Hemorrhoids – Causes, Risk Factors, Symptoms, Complications And Diagnosis
Hemorrhoids are varicose dilatations of the veins located in the wall of the anus and rectum. Veins of the anus and rectum have protective role, to help a perfect closure of the rectum. When exercising pressure on them, these vessels begin to dilate. Hemorrhoids are very common both inÂ men and women, about half of people aged over 50 have hemorrhoids.
Rectal veins in submucosa form a rich network, known as hemorrhoidal plexus. The hemorrhoidal plexus is divided into two parts: internal and external hemorrhoids hence the hemorrhoidsÂ division into two types:
- Internal Hemorrhoids. Internal hemorrhoids are hemorrhoids that are inside the rectum above the anus. Internal hemorrhoids can not be seen with the naked eye and are covered with digestive lining thatÂ is not sensitive, so there is noÂ pain.
- External hemorrhoids. External hemorrhoids are formed under the skin of the anus. External hemorrhoids mayÂ be feelt (appearing as a small prominence under the skin of the anus) and pain is present due to the distension of the skin that is rich in sensory nerves.
Hemorrhoids occur when pressure increases in the veins around the anus and rectum. Factors that increase pressure in the hemorrhoidal plexus include:
- Gastrointestinal disorders (chronic constipation, diarrhea, etc.). Increased effort during defecation is considered the most common cause of hemorrhoids. This occurs frequently in patients with chronic constipation. Long periods of time spent on the toilet causes increased pressure in the veins of the rectal canal.
- Pregnancy and childbirth. Both pressure fetus in the abdomen and hormonal changes leads to enlargement of hemorrhoidal vessels. These vessels are subject to severe pressure during childbirth. For most women, hemorrhoids that occur after pregnancy are a temporary problem.
- Lifting heavy objects can cause increases in pressure in the hemorrhoidal plexus similar to those caused by constipation. Lifting weights is known asÂ a hemorrhoids aggravating factor and is often associated with their formation.
- Poor diet, especiallyÂ rich inÂ meat and nourishing food without eating fruits and vegetables or foods that contain fiber (bran, yogurt, vegetables, etc.). The role of fiber is to stretch the gut (if you drink enough fluids) and to boost the volume bowel movements (peristalsis), easing digestion and maintaining normal activity of intestinal cells, favoring the absorption of nutrients and thus preventing constipation. Diets rich in spices favors hemorrhoids.
- Liver disease. Cirrhosis increases the pressure in the portal circulation whose expression is symptomatic hemorrhoids.
- Pelvic tumors, genital or rectal can compress the hemorrhoidal plexus drainage ways, and sometimes rectal wall itself.
- Extended sitting or standing
- Chronic Cough
- Chronic heart failure cause venous stasis in the lower hollow system.
- Excessive use of laxatives or enemas
- Excess alcohol, coffee, chocolate, caffeinated beverages consumption,
- Anal sex
Patients who have family members with hemorrhoids are more likely to develop hemorrhoids. In hemorrhoids there is a hereditary predisposition related to a lower quality of collagen, which leads to impaired venous walls.
Hemorrhoids symptoms include:
- Anal bleeding with “fresh blood”, bright red, in small quantities discoveredÂ in the stool, or on theÂ toilet paper.
- Itching or irritation in the anal region
- Pain or discomfort in the anal region
- Swelling around the anus
- Elimination of mucus in the stool
- The appearance of stains on underwear due to mucous secretions.
External hemorrhoids may remain without symptoms:Â they do not bleed, are notÂ painful and doÂ not prevent defecation. They are seen during inspection as painless growths of soft consistencyÂ that from around the anus. Hemorrhoids areÂ getting worse when coughing orÂ during defecation effort.
The dominatingÂ symptom of internal hemorrhoids is bleeding, mucous discharge, pruritus (itching) and pain. Small quantities ofÂ blood losses, but repeated ,characteristic toÂ hemorrhoids canÂ produce anemia (the patient is pale andÂ accuses tiredness). Due to continuous flow of these secretions and anal region irritation pruritus occursÂ (itching). Typically, patients with hemorrhoids do not cause pain, but the patient is complaining about theÂ feeling of weight andÂ incomplete evacuation after defecation. The occurrence of pain in patients with hemorrhoidsÂ in theÂ anal region is associated with complications, especially inflammatory complications
- Anal fissureÂ (a tear in the mucous lining of the lower rectum that causes pain and bleeding duringÂ important bowel movements .
- Anal abscess (a collection of pus in the perianal region andÂ also aÂ medical emergency)
- Perianal fistula is a communication between the anal canal and perianal skin.
- Prolapsing, (internal hemorrhoids thatÂ reach the outside, followed by their swelling and difficult transition back, causing discomfort and pain)
- Thrombosis and inflammation. Hemorrhoid formationÂ becomes painful and defecation is painful. Hemorrhoids appear as shiny purplish growths, turgid, very sensitive to touch. After 3-4 days, symptoms are relievedÂ by breaking a small thrombosedÂ nodule withÂ bleedingÂ and elimination of thrombus.
- Strangulation of internal hemorrhoids
The diagnosis of hemorrhoids is established after carryingÂ the patient medical history and physical examination. The patient is generally asked about bowel habits, including frequency and any recent changes, and certain symptoms such as pain, bleeding or itching in the anal region. Physical examination usually involves a digital rectal examination. For digital rectal examination the doctor willÂ use disposableÂ non-sterile surgical gloves, the index will be lubricatedÂ so thatÂ the maneuver willÂ be as little annoying as possible. During the digital rectalÂ examinationÂ doctor feelsÂ the hemorrhoids and highlightsÂ laxity (slip lining).
This examinationÂ means using aÂ instrument as a short thin tube equipped with lighting to analyze the anal canal (the last centimeters).
Rectoscopy is an exam that allows visual exploration of the rectum wall. A Rectoscope involves inserting through the anus into the rectum a rigid endoscope called rectoscope (a tube with a length of 25 centimeters and 1.5 centimeters in diameter, equipped with an optical system). Biopsies are possibleÂ (removal of rectal tissue). Rectoscopy is useful to diagnose internal hemorrhoids.
This allows the doctor to observeÂ a third area located in the lower colon (sigmoid colon). This exam is done using a thin tube, flexible, with a small camera is inserted all the way easily into the rectum and then moved easily through the intestine. During a sigmoidoscopy Â samples can be harvestedÂ (biopsy) for examination under a micorscope.
Other diagnostic tests, including blood tests and analysis of faeces can be used to exclude other possible causes of symptoms.