It is estimated that one third of the population suffers, to varying degrees, from hemorrhoidal disease or hemorrhoids. What are the causes, how can it be prevented and what treatments are available?

In common parlance, hemorrhoids refer to the disease itself. Yet, it is a “natural” part of our body, formed by arteries and veins, which contributes to anal continence and the process of defecation. There are internal hemorrhoids – located in the upper part of the rectal canal – and external hemorrhoids, positioned on the anal edge.

Hemorrhoids (for hemorrhoidal disease) correspond to the swelling and inflammation of the veins of the rectum and anus. They can go completely unnoticed. When they appear, they trigger a feeling of discomfort, burning, irritation, swelling in the anal area. Bright red blood loss can also be noticed during defecation, as does the production of some sort of mucus.

External hemorrhoids are much more likely to cause severe pain (related to thrombosis, with a blood clot in the vein) and itching.

However, it is important to point out that not all problems located in the anal region are hemorrhoids. Many patients who complain of pain, blood loss or swelling believe they have it, although these symptoms can occur in the presence of other conditions, such as anal fissures and abscesses.

In any case, the presence of blood in the stool and repeated bleeding, even scanty, should prompt you to consult a doctor.

Symptoms

Itching, irritation, bleeding during or after bowel movements are the trio of common symptoms of hemorrhoids. Other, rarer symptoms may also be associated with it.

Itching, burning and pain in the anal area

Whether it is internal or external hemorrhoids, itching and pain can appear. Although bothersome, you should abstain from scratching the anal area. This would only worsen the inflammation and therefore the pain.

Pain when defecating

In the case of internal hemorrhoids, defecation is painful and an internal burning sensation may be felt. Not visible, internal hemorrhoids do not allow an obvious self-diagnosis. Pain is not an element that necessarily accompanies hemorrhoidal diseases, but it usually accompanies their complications, which can be internal or external thrombosis depending on the location of the affected vessels. If treated effectively, hemorrhoids are not medically dangerous, but the thrombosis can ulcerate and bleed after a few days.

Bleeding during or after bowel movements

Bleeding is usually mild and barely noticeable on underwear or on toilet paper. In case of bleeding, tell your doctor who can, thanks to a local examination, classify the hemorrhoids according to their anatomical position. Very often, your doctor will not be satisfied with this observation and will prescribe other additional examinations, because this type of bleeding can also be the first sign of colorectal cancer.

Sensation of inflammation in the rectum

Again, this sensation can reflect the inflammation related to the presence of internal hemorrhoids.

Discharge of mucus from the anus

A pinkish or bright red discharge may indicate the presence of internal hemorrhoids. But beware, oozing through the anus can have many origins: hemorrhoids; ulcerative colitis, ulceration of the rectum, colon tumors, atrophy of the intestinal mucosa.

Sensitive protuberances through the anus

Unlike internal hemorrhoids, external hemorrhoids form small protuberances of variable size and shape, which can be identified at the exit of the anus.

Causes

It is normal for the veins in the recto-anal area to dilate slightly during defecation. On the other hand, when this dilation becomes persistent, it is problematic and we then speak of hemorrhoids. There are several possible causes for the appearance of these hemorrhoids. They can be favored by:

• a genetic predisposition;
• pregnancy and childbirth;
• constipation
• abuse of laxatives
• chronic diarrhea
• physical inactivity
• overweight
• a professional activity which requires you to remain seated for long hours
• physical efforts with increased abdominal pressure (heavy lifting, in particular)
• sitting in the toilet for too long (which increases the flow of blood to the hemorrhoidal veins)
• certain sports such as horse riding and cycling

People at risk

• People with a close relative with hemorrhoids;
• Pregnant women;
• Women who have given birth vaginally;
• People with cirrhosis of the liver;
• People who are constipated.

Diagnosis

To properly identify hemorrhoidal disease, an anoscopy is necessary. The anoscopy makes it possible to visually explore the anal canal, identify hemorrhoids and classify them according to their degree of severity. This is important in order to guide care and treatment.

• Stage 1: the hemorrhoids may bleed but do not come out.
• Stage 2: the hemorrhoids come out during defecation but quickly and spontaneously return to the anal canal.
• Stage 3: the hemorrhoids externalize during defecation and must be placed manually in the anal canal.
• Stage 4: the hemorrhoidal prolapse is permanent.

Treatment

Hemorrhoids are a mild disease. However, they can lead to very painful seizures. There are many medications, often available over the counter, that help relieve the symptoms.

In state 1 hemorrhoids, the approach is based on:

• Personal hygiene: lukewarm water, drying without rubbing, application of cold compresses for ten minutes three or four times a day to relieve itching.
• Diet: adaptation of the diet to facilitate proper functioning of the intestine for effortless evacuation (never delay defecation). It is necessary to give preference to fruits, vegetables and fibers; and to avoid spices, fried foods and alcohol. Good hydration is also extremely important.
• The practice of physical activity, even moderate but regular.
• Medicines (anti-inflammatory and analgesic ointments and suppositories, as well as oral painkillers, if necessary).

If symptoms do not improve, your doctor may recommend local intervention. The techniques will be adapted to the degree of severity of the hemorrhoidal involvement.

• Rubber band ligation (stage 1 resistant to initial treatment, stage 2 and stage 3). It consists of placing a rubber band at the base of the hemorrhoids, thus causing devitalization by strangulation. After a few days, the tissue dies and comes off. This is a painless method and there is no recovery period.

• Sclerotherapy (resistant stage 1 and stage 2). Injecting a sclerosing solution causes a reaction that will lead to reduced blood flow, decreased volume and sclerosis.
• Photocoagulation (resistant stage 1) by infrared aims to induce a phenomenon of retraction of the vein. It is also possible to perform this procedure using an electric current (electrocoagulation).
• Transanal hemorrhoidal dearterialization (stage 2, stage 3, even stage 4). The THD method does not require the removal of tissue from the anal canal, so postoperative pain is significantly reduced compared to hemorrhoidectomy (see below). Here, the technique consists, using an anoscope equipped with a Doppler probe, in locating the superior hemorrhoidal artery, which will be sutured in a few internal points.
• Hemorrhoidectomy (stage 3 and stage 4). The traditional surgical intervention, but less and less practiced. It aims to remove the bleeding or descending hemorrhoidal tissue. The technique is very effective, but very painful (due to the healing process). It requires hospitalization for several days and convalescence for a few weeks.
• Stapled Anopexy (stage 2, stage 3 and stage 4). Part of the rectal canal is removed and the hemorrhoids are repositioned to their original position. A stapler (surgical stapler) is used to remove excess lining and suture any remaining.

Prevention

Change your eating habits to avoid constipation

As constipation promotes the onset of hemorrhoidal crises and accentuates its symptoms, it is essential to ensure that it is treated quickly or that it is prevented. For this, make sure to adopt a diet rich enough in fiber, low in fat, salt and pastries, and remember to drink enough water (1.5 liters to 2 liters per day). These simple measures can significantly reduce the symptoms. Foods that help prevent constipation and hemorrhoids are fresh vegetables, fruits, raw vegetables, and legumes. If needed, mucilage can help treat constipation.

Good bowel habits

• Don’t wait to go to the restroom when needed. Otherwise, you could promote constipation, which will promote the occurrence of hemorrhoidal crises;
• On the contrary, only go to the restroom when you feel the need – and not when you think it’s time to go;
• You have the right to take your time, but avoid prolonging trips to the toilet unnecessarily at the risk of creating permanent pressure on the anal area;
• Avoid pushing too much and too hard: strong pushes put pressure on the anal area, which further promotes hemorrhoids.

Physical activity

Exercising and limiting your weight can help prevent hemorrhoids. Weight gain is a contributing factor to the occurrence of hemorrhoids. This is because the heavier you weigh, the more pressure you put on the anal area – a major risk factor associated with the development of hemorrhoids.

Physical activity can also help reduce constipation. Ideally: walking, swimming or cycling, as these activities do not put additional pressure on the pelvic floor.

Basic tips for relieving hemorrhoids

• Make sure to maintain impeccable anal hygiene: take a bath or shower every day. No need to use soap daily. It is important that the inflamed area does not become infected;
• Limit the use of toilet paper: After a bowel movement, use baby wipes or at least toilet paper soaked in water. Some doctors advise against scented toilet paper, which could facilitate inflammation;
• In case of pain or itching, apply cold compresses to the anal area several times a day. You can also do sitz baths with cold water (hot water would cause vasodilation which could accentuate the problem);
• Wear cotton underwear that will allow moisture to escape, unlike lycra, acrylic and other synthetic fibers;
• Avoid foods that can irritate the mucous membranes: coffee (even decaffeinated), alcohol, tea, strong mustard, hot pepper and other strong spices. The ideal is to opt for a vegetarian diet until the symptoms disappear;
• Avoid efforts that can increase the pressure in the veins (lifting heavy objects, straining too much while having a bowel movement, etc.).

Beware of personal treatments

Inflammation plays an important role during hemorrhoidal outbreaks. Corticosteroid creams or ointments, which have a strong anti-inflammatory effect, provide quick relief. However, they should not be used for a prolonged period, due to the lack of preventive effect on recurrence and the risk of adverse reactions. Lubricants or protectors, which can be bought without a prescription, unlike corticosteroids, can also be used, to have a bowel movement more easily (constipation playing an aggravating role).

Hemorrhoidal thrombosis

Considered a complication of hemorrhoidal diseases, external hemorrhoidal thrombosis can affect anyone with a peak incidence around the age of 30. Statistically, we will all have three thromboses in our lifetime.

A distinction must be made between external thrombosis, the most frequent, and internal thrombosis. In both cases, arteriovenous disorders are involved. The sudden opening of the capillaries puts stress on the vein and causes thrombosis.

External hemorrhoidal thrombosis results from the formation of a clot of a few millimeters to 2 centimeters, localized at the level of the hemorrhoids. The lesion is a very painful bluish swelling, often surrounded by edema of varying size.
Internal hemorrhoidal thrombosis is a progressive accident of the hemorrhoidal disease itself, which is characterized by prolapse. It is noticeable on digital rectal examination in the form of painful spherical masses. It often has to be operated on as an emergency.

The first manifestation of hemorrhoidal thrombosis is pain, which is permanent and not pulsating. It usually starts suddenly and is associated with anal swelling. Without treatment, this pain can persist for several weeks, sometimes several months. The natural course of thrombosis is that the formed clot clears itself out. This occurs in some cases and then results in bleeding.

During pregnancy, women are particularly susceptible to venous disorders. If we shamelessly evoke his heaviness in the legs, we less willingly approach his hemorrhoid problems. Doctissimo gives an update on this common problem.

Hemorrhoids during pregnancy

As we know during pregnancy, a woman’s body changes a lot. This causes some minor but unpleasant troubles. They are usually not serious but can significantly disrupt daily life. It is mainly from the 6th month of pregnancy that the uterus is large enough to compress the veins in the abdomen. The blood circulation is then completely turned upside down and varicose veins and hemorrhoids often occur. A study reveals that in 48% of cases, pregnancy causes hemorrhoidal diseases. As for its frequency, it varies enormously from one woman to another but we are talking about at least 1/3 of future mothers who would be affected during their pregnancy.

Obviously, your baby is in no danger but the irritation, itching, small bleeding, and pain associated with hemorrhoids are not exactly pleasant. Drinking lots of water, eating fiber and fruit are simple prevention measures that can be taken throughout pregnancy.

It is important to favor good lifestyle habits in order to avoid constipation. As mentioned above, constipation is the main factor involved and this would affect almost one in two pregnant women. The risk of constipation in pregnant is further exacerbated by the iron supplementation that is often recommended to pregnant women.

It is often believed that there is no solution to hemorrhoids when you are pregnant. Suffering in silence is absolutely not the attitude to adopt. In all cases, consult your doctor or ask your pharmacist for advice because, when you are pregnant, you should never take any medication without medical advice. They will be able to advise you on local treatments which will relieve you occasionally. Good news: these drugs are not contraindicated in pregnancy, especially after the first trimester.

A diet rich in fiber helps to avoid certain inconveniences such as hemorrhoids. Take advantage of your pregnancy to stock up on fruits and vegetables and especially drink plenty of water, the only essential drink for your body.