Hemorrhoids

Overview

We all have hemorrhoids: they are small cushions with blood vessels in the anal canal that help it close. When they enlarge, slip out or cause complaints, we speak of hemorrhoidal disease.

• Internal hemorrhoids are located inside the anal canal.
• External hemorrhoids are located under the skin around the anus.

Symptoms

Internal hemorrhoids usually cause bright red blood without pain, on the paper or in the toilet. According to prolapse they are divided into four grades:

• Grade I — do not protrude
• Grade II — protrude during defecation and return on their own
• Grade III — protrude and must be pushed back by hand
• Grade IV — stay outside and cannot be pushed back

External hemorrhoids cause itching, irritation or swelling. When a clot forms inside them, a blue, very painful lump suddenly appears.

Contributing factors

Constipation and straining, sitting for long on the toilet (e.g. with a phone), chronic diarrhea, pregnancy and weakening of the tissues with age. No single food causes hemorrhoids in everyone.

When to see a doctor

Any bleeding from the anus should be evaluated — do not assume on your own that it is hemorrhoids. Fissures, polyps, inflammatory bowel disease and colorectal cancer can give the same sign.

Diagnosis

The doctor performs an inspection, a rectal examination and, when needed, anoscopy. Colonoscopy is recommended when there is anemia, a change in bowel habits, an unclear source of bleeding or when screening is due according to age and risk.

Treatment

Basic measures (for all grades)

• Add fiber gradually and drink enough fluids for soft stools.
• Do not stay on the toilet more than a few minutes and do not strain.
• Physical activity helps bowel function.
• Warm sitz baths soothe the complaints.

Ointments and suppositories

They temporarily relieve symptoms. Products with corticosteroid are not used for more than a week without medical advice, because they thin the skin.

Procedures

When basic measures are not enough:

• Rubber band ligation — an outpatient procedure for internal hemorrhoids of grade I–III.
• Surgery (hemorrhoidectomy) — for high grades or when other procedures fail.

A thrombosed external hemorrhoid is assessed individually; in the first days the clot is sometimes removed with a minor procedure.

Diet

There is no need to stop bananas, okra, yogurt or cottage cheese. Limit only the foods that cause you constipation.