Hemorrhoids are varicose veins of the rectum located at or near the anal canal. Approximately 2 million people (about 12 percent of the population) in the United States receive medical care for hemorrhoids each year, based on data from the National Health Care survey. The exact prevalence of hemorrhoids is hard to measure because many opt for over-the-counter treatments instead of visiting the doctor. However, it's estimated that as many as 40 percent of the population have experienced symptomatic hemorrhoids, and as many as 75 percent of people older than 45 are affected.
Hemorrhoids are usually benign. Deaths are very rare, accounting for only 14 deaths in the United States in 2004, according to population data.
Symptoms & Causes
Hemorrhoids are usually a result of applying too much pressure to the lower rectum. This may happen if you're straining to have a bowel movement, which can occur during chronic diarrhea and constipation, according to the Mayo Clinic. It may also happen if you sit on the toilet too long because when you sit on the toilet, your anus relaxes, allowing the veins around to fill with blood, which then puts pressure on those veins.
Pregnant women are also more susceptible to hemorrhoids because of the weight of carrying the baby and also from giving birth. Around 25 to 35 percent of pregnant are affected in the third trimester, according to estimates from two studies conducted in France. Being very overweight, or standing or lifting too much can also make hemorrhoids worse.
People with hemorrhoids don't necessarily feel pain, though they may experience bleeding, anal swelling and discomfort. Internal hemorrhoids lie inside the rectum and the most common symptoms include painless rectal bleeding, prolapse or protrusion, pain and irritation, according to the Mayo Clinic. External hemorrhoids are located under the skin around the anus. They could enlarge, resulting in pain, swelling and, in serious cases, spontaneous rupture, intense pain and bleeding.
Diagnosis & Tests
Rectal bleeding is usually the most obvious symptom for hemorrhoids and also the primary reason people seek medical help. Only 5 percent of patients required emergency room visits, according to the National Health Care survey. The majority of people sought treatment at primary care and specialists' offices.
Diagnostic tests are done not only to confirm the presence of hemorrhoids, but to eliminate other possible digestive disease since bleeding from your rectum or anus or bloody stools may be a sign of something more serious such as cancer, according to the American Academy of Family Physicians. Doctors usually check for internal hemorrhoids by inserting a rubber-gloved finger into the rectum in order to feel for any protrusions or examine the lower portion of the colon with an anoscope or endoscope, according to the Mayo Clinic. Certain accompanying symptoms might suggest other digestive diseases and a more extensive examination using colonoscopy may be required.
Most hospitalizations for hemorrhoids are for surgery, which is performed most often as same-day surgery. Otherwise, most hemorrhoids heal on their own in a week or two, according to a treatment update published by University of California, Los Angeles scientists in 2009. Over-the-counter topical medications usually contain corticosteroids and anti-inflammatory agents that can provide short-term local relief from discomfort, pain and bleeding caused by external hemorrhoids.
There are a few nonsurgical treatment options for internal hemorrhoids. Sclerotherapy, where the hemorrhoid is injected with chemicals in order shrink it, is the oldest therapy. However, randomized controlled trials have found it to be less effective than other methods, according to the 2009 treatment update.
Rubber band ligation involves placing a small rubber band around the base of the hemorrhoid and stopping the flow of blood to the area. It is more effective than other methods, though it is also associated with more post-treatment pain and complications.
Infrared or electrocoagulation targets the hemorrhoid by burning it and letting it slough off. It's found to be less effective than banding and usually requires more treatments. However, it also has significantly less postoperative pain and fewer complications.
Surgical removal or stapling of the hemorrhoids may be needed if internal hemorrhoids have prolapsed or are very large, according to a review published in the Journal of American College of Surgeons in 2006.
One can maintain regular bowel movement and lessen the risk of hemorrhoids by including more fibre in their diet, according to the American Academy of Family Physicians. Laxatives, aside from bulk-forming laxatives like Fiberall and Metamucil, can lead to diarrhea, should be avoided because they can worsen hemorrhoids. Also, one should avoid exerting too much pressure during bowel movement, according to the Mayo Clinic. Try not sit on the toilet for too long when waiting for bowel movement and also avoid straining too hard when trying to pass a stool.