemorrhoids.
The lump is the result of dilated veins in the rectum and anus. In cases of internal hemorrhoids, the lump is usually palpable in grade 2 hemorrhoids and above. The lump usually protrudes during a bowel movement due to pressure that causes the blood vessels to prolapse. However, in grade 2 hemorrhoids, the prolapse can retract on its own. In grade 3, the prolapse must be pushed back manually.
Furthermore, hemorrhoids often cause discomfort in the anal area. It is not uncommon for this to cause itching, pain, and a burning sensation in the area due to the inflammation process.
Risk Factors
Several factors can increase the risk of developing hemorrhoids. Some factors can be changed, while others cannot. One example of an unmodifiable factor is genetics, particularly if a family member has a similar history. However, this condition can be helped by managing various modifiable risk factors. Diet plays a significant role in increasing the risk of hemorrhoids. People who rarely consume fiber, whether from vegetables or fruit, and who drink too little water, can increase the likelihood of experiencing constipation.
When constipated, defecation becomes more difficult and requires more pressure. If this condition persists for a long period of time, it can increase the risk of hemorrhoids. In addition to constipation, diarrhea can also increase the risk of hemorrhoids. When defecating too frequently, the rectum and anus experience greater pressure, which can cause blood vessels to dilate and form hemorrhoids.
Sitting for too long is not only unhealthy for muscle health but also for the rectum and anus. This position puts increased pressure on the area and can increase the risk of hemorrhoids. The same applies to pregnant women. The presence of a growing fetus in the abdominal cavity can increase pressure on the area and cause dilation of blood vessels, which can lead to hemorrhoids. Obese individuals also experience increased pressure on the area, putting pressure on the rectum and anus, which can increase the risk of hemorrhoids.
Heavy lifting also places greater pressure on the area. Lifting weights can also increase the risk of hemorrhoids if done incorrectly and with inappropriate weights. Furthermore, in older adults, where the tissues around the rectum and anus have decreased strength, excessive pressure can increase the risk of hemorrhoids.
Diagnosis
Anamnesis
During the initial examination, the doctor will conduct a medical interview to further investigate the patient's symptoms. A common symptom often reported by hemorrhoid patients is bloody stools. This requires further investigation, including the duration of the bleeding, to determine whether it originates from the anus or other sources such as the urinary tract, the vagina in women, or even from superficial wounds around the anus. Furthermore, it's important to determine the color of the blood.
Is it bright red or black? This is crucial to rule out other possibilities, such as upper gastrointestinal bleeding. The nature of the bleeding is also crucial in establishing a diagnosis. For hemorrhoids, a typical sign is streaks of blood in the stool or dripping after a bowel movement. It's also crucial to determine the volume of blood loss, whether it's light or heavy, to determine other possibilities, such as the risk of cancer or other conditions, and to determine initial treatment.
Hemorrhoids often cause anemia with prolonged bleeding, requiring immediate treatment. In addition to bloody stools, a common symptom is a lump around the anus. These lumps usually form due to prolapsed blood vessels. The symptoms of the lumps can also be examined in more depth to help establish a diagnosis. One factor is the process of the lump's enlargement, whether it occurs quickly or over a longer period of time. In cases of internal hemorrhoids, the lump usually enlarges slowly.
Even in the early stages, lumps felt around the anus after a bowel movement can return on their own. If a person does not change their diet to a high-fiber diet, experiences long-term constipation, and is not properly treated, the condition can worsen, with the lump becoming intractable only by hand, or even completely intractable. Other symptoms that often accompany hemorrhoids include discomfort, pain, and even burning in the anus and rectum. This condition may be worse when sitting for extended periods. It is also important to ask about a family history of hemorrhoids, as genetic factors can increase the risk of hemorrhoids and can help confirm the diagnosis.
Physical Examination
The initial examination that can be performed is a vital sign check. In the early stages, vital signs are usually normal. However, in cases of significant anal bleeding, it can cause a drop in blood pressure and an increased heart rate. An important examination is an anal examination, especially for patients who complain of a lump in the anal area.
This examination is crucial to determine whether the lump originates from the rectum and anus, or from the surrounding area. The anal lump will be assessed for size, shape, texture, and signs of irritation and inflammation.
Another examination that can be performed is a digital rectal examination. The doctor will perform this examination by inserting a gloved and lubricated finger into the anus. The doctor will assess for any lumps inside the rectum, swelling, and determine whether the lump is due to internal hemorrhoids or another cause.
Supporting Examinations
Generally, a diagnosis of hemorrhoids can usually be made through a history and physical examination. However, in chronic cases and with significant bleeding, especially in patients with low blood pressure or an increased heart rate, laboratory blood tests may be necessary to assess for anemia. If necessary, additional tests may be performed to increase confidence in the diagnosis or to rule out other possible diagnoses.
One of the supporting examinations that can be performed is an anoscopy. This examination uses a small, tube-like instrument with a camera at the tip to examine the inside of the anus and rectum. The instrument is inserted into the anus to determine whether the lump is purely an internal hemorrhoid or is caused by another condition.
If the doctor requires further examination, a proctoscopy or sigmoidoscopy can be performed. These instruments can examine not only the anus and rectum but also the lower colon. However, if the doctor desires a more detailed examination, especially if there is a suspicion of colon cancer, the doctor may recommend a colonoscopy. This examination can assess the entire colon and rectum.
Therapy
In the initial phase, it's important to improve your diet. Increase fiber intake from vegetables and fruit, and meet your daily fluid needs to reduce the risk of constipation and increased pressure on the rectum and anus. For discomfort in the rectum and anus, first aid can be done by soaking the area in warm water. This can be done several times a day, as needed.
For swollen hemorrhoids, cold compresses can help reduce inflammation and pain. Doctors can also prescribe topical medications in the form of ointments or creams to help relieve pain in the anal area. These medications usually contain lidocaine or hydrocortisone, which can be applied to the anal area.
Doctors can also prescribe oral laxatives for patients with constipation that doesn't improve with dietary changes. If the symptoms do not improve with the steps above, your doctor may recommend non-surgical procedures such as sclerotherapy, hemorrhoid ligation, infrared coagulation, and electrocoagulation using electric current. Surgical treatments include hemorrhoidectomy, which involves surgically removing the hemorrhoid. Additionally, stapled hemorrhoidopexy can be performed to reduce blood flow to the hemorrhoidal area.
Laser or ultrasonic surgery can also be used to remove hemorrhoids. However, the appropriate treatment will depend heavily on the patient's condition, severity, and various other factors, which will be considered by the treating surgeon.
Prevention
Maintaining a healthy lifestyle and consuming a balanced diet is crucial. Those with a history of frequent constipation can especially benefit from increasing their fiber intake from vegetables, fruits, and whole grains. Furthermore, it's important to drink enough water to meet your daily fluid needs. Avoid prolonged sitting and other activities that can increase pressure on the anus and rectum, such as lifting heavy objects incorrectly and obesity.
Complications
A common symptom of hemorrhoids is bloody stools. If this condition persists for a long period of time, especially with significant bleeding, it can often lead to anemia. In cases of strangulated hemorrhoids, where blood flow is cut off, this condition can cause severe pain and necrosis, or tissue death, in the area.
Hemorrhoids, especially those that form lumps, can become irritated and ulcerate, a deep open wound in the area if subjected to continuous friction. This can cause pain and bleeding. Ulceration can also increase the risk of infection due to the open tissue. If left untreated, this condition can lead to pus-filled abscesses and cellulitis, an infection of the skin and surrounding tissue.
When Should You See a Doctor?
If you experience typical hemorrhoid symptoms, such as bloody stools and lumps around the anus, but they don't improve with lifestyle changes, it's important to see a doctor for further evaluation. If necessary, you'll be referred to a surgeon for further examination and treatment to prevent complications.
Written by Dr. Valda Garcia. Reviewed by Dr. Ernest Eugene.
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