Hemorrhoids are dilated veins that form in the anus or rectum. It is normal for the veins in the anal area to swell slightly when you have a bowel movement. But unlike normal veins, hemorrhoids remain permanently dilated.

About 1 in 2 adults over the age of 50 have hemorrhoids. The main causes are constipation, pregnancy and loss of tissue tone with age. In pregnant women, symptoms of hemorrhoids usually go away after childbirth.

Symptoms are occasional and easily recognizable: itching near the anus, discomfort when sitting, and bleeding when having a bowel movement. Usually, a hemorrhoid attack lasts a few days, then the symptoms subside.

Most people with hemorrhoids are able to relieve their symptoms with a variety of home treatments and, if needed, over-the-counter medications. However, hemorrhoids sometimes cause persistent pain or almost permanent discomfort. In these cases, medical treatment may be considered.

Hemorrhoids: external or internal?

External hemorrhoids

They appear under the skin at the opening of the anus. They can cause swelling in the area. They are more sensitive than internal hemorrhoids because there are more sensitive nerve fibers in this area. In addition, the risk of a blood clot forming in a dilated vein is greater than with internal hemorrhoids.

Internal hemorrhoids

They appear in the anus or the lower part of the rectum, forming a small protuberance. They are classified according to their stage of development. They tend to progress from one degree to another if nothing is done to slow it down.

• First degree. The hemorrhoid remains inside the anus.
• Second degree. The hemorrhoid comes out of the anus at the time of defecation, and returns to its normal position when the effort is stopped.
• Third degree. The hemorrhoid should be gently replaced with the fingers after defecation.
• Fourth degree. The hemorrhoid cannot be placed back inside the anus.

Symptoms: recognizing a hemorrhoid

• Burning, itchy, or discomfort sensation in the anal area.
• Bleeding and slight pain when defecating.
• Sensation that the inside of the rectum is swollen.
• Weeping mucus from the anus.
• Exit from the anus of tender protuberances (only in the case of internal hemorrhoids of the 2nd, 3rd or 4th degree).

People at risk

• People with a close relative who has hemorrhoids.
• Pregnant women.
• Women who have given birth through vaginal birth.
• People with cirrhosis of the liver.

Risk factors

• Have constipation or diarrhea on a regular basis.
• Suffer from obesity.
• Remain seated on the toilet seat for a long time.
• Being called upon to frequently lift heavy objects.
• Practice anal intercourse.

Possible complications

When the discomfort or mild pain turns into severe pain, it is usually a sign that a blood clot has formed in a hemorrhoid. This is a painful, but harmless, hemorrhoidal thrombosis. Symptoms normally go away within 1 to 2 weeks, with pain relievers and emollient laxatives, which soften the stool. After the clot has cleared, a small, painless swelling in the anus, called a mariscus, may form (only with external hemorrhoids).

In rare cases, an ulceration (sore that tends to spread) may appear. Heavy blood loss can also cause anemia.

It is recommended that you consult a doctor without delay in the event of anal bleeding, even if it is mild. This symptom may be a sign of another type of condition in the anal area or a more serious medical problem.

Prevent the onset of hemorrhoids

Food

• Gradually increase the amount of fiber in your diet. This is the best possible prevention. Fruits and vegetables, cereals and whole grain breads are great sources of fiber. It is best to incorporate them gradually into the diet. The fibers soften the stools and increase their bulk, which facilitates their smooth expulsion. You have to be patient: improvement occurs within a few weeks.
• Drink enough water and other fluids throughout the day.
• Take the time to eat in the morning. The intestine has a reflex to empty out after meals, especially after breakfast.
• Regular physical exercise
• About twenty minutes of walking a day at a good pace can stimulate intestinal transit.
• Do not sit for long hours. If you can’t help it, get up occasionally for 1 or 2 minutes.

Intestinal hygiene

• Have a bowel movement regularly. Do not delay the time to defecate if the need arises. The longer you wait, the drier and harder the stool becomes. When defecating, avoid straining by holding your breath.
• Do not sit on the toilet seat longer than necessary (avoid reading there). In this position, the muscles of the anus are relaxed, causing a rush of blood
• Prevent recurrence
• If necessary, take fiber supplements, such as psyllium (Metamucil®, Fibropur®, Prodiem®, etc.) or other types of fiber (Fibramax®). They are found over the counter in pharmacies. They can be taken long term without any problem. Be sure to drink plenty of fluids to avoid blockage of the digestive tract.
• Avoid taking types of laxatives other than fiber supplements.

Basic advice and care

• Keep the anal area clean: take a bath or shower daily. However, it is not necessary to use soap.
• After having a bowel movement, gently cleanse yourself with a water-soaked toilet paper, a damp baby towel, or a damp cotton cloth. Avoid scented toilet paper.
• If itchy, apply cold compresses to the anus for about 10 minutes, 3 or 4 times a day.
• If you have a clot or hemorrhoid has come down, take a sitz bath in warm water for 10 to 15 minutes, 2 or 3 times a day, to relieve pain. Some pharmacies and specialty stores sell small baths that can be installed over the toilet. Do not add soap to the water. Gently pat dry and put in an unscented powder to keep the skin dry (for example, cornstarch or antifungal powder).
• Wear cotton underwear. Lycra, acrylic and other synthetic fibers keep moisture out.
• Until the hemorrhoids are cured, avoid drinks and foods that can irritate the mucous membranes: coffee (even decaffeinated), alcohol, strong mustard, hot pepper and other strong spices.
• Also avoid lifting heavy objects, as this increases the pressure in the veins.

Treatments for hemorrhoids

Most often, symptomatic treatment is sufficient for all minor symptoms.

A local treatment by cream and/ r suppository, associated with the hygieno-dietetic rules relieves the chronic discomfort or the thrust by protecting the anal canal and facilitating the passage of the stool. We must fight against constipation and drink well.

In some more moderate to severe forms, a medical consultation is necessary. Systemic treatments are then prescribed by your doctor such as analgesics, anti-inflammatory drugs or venotonics.

In herbal medicine, Horse chestnut is indicated in the event of hemorrhoidal crises.

Sometimes specialized interventions may be necessary and only if this is unsuccessful is surgery, which involves removing hemorrhoids, offered.