Anorectal Diseases Hemorrhoids

Hemorrhoids, or piles, are swollen veins located in the anus and rectum. Hemorrhoids affect people of all ages, and are one of the most common causes of rectal bleeding. Approximately half of all people older than fifty have experienced hemorrhoid symptoms.

Internal and External Hemorrhoids

External hemorrhoids and internal hemorrhoids describe the location of piles in the rectum. Internal hemorrhoids, as the name implies, are located inside the anus. External hemorrhoids develop in the skin surrounding the anal opening. Both internal and external hemorrhoids can protrude outwards.

Causes of Hemorrhoids

The causes of hemorrhoids include constipation and excessive straining during bowel movements. Persistent diarrhea and loose stool movements are also causes of hemorrhoids, and some people inherit a family tendency to develop piles.

Women are more susceptible to hemorrhoids during pregnancy, as pressure from the growing uterus restricts blood flow in the pelvic area.

Lifestyle factors can also contribute to hemorrhoid development. Other causes of hemorrhoids include sitting or standing for long periods of time, heavy lifting and obesity. Some cases of piles have been associated with anal intercourse.

Hemorrhoid Symptoms: Rectal Itching and Bleeding

Despite the discomfort assumed to accompany piles, many hemorrhoids are asymptomatic. When hemorrhoid symptoms are present, rectal itching and rectal bleeding are the most common symptoms.

Piles are usually painful only if the veins have ulcerated or thrombosed (filled with clotted blood). Symptoms of specific types of hemorrhoids are described below:



internal hemorrhoid symptoms
  • may protrude
  • mucus discharge
  • rectal bleeding
  • rectal itching
  • feeling of incompletely emptying bowels.
external hemorrhoid symptoms
  • rectal itching uncommon
  • may protrude
  • rectal bleeding
  • interferes with anal hygiene.
thrombosed hemorrhoid symptoms
  • protrude
  • rectal itching
  • rectal pain
  • rectal bleeding
  • tenderness
  • swelling.
ulcerated hemorrhoid symptoms
  • rectal itching
  • rectal bleeding
  • swelling
  • severe rectal pain.

Rectal Bleeding and Piles

Rectal bleeding, one of the most common hemorrhoid symptoms, is also one of the most alarming. Piles usually bleed after a bowel movement, and blood may be detected in the toilet or on toilet tissue.

Diagnosing Piles

A physical exam and history of hemorrhoid symptoms is usually sufficient to diagnose piles. An examination of the anal region can reveal swollen blood vessels. In a digital rectal exam, the doctor inserts a lubricated, gloved finger into the rectum to detect swelling and other signs of piles.

Detecting internal hemorrhoids may require the use of an anoscope, a thin tube inserted into the anus that transmits pictures back to a monitor.

Rectal bleeding can indicate serious health conditions. Even if an anoscope detects piles, further testing may be required to rule out more serious causes of rectal bleeding.

Treating Hemorrhoids

If no hemorrhoid symptoms are present, or if symptoms are mild, piles often resolve by themselves and disappear in a few weeks. During this time stool softeners and bulking agents such as psyllium can relieve constipation, prevent excessive straining and facilitate healing of the hemorrhoid. Avoiding heavy exercise or lifting during the healing process is recommended.

Swelling and rectal itching can be alleviated with sitz bathssoaking the anal region in warm wateror by applying compresses to the anus. Using a solution of magnesium sulfate is recommended for both sitz baths and compresses. Use half a cup magnesium sulfate per sitz bath of water.

Severe rectal pain caused by piles can be relieved with oral painkillers, including narcotics, if rectal pain is intense. Heavy rectal bleeding can be stopped, at least temporarily, by an injection of five percent phenol directly into the affected vein.

Surgical Treatment of Hemorrhoids

Large piles that do not respond to other treatments may be surgically removed. The most common hemorrhoid surgery is called rubber band ligation. The piles are gently drawn through a stretched rubber band. Once in place the rubber band cuts off blood flow to the piles, causing cell death in the hemorrhoids. Eventually the piles simply drop off.

If piles are small enough, infrared photocoagulation is used to cut off the hemorrhoid’s blood supply. Infrared photocoagulation is also used for hemorrhoids that are too painful to be treated with rubber band ligation.

The actual surgical removal of hemorrhoids, called hemorrhoidectomy, is not commonly performed. Surgical removal of piles is usually undertaken only if thromosed hemorrhoids are causing excessive rectal bleeding.

Preventing Piles

Preventing piles is the best possible hemorrhoid treatment. While no strategy completely removes the risk of hemorrhoids, following these suggestions can lower the risk:

  • Avoid sitting or standing for long periods.
  • Avoid straining during bowel movements.
  • Drink enough liquid for proper hydration.
  • Eat a diet high in fiber.
  • Exercise regularly.
  • Go to the bathroom when you need to; don’t wait.
  • Take fiber supplements recommended by your doctor.


Beers, M.H.