Hemorrhoids

Hemorrhoids are swollen and inflamed veins in your anus and lower rectum. Hemorrhoids are very common. By age 50, at least half of adults have experience about hemorrhoids. Based on location, there are three types of hemorrhoids: 1. Internal hemorrhoids, which locates inside the rectum; 2. External hemorrhoids, which locates under the skin around the anus; 3. Mixed hemorrhoids, which locates inside and outside of the rectum. Pictures below are endoscopic views of hemorrhoids from inside the rectum.

Causes and Risk Factors

The common ones are:

Straining during bowel movements
Sitting or standing for long periods of time
Constipation
Diarrhea
Obesity
Pregnancy
Anal intercourse
Anal infections
Certain diseases, such as liver cirrhosis

Symptoms and Signs

The most common ones may include:

Anal itching
Anal pain
Painless bleeding. Small amounts of bright red blood might be seen on the toilet paper or dripping into the toilet bowl.
Painful bowel movements
One or more hard tender lumps near the anus
Swelling around your anus
Leakage of stool

Diagnosis and Treatment

Diagnosis is based on clinical presentation with one or more of the following tests:

Blood works
Stool studies
Sigmoidoscopy
Colonoscopy

Treatments for hemorrhoids are based on the type, symptoms, causes, and the patient’s preferences. There are many methods available to treat hemorrhoids. The most common ones are:

Life style modifications
Stool softeners
Hemorrhoid creams to help reduce pain and swelling
Sitz baths can increase blood supply and aid in healing
Infrared coagulation
Endoscopic rubber band ligation
Surgical hemorrhoidectomy
Minimal invasive procedure: Hemorrhoids banding with CRH system

References:

PubMed.
Wikipedia.
Mayo clinic online health information.
Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
The Little Black Book of Gastroenterology-by David W. Hay.
Principles of Clinical Gastroenterology by Tadataka Yamada, et al.

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