Understanding Hemorrhoids: Symptoms, causes and treatment

Source: Nida Al Watan

Hemorrhoids are one of the most common anal health issues affecting both men and women. Despite their prevalence, many people remain hesitant to talk about them due to embarrassment, often leading to neglecting treatment or delaying seeking medical advice. In fact, hemorrhoids are a common condition affecting about one in every twenty people, and the percentage increases to nearly half of individuals after the age of fifty.

What are Hemorrhoids?

Hemorrhoids, also known as "anal fistulas," in some common uses (though the medical term differs), are swollen and inflamed veins in the anal area or the lower rectum. They resemble varicose veins but occur in a sensitive part of the body.

Hemorrhoids are categorized into two main types:

- External Hemorrhoids: These form under the skin around the anus and can be painful, causing itching or swelling.

- Internal Hemorrhoids: These develop inside the rectum and are often painless, but they may cause bleeding during bowel movements. In some cases, they can prolapse outside the anus, referred to as prolapsed hemorrhoids.

Who is more prone to Hemorrhoids?

The likelihood of developing hemorrhoids increases in the following cases:

- Straining and pressure during bowel movements.

- Sitting for prolonged periods on the toilet.

- Chronic constipation or diarrhea.

- A low-fiber diet.

- Aging (especially after fifty).

- Pregnancy.

- Repeatedly lifting heavy weights.

As people age, the tissues supporting the veins in the anal and rectal areas weaken, making them more prone to swelling and enlargement.

Symptoms of Hemorrhoids

Symptoms vary depending on the type of hemorrhoid, with the following:

External Hemorrhoid Symptoms:

- Anal itching.

- Presence of one or more hard, painful lumps near the anus.

- Pain, especially when sitting.

- Swelling or irritation.

- Excessive rubbing or harsh cleaning may worsen the symptoms.

Internal Hemorrhoid Symptoms:

- Bright red anal bleeding appearing on stools, toilet paper, or in the toilet bowl.

- Prolapsed hemorrhoid hanging outside the anus.

Non-prolapsed internal hemorrhoids usually don’t cause pain, but prolapsed ones can cause discomfort and pain. It’s important to note that anal bleeding is not always caused by hemorrhoids; it may also indicate other digestive diseases, such as colon inflammation or even colon cancer, so symptoms should not be ignored.

Potential complications

Although most hemorrhoid cases are simple, some complications can occur, such as:

- Blood clots forming inside external hemorrhoids.

- Skin tags appearing after a clot has dissolved.

- Inflammation or ulceration of external hemorrhoids.

- Blood supply to internal hemorrhoids being cut off.

- Anemia due to chronic bleeding.

If severe pain, bleeding, fever, or abdominal pain occurs, immediate medical attention should be sought.

Diagnosis

The doctor will rely on the medical history and a clinical examination for diagnosis. A manual digital rectal exam may be performed to assess the muscles and check for lumps or bleeding.

In some cases, special tools such as an anoscope may be used to examine the lining of the anus and rectum, or a colonoscope for lower colon examinations. Hemorrhoids may also be detected during routine tests like a colonoscopy.

How are Hemorrhoids treated?

In most cases, hemorrhoids can be treated at home by:

- Increasing fiber intake.

- Using fiber supplements like psyllium.

- Drinking enough water daily.

- Avoiding strain during bowel movements.

- Not sitting for long periods on the toilet.

- Using over-the-counter pain relievers when needed.

- Sitting in warm water (sitz bath) several times a day.

Topical creams or suppositories can also help relieve pain and itching, but it is advised not to use them for more than a week without consulting a doctor.

For advanced cases, medical procedures may be required, such as:

- Banding the hemorrhoid with an elastic band to cut off blood flow.

- Injection with a sclerosing agent to shrink the hemorrhoid.

- Infrared or electric coagulation.

- Surgical removal in large or recurring cases.

Diet: The foundation of prevention and treatment

Diet plays a key role. A diet low in fiber and high in processed foods and saturated fats slows down bowel movements, making stools harder and increasing the likelihood of constipation and, consequently, hemorrhoids.

Fiber: The most important nutrient

Dietary fiber is the first line of defense against constipation. It helps increase stool volume and softens it, making it easier to pass without strain or pressure. Fiber comes in two types:

Soluble fiber: Found in oats, legumes, apples, and pears, it helps absorb water and soften stools.

Insoluble fiber: Found in whole grains, leafy vegetables, and fruit peels, it helps speed up bowel movements.

Adults are recommended to consume between 25 to 35 grams of fiber daily, but sadly, most people fall short. Simple steps like adding vegetables to every meal, choosing whole-grain bread instead of white, and including legumes in the diet can make a significant difference.

Water: Fiber’s essential partner

Simply increasing fiber intake is not enough without drinking enough water. Fiber needs fluids to function properly. If fluids are insufficient, increasing fiber can worsen constipation.

Drinking at least 1.5 to 2 liters of water daily (more depending on weather and physical activity) helps maintain stool softness and reduces strain during bowel movements.

Foods that may worsen symptoms

Some foods may not directly cause hemorrhoids but can worsen symptoms for those already suffering, such as:

- Very spicy foods that may irritate the anal area.

- Fast food and fatty meals that slow digestion.

- Excessive caffeine intake, which can contribute to dehydration if not paired with enough water.

- Lack of fresh fruits and vegetables in the diet.

Balance is key. This doesn’t mean complete avoidance, but moderation and paying attention to how the body responds.

Weight and lifestyle

Excess weight, especially around the abdomen, increases pressure on the pelvic and rectal veins, raising the risk of hemorrhoids. Therefore, a balanced diet aimed at maintaining a healthy weight indirectly helps in prevention.

Also, lack of physical activity affects bowel movement. Sitting for long periods, whether at work or in front of screens, slows digestion. Incorporating daily physical activity like a 30-minute walk can stimulate the intestines and reduce constipation.

Bad habits to avoid

Along with diet, daily habits directly impact the condition:

- Delaying bathroom visits when the urge arises.

- Sitting for extended periods on the toilet.

- Using laxatives indiscriminately without consulting a specialist.

Correcting these behaviors, along with improving the diet, can prevent worsening of the condition and reduce the need for medical interventions.

When to see a Doctor?

A doctor’s visit is necessary if symptoms persist for more than a week despite home treatment, or if there is anal bleeding, severe pain, or unusual symptoms.

Ultimately, hemorrhoids are not as embarrassing as they are common and can be managed with awareness and lifestyle changes. A balanced diet rich in fiber, alongside adequate water intake and physical activity, is the cornerstone for digestive health and preventing this annoying issue.