Hemorrhoids: Early Signs, Causes, Self-Help, Relieving Techniques & Medical Intervention

Diseases A-Z

Hemorrhoids are a common, but nevertheless unfortunate inconvenience. It may bleed, itch and dander around the rectum opening. It may also leak a bit of mucus or stool and you may feel something that bends at the rectum opening. Hemorrhoids are often better by themselves, but you may need medication that relieves the symptoms.Hemorrhoids

What are hemorrhoids?

Hemorrhoids are a bothersome and widespread problem: it is estimated that at least 50% of adults will suffer, more frequently between 45 and 65 years, with a similar distribution between male and female population. In women there is a peak of incidence related to pregnancy: during this sensitive period, in fact, several factors can influence the appearance or aggravation of this pathology.

In women there is a peak of incidence related to pregnancy: during this sensitive period, in fact, several factors can influence the appearance or aggravation of this pathology (in particular the hormonal changes, the mechanical effect due to the size of the fetus that increases, the increase of intra-abdominal pressure during delivery). The so-called postpartum hemorrhoids are quite common, which appear as a result of particularly intense pressures during natural birth; it is a mechanical phenomenon, technically more a prolapse than true hemorrhoids, which in almost all cases spontaneously regresses within a few months.

Although the disorder is commonly known as ‘hemorrhoids’, it is more correct to speak of hemorrhoidal disease, since hemorrhoids are actually present in any healthy organism: they are small pads of spongy and extremely vascularized tissue, positioned in the anal canal, whose task is to allow and encourage a physiological evacuation and an adequate continence to feces and gas, the hemorrhoidal disease occurs instead when due to degenerative phenomena of the tissues and the natural support means of the same the tissue progressively prolapses outwards.

Types of hemorrhoids

Depending on their location, we can classify internal and external hemorrhoids. The former develop within the anal canal (i.e. in the last three centimeters of the alimentary canal, after the rectum) and are often asymptomatic (the most common symptom in this case is bleeding); the external ones, vice versa, are evident outside the anus with prolapse and present themselves as hard and sometimes painful protuberances.

Based on the tendency to escape outside, that is to prolapse, the hemorrhoids are classified into four stages:Hemorrhoid-stages

First degree

In the absence of prolapse; at this stage the hemorrhoids, which do not come out and often do not cause pain, are not externally observable and the most common symptom is blood loss to defecation;

II degree

In the presence of moderate prolapse, visible only under stress, which tends to re-enter spontaneously; at this stage common symptoms are pain and itching during the evacuation phase in addition to bleeding;

III degree

When the prolapse is more evident but there is the possibility of manually re-entering the prolapsed hemorrhoids;

IV degree

In the presence of permanent prolapse not even manually reducible, with possible symptoms such as intense pain (especially if there is a complication known as hemorrhoidal thrombosis) and swollen anal mucosa.

When the hemorrhoids have reached the last stage and are, therefore, definitively prolapsed, more complications may arise, such as the formation of blood clots within them: we speak, in this case, of hemorrhoidal thrombosis, which can also lead to at the rupture of the affected hemorrhoidal vein, causing significant bleeding.

Hemorrhoidal disease can be associated (so that sometimes the symptoms are confused) also the presence of anal fissures, which are small wounds of the mucosa but they have nothing in common with the hemorrhoids except the seat and that depend on a completely different mechanism , they can be extremely painful but they are not lesions that tend to develop into tumors, even if they hardly regress spontaneously.

In the presence of a chronic pathology and important bleeding, then, anemia could classify as microcrytic sideropenic, that is to say from an iron deficiency (sideremia), with red blood cells smaller than normal.

Hemorrhoid symptoms

As for the symptoms, the most frequent and easily identifiable – both in the case of external and internal hemorrhoids – is bleeding, characterized by blood-red blood loss, which usually occurs after an evacuation and are visible in the stool, on paper hygienic or even on clothing. During the passage of the feces, you can also feel burning, intense itching and discomfort when sitting.

Sometimes, one feels the sensation of not being able to defecate completely, continuing to feel the presence of a foreign body inside the rectum. In some cases it is possible to observe losses of mucus, which are evident as whitish thickening visible in the feces. Even when the disease was first asymptomatic, it can begin with a complication or thrombosis and manifest itself with the appearance of hard and painful swelling.

A common sign of hemorrhoids is that you bleed from the rectum, for example, some light red blood may appear on the paper when you wipe yourself for a restroom or a blood splash in the toilet seat. The blood is usually not mixed with feces.

It can pinch and itch around the rectum opening. The sphincter can leak gases, mucous or stools without hindering it. It may hurt when you defecate. You may feel something that bulges at the rectum opening.

The fact that it is itchy may be explained by the intestinal mucosa adjacent to hemorrhoids having become irritated and small cracks have formed. Leakage can occur because hemorrhoids are covered by mucous membranes that secrete mucus, and the rectum opening does not close properly.

As you strain, hemorrhoids may appear and be palpable at your fingertips. Sometimes it is possible to press the hemorrhoids back again. Large hemorrhoids can be difficult or impossible to push back at the same time as they may hurt if they become inflamed.

Hemorrhoid causes and risk factors

Scientific certainty regarding the causes of hemorrhoidal disease has not yet been reached: rather, there are different theories about its genesis; among the most accredited are the theory of vascular origin (vascular hyperplasia), which considers hemorrhoids to be venous varicosities, and that of mechanical origin, according to which the sliding of the ano-rectal mucosa would be the consequence of a gradual weakening of the submucosal tissue surrounding the hemorrhoids and subsequent prolapse.

Hemorrhoid causes and risk factorsWhat is certain is that, based on the onset of hemorrhoidal disease, there are several predisposing factors such as familiarity, an improper lifestyle and disordered eating habits, smoking, excessive consumption of alcohol, obesity, age (they are more frequent at a later age). The habit of retaining the stimulus to defecate is considered deleterious and, in the long run, can become a triggering factor of the disease, as well as poor anal hygiene (it is advisable to wash thoroughly after having defecated and, if you are away from home, use the appropriate wipes) and the abuse of enemas and laxatives can exacerbate the symptoms.

A fundamental role in the onset of this disorder is certainly covered by constipation or chronic diarrhea, which are among the most significant risk factors, due to the prolonged stimulation and irritation on the perineum they entail. Then there are some pathologies, such as some liver diseases such as cirrhosis, which are associated with the appearance of hemorrhoids as a result of portal hypertension.

Hemorrhoids are a rather common pathology that is estimated to affect almost the entire population at least once in their lifetime. According to other sources, over 40% of the adult population suffer from hemorrhoids. The problem is manifested with equal frequency in both sexes even if in women it is necessary to consider the possible risks related to pregnancy. During this period there are in fact several factors that can influence the appearance or aggravation of the hemorrhoidal disease. Among the main ones are:

  1. hormonal changes that directly affect vascular tissue
  2. mechanical effect due to the presence of the fetus
  3. drastic increase in intra-abdominal pressure during delivery

Hemorrhoids predominantly arise between 45 and 65 years and tend to worsen over time. At the origin of the pathology there are also predisposing factors such as familiarity, lifestyle and eating habits.

Among the main risk factors, the most influential is related to the presence of intestinal dysfunction, such as constipation or chronic diarrhea. Sedentariness, excessive efforts, abuse of laxatives, prolonged standing, alcohol and / or nicotine abuse and incongruous feeding are other factors that can trigger or aggravate hemorrhoidal disorders.

Regarding dietary habits it is important to stress that a healthy organism is perfectly capable of handling any food, including those considered at risk for hemorrhoids. Obviously a massive and prolonged use of these particular foods could in the long run determine the appearance of the disease or of other proctological pathologies. If the subject already suffers from hemorrhoids will be abolished or at least limited all those foods that can irritate the anal mucosa such as chili, sausages, alcohol, chocolate and spicy spices.

Preventing hemorrhoids

Considering the impossibility of determining with certainty a unique cause, for hemorrhoids it is not possible to talk about a real primary prevention work. To remove the onset it is therefore sufficient to follow some general advice, useful to improve the functionality of the entire organism and protect it at the same time from many other diseases.

In order to prevent hemorrhoids it is therefore very important to lead an active life, carrying out physical activity regularly and avoiding smoking and alcohol. Sports such as jogging, dancing, walking or gentle exercise for the elderly enhance the bodily functions while reinforcing the pelvic region.

Preventing hemorrhoidsNutrition, on the other hand, plays an important role in both primary and secondary prevention (after the onset of hemorrhoids). A balanced diet, rich in water and fiber, helps to regularize intestinal functions, removing one of the main risk factors.

Accurate personal hygiene, not only prevents hemorrhoids but also other very annoying diseases, such as anal fissures or fistulas. Even the choice of underwear is very important because permeable fabrics such as cotton “let the skin breathe” avoiding the stagnation of heat and humidity.

Hemorrhoid diagnosis

When the first symptoms occur, it is important to go to the doctor immediately – possibly by a proctologist specialist who can confirm the diagnosis and rule out the presence of different diseases.

The diagnosis of the hemorrhoids is carried out, first of all, through an accurate history and a careful objective examination, followed by a digital examination, which is performed with the patient in a left lateral position (called Sims) or in a prone position (called Jack-knife), or in a gynecological position, to evaluate the appearance of perianal skin, the presence of inflamed skin or outcomes of previous thrombosis, possible fissures, fistulas, signs of infection or abscesses in progress, and the presence of muco-hemorrhoidal prolapse.

Secondly, the doctor will generally perform a proctoscopy for a direct visual evaluation of the anal canal and will sometimes program a colonoscopy, useful to exclude the presence of other rectal or colic diseases. Another examination, from some used to completion, is the digital videoproctoscopy which, however, does not appear to provide information that is significantly more adequate than traditional proctoscopy.

Once a correct diagnosis has been made, the hemorrhoidal disease should be treated firstly by correcting the lifestyle if incorrect and, when indicated, by associating a pharmacological treatment with the adoption of healthier eating habits. Only hemorrhoids whose symptoms persist after taking all these measures may require the surgeon’s intervention. Specifically, it is essential to adopt a balanced diet and practice regular physical activity: in this way it will be easier to control the weight and intestinal regularity.

In the most stubborn cases where constipation is a problem, it may be useful to increase fiber intake through the consumption of whole foods, fruits, vegetables and legumes and eliminate foods with irritating properties such as chocolate, fried foods and spices. it is also important to drink a lot of water and eat meals at regular times and with peace of mind. If all this is not sufficient, it is advisable to take a fiber supplement.

As for life habits, it is always good to avoid sitting on the toilet for a long time, to spend many hours in the same sitting or standing position and to lift very heavy objects or undergo excessive stress (excessive load can facilitate the appearance or worsening of the disorder).

Very important are also intimate hygiene, to be treated in a particular way, and the choice of clothing (it is good to wear linen in natural fibers, which do not retain heat and humidity). It is also good to avoid bathing with excessively hot water.

The typical itching of this disorder can be relieved with washing (or wet wipes), made with a neutral soap dissolved in warm water, or, if you look for a natural remedy, with decoction of mallow or chamomile (herbs with emollient properties), having always cure to dry the treated part well, gently dabbing it without rubbing.

If washings are not enough, on the market there are excellent products based on cortisones (creams, ointments, ointments, foams and suppositories), to be applied locally to soothe inflammation, itching and edema; such preparations also have in some cases a drug associated with mildly anesthetic properties. In any case, the use of these topical drugs must be limited to a short period of time, after which, without having noticed significant improvements, it will be necessary to contact the doctor for a more detailed analysis.

For those wishing to rely on homeopathy, various ointment preparations are available (for example, ratanhia, aesculus compose, lachesis dilution 5 and berberis dilution 9). If over-the-counter medications do not solve the problem, it may be necessary to resort to a different treatment.Hemorrhoid diagnosis

The possible types of intervention

  • The elastic ligature, made with rubber rings which, by tightening the so-called hemorrhoidal grembon at the base, chokes it, causing it to fall within a few days indicated in the second degree hemorrhoids with bleeding.
  • Sclerosing treatment (recommended only in case of I and II degree hemorrhoids). They are both painless, outpatient procedures that do not require anesthesia, repeatable and effective if used with the correct indications
  • Cryosurgery (krio, from Greek, means cold), with which the tissue to be treated is subjected to very low temperatures (it reaches -90 degrees), using nitrous oxide or other gases. The hemorrhoidal vessel, treated with frost, is eliminated; this technique was used in conjunction with the ligation, in order to act in a more selective way on the tissues (selective cryotherapy) but today it has fallen into disuse and not recognized by coloproctological scientific societies due to its modest efficacy and possible complications.
  • Surgical removal of hemorrhoids, performed under general or spinal anesthesia; it is the most radical and invasive intervention, usually indicated in case of last-stage pathology called hemorrhoidectomy according to the Milligan-Morgan technique, sometimes executable with the use of a new technology (radiofrequency-ligasure or ultrasound-ultracision);
  • Mucoprolaxectomy according to Longo or PPH performed with the use of a mechanical stapler; it is a technique that, instead of removing the stretch of prolapsed fabric, allows it to be repositioned in its natural seat.
  • Transanal haemorrhoidal doppler diarrhealarization (or THD method). it is a method with scientific validity, tested and safe, which addresses these problems by reducing the arterial hyperafflux to hemorrhoids and correcting any prolapse, repositioning the mucosa in its original location. The operation is performed in an area without nerve endings and in this way the main problem of traditional surgical methods is eliminated, which is due to the possible post-operative pain. It is also a minimally invasive procedure, because it does not involve the removal of tissues, and with rare and not severe complications. The long-term effectiveness of the method that cannot be assessed as a recent technique remains to be determined. These techniques require anesthesia, a hospitalization generally short or day hospital and provide for convalescence.

Possible complications that may occur concomitantly with these treatments are infections, bleeding, urinary retention, stenosis (narrowing of the anal canal), pelviculareal pain or weight sensation and other rare or anecdotal. All the techniques have a certain number of recurrences, generally low but never equal to zero.

There are also other less commonly applied techniques (e.g., hemorrhoidectomy according to Parks, Ferguson for example) or fallen into disuse due to the greater efficacy and lower incidence of complications and recurrences of the techniques mentioned above.

Anal pain: fissures, anorectal abscess and hemorrhoidal thrombosis

Anal pain fissures, anorectal abscess and hemorrhoidal thrombosisA symptom of great concern and often leading to an urgent proctological visit is acute onset anal pain. The anal canal and perianal skin are in fact provided with a rich innervation and highly sensitive to pain, unlike the rectum and the rectal mucosa, where the different type of innervation makes this area relatively insensitive.

The causes of acute anal pain can be divided into frequent and rare. Three conditions are frequent causes of acute anal pain: anal fissure, perianal abscess and hemorrhoidal thrombosis. The type of pain can lead to a first evaluation of the possible cause, in fact the burning is typical of the pathologies localized to the perianal skin or the anal margin (dermatitis, hemorrhoids), the pulsating intermittent pain is typical of abscesses while the acute pain, which follows defecation is more frequently associated with pathologies of the anal canal and in particular with the fissure.

A fissure in particular is a linear lesion that presents itself as a wound usually localized in the anal canal posteriorly, towards the coccyx, is characterized by pain, modest bleeding and pruritus in general consequent to defecation and is typically associated with the increased basal tone of the internal or involuntary anal sphincter. The intensity of pain in this case can be noticeable and unbearable and prevent the evacuation that typically increases the symptom. Digital rectal exploration during a proctologic examination may be impossible for muscle spasm and internal pain and therefore require an anesthesia visit to confirm the diagnosis.

Acute phase therapy aims to keep soft stools, reduce sphincter hypertonus and control pain. Anorectal abscess consists of a collection of purulent material in perirectal spaces and is typically characterized by pulsating pain, aggravated by coughing, sitting and defecation. This is almost always associated with the presence of a visible ovoidal swelling fluctuating or appreciable by rectal exploration. In cases of small abscesses or localized in particular areas, however, the swelling may not be evident. Finally the fever is typically present.

The therapy consists of the surgical drainage that can be performed with anesthesia and modalities depending on the local situation and the general condition of the patient.

Hemorrhoidal thrombosis is the main complication of hemorrhoidal disease and typically presents with intense and sudden pain. At the visit we usually observe one or more dark red swollen tears of small dimensions, painful that evolve towards necrosis and ulceration with blood emission – dark coagulated clots in small quantities.

Thrombosis is not infrequently the symptom of the onset of an asymptomatic hemorrhoid disease. Medical therapy involves taking oral and topical medications, while the surgical incision under local anesthesia, if performed early with respect to the onset of thrombosis, resolves the complication and its symptoms quickly and effectively. There are also less common causes of anal pain: anorectal neoplasms, herpes zooster, hydroxyadenitis, perianal extension of sacrococcygeal abscess, condylomatosis, lue, traumas and finally the fleeting proctalgia and coccygeal anorectal neuralgias of orgin genital or psychotic.

 Differential diagnosis always requires careful medical history, a physical examination including anorectal inspection and exploration and sometimes instrumental or biopsy findings. In general, to reduce the symptom pending the specialist proctological evaluation, a bidet can be indicated with lukewarm water, soften the stool and, after evaluation by your doctor, possible analgesic therapy (either oral or topical).

Anal bleeding: a symptom not to be underestimated

The presence of blood in the stool is one of the most alarming symptoms of patients and is one of the most frequent reasons for specialist or proctological examination. It is found in the presence of anorectal bleeding when there is blood in a variable quantity that escapes from the anus. It is always a pathological event or a consequence of a disease of the alimentary tract that requires extreme attention from the patient and the doctor.

The amount of blood presents can vary from microscopic (and in this case we speak of occult bleeding, that is not visible to the naked eye but only diagnosed by specific tests on faeces) to massive and constitute a potentially lethal emergency. Most anorectal bleeding originate from the lower digestive tract consisting of a right colon and anus. It is believed that the darker the color of the blood, the greater the probability that the bleeding originates from the highest portions of this segment, or more distant from the anus.

Fissures, hemorrhoids, malignant neoplasms and colorectal polyps, diverticulae, colon angiodysplasia, ulcerative and Crohn colitis, infectious, ischemic and finally the so-called Meckel diverticulum account for anal bleeding. Then there are rare causes constituted for example by the presence of aortoduodenal fistula after prosthetic surgery, ileal neoplasms or rectal ulcers, anorectal traumatism, drug intake, hematological diseases.

Finally, bleeding can originate from the upper digestive tract and in this case the most common causes are gastroduodenal ulcers, gastroduodenitis, and gastric esophagus neoplasms. In the presence of anorectal bleeding it is always advisable to contact your doctor and possibly a specialist who has the task of identifying the site of bleeding, the cause and finally to propose a therapy.

The anamnesis and the visit with rectal exploration are the first step to be taken, and generally allow to identify the anal cause of bleeding but above all to exclude a possible origin in this place suggesting extending the research in other locations. Anoscopy is a diagnostic act complementary to rectal exploration and allows, through the introduction of an instrument called anoscope in the anal canal, to obtain a direct visualization of the anorectal region.

AnoscopyThe endoscopic examinations then (rectosigmoidoscopy, colonoscopy and possibly transcolic ileoscopy) allow to visualize the whole inferior digestive tract allowing to identify most of the causes of low bleeding and in some cases to perform therapeutic maneuvers such as the removal of polyps. In selected cases, when the bleeding site is not identified, there are particular methods such as scintigraphy or angiography that allow identifying rare causes in atypical sites such as the ileum. The upper digestive tract can finally be investigated by gastroduodenoscopy and the most frequent diagnosis in this case is peptic ulcer.

The definition of the site and the cause of bleeding is fundamental because each pathology has a different therapeutic approach and it is impossible to set up a therapy without a precise diagnosis. It is important to remember that the possible presence of an evident anal bleeding cause, such as hemorrhoids, does not exclude the possibility that another pathology is present at another site, it is therefore absolutely inadvisable to omit to report the problem to the doctor in the wrong belief that he has already identified the cause of the problem.

This pathology is often endured and badly treated due to an unjustified embarrassment and sense of shame on the part of those who are afflicted with it. it is, on the other hand, very important to recognize it, diagnose it and treat it before it gets worse, reaching a high level, which would make the use of surgery inevitable to solve the problem

In terms of prevention, very important with regard to this type of disorders, it is good practice to maintain a healthy lifestyle, with a balanced diet, rich in fiber and low in fat (consuming large portions of fruit and vegetables) and drink plenty of water (at least two liters a day), in order to keep the soft stools and physiological evacuations. The foods to be restricted are spirits (especially liqueurs), coffee, tea, cocoa, carbonated drinks, fried foods and sweet fats, spices (in particular pepper and chili), sauces, crustaceans, aged cheeses and sausages. In fact, numerous studies show a close link between diet and hemorrhoids, so much so that this pathology is prevalently present in industrialized countries, where the diet is extremely rich in fats and refined foods.


It is very important, then, to carry out a constant physical activity, to keep body weight under control and to facilitate intestinal regularity and venous return and, as already underlined, to abolish the smoke and avoid lifting heavy objects and performing very intense efforts.

Hemorrhoid and anal fissures

The fissures are small but deep skin erosions, which can affect various body regions and in particular the orifices, such as the mouth and the anus. Specifically, the anal fissure is a small ‘cut’ that is created on the same opening, due to excessive dilatation during the passage of the stool. Here, the presence of abundant nerve endings makes the disorder particularly irritating and painful.

The thickening becomes more intense at the time of defecation, especially when hard and voluminous stools are excreted, which, by friction, favor the lesion of the anal folds. In addition to aggravating this annoying disorder, constipation is also one of the main random agents. Given the diffusion of the constipation problem, it should not be surprising that anal fissures are a condition frequently found in proctological practice.

Constipation, with all its consequences, is a determining cause of anal fissures. In addition to the consistency of feces, it is necessary to take into account other factors, such as the abuse of laxatives or the use of digital maneuvers to facilitate evacuation; Diarrhea: when the intestinal peristalsis is particularly fast, the reabsorption of water, electrolytes and a small part of nutrients is incomplete. The combination of these substances gives an alkaline pH to the faeces, which is particularly harmful for the anal mucosa. When diarrhea is frequent, due to pathological causes or the abuse of laxatives, the anal canal tends to shrink. In these situations the sudden passage of hard and voluminous stools represents a further insult to the anal mucosa; Anal coitus and other sexual practices centered on the insertion of objects or body parts in the anal orifice; Reduced personal hygiene.

The presence of fissures causes a spasm of the internal anal sphincter, whose control, unlike what happens for the outer ring, is independent of the will of the individual. This contractural condition is responsible for the chronicity of the disorder, because, in addition to preventing the normal and physiological dilatation of the anus, it hinders the flow of blood and with it the possibility of spontaneous healing. The symptomatology of anal fissures in its nature is so characteristic as to make the disorder easily identifiable.

The pain associated with defecation is in fact particularly intense, so annoying that it pushes the patient to fear only the thought of evacuation. Such psychological repercussions tend to induce a secondary constipation or aggravate a pre-existing constipation, making the subsequent, and inevitable, evacuation even more painful.

anal fissureThe pain associated with defecation recognizes three characteristic moments: the passage of feces becomes particularly acute, after which it fades for a few minutes and reappears, with different degrees of intensity, in the next three or four hours. If we consider the true extent of the lesion, the pain associated with anal fissures is often disproportionate. In addition to the dimensions, generally contained, a fundamental anatomical feature of the cracks is the longitudinal course that appears, in the vast majority of cases, in the posterior and upper seat.

Often the crack is so small as to be unrecognizable to the naked eye, especially if examined by a non-specialist. As the disease becomes chronic, the edges of the lesion become more irregular and evident.

Another characteristic sign of a fissure is the evidence of traces of bright red blood on toilet paper, more rarely there are signs of blood around the stool. However, this is a contained hemorrhage which, tendentially, has nothing to do with the more copious hemorrhaging associated with the hemorrhoidal disorder. Since in some cases the two pathologies are associated, the presence of traces of blood may be due to the concomitant presence of hemorrhoids or other lesions.

One of the few positive aspects of anal fissures concerns the relative ease with which the disorder resolves into a number of cases. In fact, the most superficial lesions can heal spontaneously within a few days. If this were not the case, the first approach to the disease involves the use of fiber supplements and mild laxatives, accompanied by abundant amounts of water.

The use of these dietary supplements must obviously be preceded by a clear medical indication. In any case, it is good to start the therapy with cautious graduality, to avoid that an excessive laxative effect results in diarrhea, worsening the problem. Lukewarm baths and anesthetic ointments have the purpose of keeping the pain under control and favoring the loosening of the internal anal sphincter.

Washings with lukewarm water, although effective in reducing sphincter spasm, only provide temporary relief and must therefore be repeated frequently. Do not underestimate the possible effectiveness of anxiolytic drugs, to avoid that stress and daily tensions. If the internal anal sphincter remains heavily contracted, the doctor may recommend the use of anal dilators. In many cases, their regular use allows a slow recovery of the sphincter elasticity. Whatever the true extent of the disorder, regularization of the intestine is always an essential factor to promote the healing of anal fissures.

Sometimes this ‘soft’ approach is not sufficient to solve the problem and, after temporary improvement, the symptoms tend to recur. In the case of chronic fissures, the surgical solution is often undertaken, based on the partial resection of the internal anal sphincter, or on the so-called anuloplasty. This last surgical technique is based on the on-site carrying of skin flaps taken elsewhere, with the purpose of covering the damaged area.

Both interventions are quite simple, do not require particularly long hospitalizations (normally the patient is discharged within 24 hours) and have a low risk of complications. One more reason to win taboos and reticence, turning to the doctor at the appearance of the first symptoms due to the presence of anal fissures.

Hemorrhoid in pregnancy

Hemorrhoid in pregnancyIt is common for pregnant to get hemorrhoids. In part, pregnant has a larger amount of blood in the body, and on the other hand, the growing uterus prints on the large blood vessels in the abdomen which in the long run makes it a little more difficult for the blood to circulate. This causes the pressure in the rectum’s blood vessels to become higher and hemorrhoids become more easily formed. Usually they disappear after delivery. Hormone changes in pregnancy can also cause constipation. Some medicines can help constipation and thus cause major hemorrhoids.

This applies, for example, to the following medicines: Iron preparations. Some analgesics. Some medicines for mental illness. Some medicines for high blood pressure. Some medicines against sore stomach.

Consult the doctor who wrote the prescription if you suspect it is a medicine that causes constipation. Together, you can weigh the trouble with constipation against the benefit the drug can do. Occasionally, your doctor may change your dose or suggest another drug that may cause less trouble with constipation.

What can I do myself?

Constipation increases the inconvenience of those who already have hemorrhoids. If you are easy to get constipation, it is good to avoid causing hard stools. Among other things, food and drink affects the texture of the feces.

‘Stuffing’ foods can cause hard stools. Examples of stuffing foods include food products that contain processed white flour like pasta and light bread. Some drugs can also cause hard stools. You can reduce your inconvenience through regular physical activity. Eat more fiber. To avoid constipation, it is good to eat more fiber rich foods like muesli and coarse bread. Wheat clay is also rich in fiber and can be mixed in porridge or other dishes.What can I do myself

Other things you can do are the following:

  • Replace salad, tomato and cucumber that does not contain so much fiber against beans, peas, potatoes, broccoli and cauliflower.
  • Drink an extra glass of water at each meal.
  • Try to go to the bathroom every day, and preferably the same time, for example after breakfast.
  • If you find it difficult to get fiber with your food, there are fibers in powder form, so-called bulking agent that the doctor can prescribe. They are also available to buy prescription-free at the pharmacy.

You should take a lot of liquid with a lot of fluid. The bulking agent binds to the fluid in the large intestine. If the stomach is sluggish, the effect will increase the volume of intestine and the bowel gets more to work with. All fluid also makes the intestinal content soft and smoother. This facilitates the passage through the intestine and facilitates the removal of the stool. Bulk and food containing fibers often give gases to the stomach, but also the gases help to ease the intestinal drainage. You can reduce the amount of fibers temporarily if the gas formation becomes too difficult.

Increase fiber intake for at least six weeks. Then the inconvenience of hemorrhoids usually disappears, but they can return if you get lost again. You can relieve the problems with prescription drugs if you are sure you have hemorrhoids. Then it is important to wash the skin around the rectum opening with lukewarm water after bathing, as well as morning and evening. Wash using nothing but water. Soap can further irritate the skin. Wipe gently by tapping dry with the towel, instead of rubbing. You can also try to push back hemorrhoids, but it should not hurt.

When and where should I apply for care?

Hemorrhoids can be formed both inside the anal cushions and in the skin in the anal opening. In the lower part of the rectum there is the anal channel leading into the rectum opening. There are small cushions that consist of connective tissue and blood vessels. They can be enlarged and swollen, and even slide down so they come out through the anal opening. This is what is called internal hemorrhoids. External hemorrhoids are formed in the skin in the anal opening that forms tabs. Often internal and external hemorrhoids occur at the same time. An explanation for increasing swelling may be increased tension in the muscle that regulates the opening of the rectum opening.

Hemorrhoids are common and usually harmless. It is very rare that they turn into something serious. You can often treat hemorrhoids yourself if you have had hemorrhoids earlier and recognize the symptoms. Bleeding that changes should always be investigated by a doctor. For example, the blood may become darker and more mixed with the feces.

The biggest risk of hemorrhoids is that they can conceal a more serious disease, as both can cause blood in the stool. Therefore, always contact a healthcare center, it will be blood in the stool for the first time.

Contact a healthcare center if you have one or more of the following symptoms: You bleed from the rectum. You have pain in or around the rectum opening. It has been itching around the rectum for more than a week. The sphincter spills out mucus or stools. The trouble is not over, despite treatment for two to three weeks.

Before the examination, you should tell your doctor about your discomfort, how long you have had them and how they feel. You may also respond if you have any diseases and if you are taking any medicines. The doctor begins examining how it looks around the rectum opening. Then the doctor feels a finger inside and inside the rectum opening.

Thereafter, the doctor examines the mucous membrane of the rectum and the lower part of the large intestine by means of a tubular instrument inserted into the intestine. The instrument is called proctoscope. The tube is made of plastic and is eight to ten centimeters long. To make the instrument slip more easily, a sliding gel is used. The doctor then looks at the intestinal mucous membrane through the proctoscope while slowly advancing it. At the same time, you are encouraged to cry. If you have hemorrhoids, they bend into the proctoscope and they can be easily investigated.

The doctor may also find it necessary to study the rectum if you bleed from the rectum. It does with the help of a so-called rectoscope. It is important to investigate if there is any more serious change in the intestine that causes bleeding. The doctor may also take samples from the mucosa which is then examined by means of a microscope. If it is uncertain where the bleeding occurs, the doctor may look even further into the large intestine using a colonoscope. You will then receive a referral to the survey, which will be done later on after some preparation.

If the doctor does not detect any hemorrhoids, the inconvenience may be due to the following reasons:

  • Cracks in the skin in the anal canal, called anal fissure.
  • An intestinal tuberculosis caused by a bacterial infection.
  • A fistula, which is a small opening to a channel, or connection that normally should not exist. It can occur, for example, if you have inflammatory bowel disease.
  • Itching around the rectum orifice that can be caused by skin infections or mask in the intestine, such as a jump mask.

You can bleed from the rectum opening without the doctor finding any particular cause. This may be because the mucous membrane is damaged, for example, it has become angry because of an inflammation or that you have dried too much.

Hemorrhoid treatment

If hemorrhoids are small and do not cause too much trouble, the doctor recommends a prescription drug that is available for purchase at a pharmacy. The doctor can also recommend a prescription drug. The medication relieves pain and suppresses the skin. Some of them contain substances that suppress the inflammation, if you have one, or put together the blood vessels. The drugs are available in two different forms. In part, you stop as you enter the rectum, and as an ointment you lubricate on hemorrhoids and around the rectum opening. The medications are usually used for two to three weeks. Detailed instructions are included in the packaging.

Hemorrhoid treatmentExamples of non-prescription medicines available at pharmacies:

  • Xyloproct and Scheriproct relieves pain, reduces bleeding and prevents itching and inflammation. The drugs are both in the form of suppositories, which one enters the rectum, and ointment.
  • Alcosanal relieves itching and is found as pillars and ointments.
  • Xylocain ointment is used temporarily if it hurts to empty the intestine. The ointment seems stunning.

Consult your doctor if the non-prescription medicines do not help. There are prescription drugs that your doctor can print. In case of skin irritation and pruritus it may occur Consult your doctor if the non-prescription medicines do not help. There are prescription drugs that your doctor can print. For example, in case of skin irritation and itching, cortisone ointment or cortisone cream may be used for a few weeks. Examples are Mildison Lipid cream and Hydrokortison CCS salva, and can be purchased without prescription in smaller packages.

Hemorrhoid surgery

Sometimes surgery is needed. You may need to be examined by a surgeon if it appears that the hemorrhoids are large or that they cause severe bleeding. There are several different treatment methods to remove hemorrhoids.

Medicines are injected with a syringe at the hemorrhoids. The agent causes the blood vessels that lead to hemorrhoids to shrink. Consequently, the blood supply and hemorrhoids are reduced gradually. Using a special device, a rubber band is pulled around the hemorrhoid. Because hemorrhoids no longer get any blood supply they shrink and dissolve after one to two weeks.

During surgery, the hemorrhoids are removed. You get epidural anesthesia or you will be sown during surgery. The wound is sewn together again or left open and heal itself. Other methods are cutting the hemorrhoids with a special device that also clears the mucous membrane with small staples. Or a stitch around the hemorrhoids blood vessel is put.

There are pros and cons of all the methods. Removing hemorrhoids is considered to be more effective than injection with a syringe or rubber band. However, there is some risk that hemorrhoids will return after surgery. It often hurts during the healing itself, but the pain usually disappears after one to two weeks. The time immediately following surgery may be a little difficult and it is important that the stool is kept soft to reduce the pain. For example, it is good to drink a lot of water and eat fiber-rich. There are also a variety of non-prescription drugs at pharmacies that make it easier to bait.

Complications are rare. There may be remains of skin flaps adjacent to the rectum opening when hemorrhoids have returned. The tabs usually do not give any direct inconvenience, but because they are hard to keep clean you can get itching. Possibly the tabs may need to be removed for that reason.

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