Commonly known as piles, hemorrhoids are abnormally enlarged and bulging blood vessels in and about the anus and lower rectum. There are two types of hemorrhoids: external and internal, which refer to their location.
External (outside) hemorrhoids develop near the anus and are covered by very sensitive skin. If a blood clot develops in one of them, a painful swelling may occur. The external hemorrhoid feels like a hard, sensitive lump. It bleeds only if it ruptures.
Internal (inside) hemorrhoids develop within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptom. However, an internal hemorrhoid can cause severe pain if it is completely "prolapsed" - protrudes from the anal opening and cannot be pushed back inside.
An exact cause is unknown; however, the upright posture of humans alone forces a great deal of pressure on the rectal veins, which sometimes cause them to bulge. Other contributing factors include:
- Aging
- Chronic constipation or diarrhea
- Pregnancy
- Heredity
- Faulty bowel function due to overuse of laxative or enemas; straining during bowel movements
- Spending long periods of time (e.g., reading) on the toilet
Whatever the cause, the tissues supporting the veins stretch. As a result, the veins dilate; their walls become thin and bleed. If the stretching and pressure continue, the weakened veins protrude.
- Bleeding during bowel movements
- Lump at the anus coming out during bowel movements
- Itching in the anal area
- Pain
- Sensitive lump(s)
Do hemorrhoids lead to cancer?
NO. There is no relationship between hemorrhoids and cancer. What is important is that the symptoms of hemorrhoids, particularly bleeding, are similar to those of colorectal cancer and other disease of the digestive system. Therefore, it is important that all symptoms are investigated by a doctor. Do not rely on over-the-counter medications or other self-treatments. See your doctor first so that your symptoms can be properly evaluated and effective treatment prescribed.
Mild symptoms can be relieved frequently by increasing the amount of fibre (e.g., fruits, vegetables, breads and cereals) and fluids in the diet. This decreases straining during motion so that the pressure on hemorrhoids is reduced. This helps prevent them from bleeding or protruding.
If this does not help, some special treatment may be required. This includes:
Ligation - the rubber band treatment - works effectively on internal hemorrhoids that protrude with bowel movements. A small rubber band is placed over the hemorrhoid, cutting off its blood supply. The hemorrhoid and the band fall off in a few days and the wound usually heals in a week or two. This procedure sometimes produces mild discomfort and bleeding.
Injection can also be used on bleeding hemorrhoids that do not protrude. This method is relatively painless and cause the hemorrhoid to shrivel up.
Both ligation and injection can be done in your doctor's clinic without need for hospitalisation.
Hemorrhoidectomy - surgery to remove the hemorrhoids - is the best method for the permanent removal of hemorrhoids. It is necessary when clots repeatedly form in external hemorrhoids; ligation fails to treat internal hemorrhoids; the protruding hemorrhoid cannot be reduced; or there is persistent bleeding.
A hemorrhoidectomy removes excessive tissue that causes the bleeding and protrusion. It is done under anesthesia and usually require hospitalisation. Laser hemorrhoidectomies do not offer any advantage over standard operative techniques. They are also quite expensive, and contrary to popular belief, are no less painful.
Other treatments include cryotherapy, BICAP coagulation and direct current. Cryotherapy, popular 20 years ago, consists of freezing piles tissue. It is not recommended for hemorrhoids because it is very painful. BICAP and direct current are methods that shrink the hemorrhoid. None of these treatments have gained widespread acceptance.