What are Hemorrhoids

Men and women alike have hemorrhoids, they occur naturally in the body. Hemorrhoids or “anal cushions” are a complex of blood vessels in the anal canal. These cushions are part of the normal anatomy and are thought to aid in defecation and assist in closing the anal canal. Hemorrhoids are custom cushions where blood flows in and out to swell or shrink the tissue to provide continence.

Over time these cushions can enlarge with straining or extended time spent on the toilet which thins the overlying mucosa and produces bleeding with bowel movements. As they continue to enlarge they can prolapse or protrude from the anus.

Conservative Treatments:

Conservative treatment of hemorrhoids consists of educating patients on the main causes of enlarged hemorrhoids and correcting them. Simple treatments such as fiber therapy, taking all of the reading material out of the bathroom, not straining to have a bowel movement and weight loss can make a difference and allow patients to avoid surgery for their hemorrhoids.

Hemorrhoid Causes:

• Increased straining during bowel movements
• Sitting too long during bowel movements
• Pregnancy – increased straining, hypertension, delivery
• Constipation and diarrhea
• Obesity

Hemorrhoid Types and Symptoms:

There are two types of hemorrhoids, internal hemorrhoids and external hemorrhoids:

INTERNAL HEMORRHOIDS are inside the anal canal and generally do not cause pain. The most common symptom of internal hemorrhoids is bright red blood - in the stool, on toilet paper, or in the toilet bowl. Additionally, an internal hemorrhoid may form and prolapse outside the anus and become irritated and painful. This is referred to as “prolapsing” hemorrhoids.

Prolapsed Hemorrhoids: These are internal hemorrhoids that are so distended that they are pushed outside the anus. They may spontaneously reduce or be manually reduced. If the prolapsed hemorrhoid cannot be gently reduced, consult with a doctor to discuss the treatments.

Grading of Internal Hemorrhoids:

  • 1st Degree: The hemorrhoids do not prolapse.
  • 2nd Degree: The hemorrhoids prolapse upon defecation but spontaneously reduce.
  • 3rd Degree: The hemorrhoids prolapse upon defecation, but must be manually reduced.
  • 4th Degree: The hemorrhoids are prolapsed and cannot be manually reduced.

THD is indicated for symptomatic internal hemorrhoids, degree 2nd, 3rd and 4th.

EXTERNAL HEMORRHOIDS are found outside the anus. Some form blood clots, bright red blood is seen on toilet paper or in the toilet after a bowel movement and often a lump on the anus presents outside the body. With external hemorrhoids, you may experience itching, bleeding and painful swelling.

In most cases, hemorrhoids go away on their own. It is important to discuss all anorectal issues with a physician so they can diagnose the problem correctly.

Learn More
For more educational material on hemorrhoids, please visit the sites below.
Mayo Clinic
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