Hemorrhoids, a common health condition, are essentially vascularized tissue pads found in the terminal part of the rectum, near the anus. They are firmly anchored to the wall of the anal canal with the help of fibrous ligaments. However, under certain conditions, these structures can become inflamed, swell excessively, and become visible to the naked eye. This dilation and inflammation can lead to prolapse, bleeding, or thrombus, i.e., the formation of blood clots inside them. This condition is known as hemorrhoidal disease.
Hemorrhoidal Disease vs Hemorrhoids
In everyday language, the term "hemorrhoids" is commonly used to refer to what medical professionals recognize as hemorrhoidal disease. However, this terminology is inaccurate. Hemorrhoids, correctly known as the hemorrhoidal plexus, are vascular structures naturally present in the anal canal of every individual. These structures are essential for maintaining continence, which involves the retention of feces, liquids, and gases, and they play an important part in bowel evacuation.
Hemorrhoids are equipped with the ability to expand and contract, thanks to the inflow and outflow of blood. This adaptability aids in managing the anal pressure during bowel movements. However, when these vascular cushions become chronically inflamed or irritated, they can swell excessively and may protrude outside the anus. This condition, properly referred to as hemorrhoidal disease, manifests through symptoms such as swelling, discomfort, and bleeding.
Classification and Types of Hemorrhoids
Hemorrhoids can be categorized into internal and external types based on their anatomical location.
Internal Hemorrhoids These are located inside the anal canal, above the dentate or pectineal line, which divides the anal canal into two parts. Internal hemorrhoids are generally painless and not visible to the naked eye. They can prolapse during defecation and then re-enter spontaneously. Pain is only caused when the prolapse is complete or is associated with fissures.
External Hemorrhoids These are located below the dentate line, at the margins of the anal orifice. They are visible to the naked eye, develop near the anus, and appear as hard, painful bumps.
Hemorrhoidal disease can be further classified based on the severity of the condition:
1st degree hemorrhoids The hemorrhoidal cushions increase in volume but do not prolapse outside the sphincter. They cause discomfort, itching, and possible bleeding during defecation, while pain is often absent.
2nd degree hemorrhoids Hemorrhoid prolapse occurs following excessive efforts, for example, during defecation or childbirth, with subsequent spontaneous reduction once the contraction has ceased. In addition to bleeding, itching, and loss of secretions may also be present.
3rd degree hemorrhoids Hemorrhoid prolapse is independent of effort. Hemorrhoids can be manually repositioned to fit inside the anal canal. Symptoms include pain and slight loss of feces outside, with soiling of the underwear.
4th degree hemorrhoids They are completely prolapsed and cannot be repositioned inside the anus, so they always remain outside. Symptoms include pain, intense itching, and fecal incontinence.
Causes
Hemorrhoidal disease is multifactorial, meaning it arises from multiple contributing factors. Key causes include:
Dietary Habits An unbalanced diet lacking in fiber can lead to chronic constipation, which puts excessive strain on the rectal veins.
Chronic Constipation Frequent constipation increases pressure in the rectal area, exacerbating vein enlargement.
Pregnancy The increased pressure from the growing uterus and hormonal changes can cause hemorrhoids during pregnancy.
Lifestyle Factors Sedentary behavior or sitting for prolonged periods can increase rectal vein pressure.
Obesity Excessive body weight can exert additional pressure on the pelvic veins, contributing to hemorrhoid formation.
Medications Certain medications, such as laxatives used excessively, can aggravate constipation and subsequently hemorrhoids.
Comorbid Diseases Conditions that increase abdominal pressure, like chronic cough and liver disease, can also contribute.
Defecation Habits Delaying or rushing bowel movements can lead to increased strain during defecation, contributing to hemorrhoids.
Genetic Predisposition Individuals with a family history of vascular fragility or varicose veins may have a higher risk of developing hemorrhoids.
Symptoms
Hemorrhoids can manifest a range of symptoms and complications. Initial signs often include discomfort in the anal area, such as itching, burning, and the leakage of mucus. These symptoms may also be accompanied by an urge for frequent bowel movements.
As hemorrhoids progress to more advanced stages, they can cause significant pain and physical discomfort. This is often exacerbated by the contraction of the anal sphincter. External hemorrhoids are particularly susceptible to injury from excessive rubbing or pressure, which can thin the tissues and lead to bleeding.
Patients with hemorrhoids typically experience cycles of acute flare-ups followed by varying periods of relief. However, the condition is prone to recurrence, creating a pattern of ongoing discomfort.
Complications
Complications from hemorrhoids can be severe and include:
Bleeding This may occur from either internal or external hemorrhoids and is often noticed during bowel movements.
Thrombosis Hemorrhoid thrombosis happens when a blood clot forms within the hemorrhoid, leading to intense pain and swelling.
Strangulation This occurs if prolapsed hemorrhoids—the ones that extend outside the anal canal—become constricted and their blood supply is cut off.
Abscess Formation Both anal and perianal abscesses can develop, characterized by painful, pus-filled infections near or around the anus.
Fecal Incontinence In some cases, ongoing damage from hemorrhoids can affect the ability to control bowel movements.
Seeking Medical Help
When the typical symptoms of hemorrhoids appear, it is crucial to overcome any reticence and seek medical help. Early intervention can significantly aid recovery from the disease. It's also important to remember that the symptoms of hemorrhoids can be alleviated by making changes to diet and lifestyle habits. These general measures form the basis of every treatment, whether pharmacological, surgical, or phytotherapeutic. Therefore, diet and lifestyle corrections must always be implemented, regardless of any additional treatments.
