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What are hemorrhoids/piles?

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Paul Bass
5th year medical student
University of the Gambia

UTG Medical Students’ Association

Characterized by pain in the anus often when one sits for long and when passing stool, hemorrhoids, also known as pile, is a common illness affecting many people in the Gambia and around the world.

The rectum and anus have venous cushions which are a cluster of blood vessels. These are usually normal and okay but because of their locations and vulnerability, they easily become filled up with blood and irritated occasionally resulting in bleeding.

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Millions of people are affected around the world, and it is a major health and socioeconomic problem.

Many factors have been said to be the cause and origin of hemorrhoidal development, which includes constipation and prolonged straining.

Hemorrhoids are common, an estimated 75% of people will experience hemorrhoids at least once in a lifetime but only 5% of them will see the Doctor due to lack of symptoms.

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The abnormal increase in volume and distortion of the vascular channels (blood vessels), together with bad changes in the supporting connective tissue within the anal cushion, is a major finding in hemorrhoidal diseases. Inflammation and vascular increase in size (due increase in the number of cells) may be seen in hemorrhoids.

Causes of hemorrhoids

Hemorrhoids are just their name- blood vessels that are filled with blood and irritated around the anus.

Usually, this is due to too much pressure on the blood vessels around the anus but the exact cause of hemorrhoids is not well understood.

Straining puts pressure on veins in your anus or rectum, causing hemorrhoids. You might think of them as varicose veins that affect your bottom.

Any sort of straining that increases pressure on your belly or lower extremities can cause anal and rectal veins to become swollen and inflamed. Hemorrhoids may develop due to:

o          Pelvic pressure from weight gain, especially during pregnancy.

o          Pushing hard to have a bowel movement (poop) because of constipation.

o          Straining to lift heavy objects or weightlifting.

Other factors that increase pressure on the perianal blood vessels are:

1.         Prolonged sitting,

2.         obesity

3.         diarrhea

4.         Old age

5.         anticoagulation and antiplatelet treatment, conditions which are considered risk factors for hemorrhoids.

To stretch a little wider, risk factors for constipation are also risk factors for hemorrhoids including diets poor in fiber.

Signs and symptoms of hemorrhoids

There are two types of hemorrhages; internal and external hemorrhages.

 While internal hemorrhoids are further graded from grade I to grade IV based on their degree of prolapse or protrusion and presentation. With Grade I being non-prolapsing hemorrhoids and grade IV being non-reducible prolapsing hemorrhoids which includes acutely thrombosed/harden with blood and ulcerated hemorrhoids.

1.         1.The commonest presentation of hemorrhoids is painless bleeding in the rectum and anus associated with bowel movement.

2.         Prolapsing or protruding hemorrhoids may cause irritation or itching around the anus due to mucous secretion or fecal soiling.

3.         A feeling of rectal fullness (tenesmus) is also reported in patients with large hemorrhoids.

4.         Pain is not usual occurrence caused by the hemorrhoids themselves unless due to thrombosis, specifically in an external hemorrhoid or if a fourth-degree internal hemorrhoid becomes strangulated.

5.         Anal fissure or tearing and perianal abscess are more common causes of anal pain in hemorrhoidal patients.

Other conditions that cause hemorrhoid type symptoms

Different gastrointestinal disorders can cause rectal bleeding and other symptoms similar to hemorrhoids. Some of these disorders are life-threatening. For this reason, it’s important to let a healthcare provider know when you’re having symptoms.

Bowel diseases that can cause bleeding include:

o          Colon cancer- a type of cancer that begins in the large intestine.

o          Crohn’s disease- is a type of inflammatory bowel disease that causes swelling of tissues of the digestive tract.

o          Ulcerative colitis- is a long term condition where the Colon and rectum becomes inflamed.

Management and treatment of hemorrhoids

Management and treatment of hemorrhoids is divided into:

1.         dietary life-style changes,

2.         medical treatment and rarely

3.         surgical treatment.

1.Life-style changes includes diets rich in fiber, enough drinking of water, exercise and avoidance of food that may cause diarrhea and constipation.

2.The main focus of medical treatment is to relief acute symptoms of hemorrhoids rather than to cure the hemorrhoids itself. There are modern drugs and traditional medicine used which are available in different formats including pill, suppository, wipes and creams.

3.Surgical excision of hemorrhoid is considered invasive, but although the less invasive methods heal faster, the risk of reoccurrence is greater. So surgical excision may be employed for grade IV hemorrhoids and those whose symptoms are not manageable by medical treatment or dietary lifestyle modifications.

When you notice bleeding and pain around the anus accompanied with some of the symptoms in this article, try and visit a health facility for better evaluation of the signs and symptoms as this will help in treatment and prevention of complications.

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