Hemorrhoids: How to prevent this excruciating pain?!

Hemorrhoids are vascular structures in the anal canal which primarily act as cushions for the anal cavity aiding in passing of the stool.

Hemorrhoids get swollen & inflamed due to certain causes & this is classified as a condition, it is also called as Piles.

There are two types of hemorrhoids:

  1. Internal hemorrhoids: These fleshy structures are present on the inside of the anus & get swollen inside the anus, however these are usually painless with internal bleeding
  2. External hemorrhoids: These are structures present outside the anus & present with swelling & pain, blood may or may not be present.

SIGNS & SYMPTOMS OF HEMORRHOIDS

  • Pain around the anus.
  • Swelling around the anus.
  • Skin tag formation i.e. small benign tumor formed around the anal opening.
  • Irritation and itchiness around the anus.
  • Rectal bleeding during or followed by bowel movement.
  • Bright red bleeding in internal hemorrhoids without pain.
  • Dark red bleeding in external hemorrhoids with pain.
  • Mucous discharge
  • Fecal incontinence.

CAUSES & RISK FACTORS OF HEMORRHOIDS

  • Irregular bowel habits like constipation & diarrhea.
  • Lack of exercise
  • Low fiber diet
  • Increased intra-abdominal pressure
  • Straining or sitting on the toilet for too long
  • Fluid accumulation in the abdomen
  • Squatting position for defecation
  • Chronic cough
  • Pregnancy
  • Genetics
  • Obesity
  • Aging
  • Anal intercourse
  • Regular heavy lifting.

COMPLICATIONS

  • Anemia
  • Blood clots
  • Thromboses if the upper part of the body
  • Strangulated hemorrhoid
  • Fainting
  • Fissure
  • Fistula
  • Bursting of a clot in the brain.

DIAGNOSIS

  • Physical examination of the condition by visual examination of the affected area.
  • Rectal exam of the affected area for detection of hematoma, polyps, tumor, or an enlarged prostrate etc.
  • Diagnosis of the internal hemorrhoids is done by implication of a visual device like an anoscope which will have a small light attached to it.
  • Internal hemorrhoids are classified on the basis of grade as;
  • a) Grade I: No prolapse, just prominent blood vessels.
  • b) Grade II: Prolapse upon bearing down, but spontaneous reduction.
  • c) Grade III: Prolapse upon bearing down requiring manual reduction.
  • d) Grade IV: Prolapse with inability to be manually reduced.

DIFFERENTIAL DIAGNOSIS

  • Fissure
  • Fistula
  • Abscess
  • Varices
  • Polyps
  • IBD disease
  • Colon Cancer.

TREATMENT FOR HEMORRHOIDS

Medication:

  • Pain killers like ibuprofen
  • Anesthetic topical cream/gel containing like lidocaine
  • Topical cream/gel containing sucralfate
  • Topical gel containing diltiazem for increasing blood flow to the area and natural healing of injured spots.
  • Fiber supplements like isapgul husk & PEG fiber.
  • A new drug called prucalopride, used for stimulation of serotonin receptors in the anal canal, eases bowel movement.

Surgical procedures:

  • Excisional hemorrhoidectomy is a surgical excision of the hemorrhoid recommended in people with thrombosed external hemorrhoids.
  • Procedure called THD uses doppler ultrasound for llocation of arteries, therefore these arteries are tied off & the hemorrhoids are put back in place.
  • Stapled hemorrhoidectomy, also known as stapled hemorrhoidopexy, involves the removal of much of the abnormally enlarged hemorrhoidal tissue.

Minimally invasive procedures

  • Rubber band ligation: A rubber is used to tie the base of the internal hemorrhoid, therefore it cuts off the blood supply, thus the hemorrhoid withers and falls off.
  • Sclerotherapy: A chemical solution such as phenol is injected into the hemorrhoid walls to collapse & shrink.
  • Cauterization techniques that employ laser or infrared light or heat.

MANAGEMENT & PREVENTION

  • Regular exercise¬† & physical activity.
  • High fiber diet
  • Drink plenty of fluids
  • Avoid sitting on the toilet too long.
  • Don’t strain
  • Reduce alcohol consumption & smoking
  • Ayurvedic medicines are used for stimulation & easing of defecation.
  • Ayurvedic oils are also employed for pain management, faster healing of injuries & shrinkage of swelling.
  • Avoiding diet that causes allergy & complications.