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Learn-More-About-Hemorrhoids-and-Its-Treatments
Learn More About Hemorrhoids and Its Treatments

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Hemorrhoid-Diagram

Hemorrhoids can be internal (up in the lower rectum) or external (outside the anal area).

Everyone has internal hemorrhoids, also known as piles. They help prevent fecal incontinence and protect fragile veins in the rectal area. For some, they remain of normal size and present no discomfort.

  • However, it is estimated that at least 50% of American adults will experience painful hemorrhoids at some point during their lifetime.
  • Although they are not dangerous or life-threatening, they can be extremely uncomfortable.

If there is increased pressure in the rectal area (for various reasons), over time, delicate blood vessels can become enlarged, thin, swollen, and painful. In fact, hemorrhoids are often referred to as varicose veins of the rectum or anus. This is typically when a person says they “have hemorrhoids.”

How are Hemorrhoids Classified?

Hemorrhoids are graded, based on their severity:

  • Grade 1 - These hemorrhoids bleed but do not slip down out of the anus. (This is commonly called prolapse).
  • Grade 2 - Still considered mild, these hemorrhoids will prolapse (usually during a bowel movement), but will spontaneously return back into the anus on their own.
  • Grade 3 - This grade will prolapse even further out. They will not spontaneously return inside the rectum, but they can be manually pushed back in.
  • Grade 4 - These hemorrhoids are the most severe and may cause intense pain. They prolapse and cannot be pushed back in. Grade 4 hemorrhoids may require surgery to repair.
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Woman-with-Hemorrhoid-Pain

Doctor-Discussing-Hemorrhoid-Treatments

Symptoms

Symptoms may range in severity, depending on the type and grade of hemorrhoid. They may be present only when having a bowel movement, or they may be a constant discomfort. Bright red blood might be visible in the toilet or on toilet paper after having a bowel movement. Anal pain and irritation is common. Itching could also be noted. If the hemorrhoid is external, a hard painful lump is felt under the skin, around the anus. This may look like a blood blister.

Causes and Risk Factors

Several causes and risk factors have been identified:

  • Chronic constipation or diarrhea
  • Heavy lifting (or anything that causes straining)
  • Sitting for long periods of time
  • Stress
  • Obesity
  • Low-fiber diet
  • Aging
  • Pregnancy
  • Anal intercourse
  • Family history

Diagnosis

A diagnosis is made after a detailed medical history and physical examination is completed. Symptoms and risk factors will be discussed. The anal area will be visualized and a digital rectal examination may be performed to verify the presence of hemorrhoids. If more severe hemorrhoids are noted, other diagnostic testing may needed, including anoscopy, sigmoidoscopy, or colonoscopy.

Treatment

Treatment for mild to moderate hemorrhoids generally includes medical management and home interventions. Over-the-counter and prescription creams may be used to help relieve symptoms and reduce inflammation. Warm baths or ice packs might be helpful during a flare-up.

Lifestyle changes should be implemented to help reduce straining with bowel movements and decrease pressure in the anal and rectal areas. Drinking more water, increasing fiber in the diet, exercising, and maintaining a healthy weight may all help alleviate uncomfortable symptoms.

If hemorrhoids are severe, surgical treatment may be necessary.

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