Hemorrhoids

About Hemorrhoids

Hemorrhoids are swollen veins in the lower rectum and anus, and are very common, affecting a large proportion of adults at some point. Internal hemorrhoids occur inside the rectum and are usually painless, causing bright red blood on toilet paper or in the toilet bowl. Prolapse may occur with straining. External hemorrhoids occur under the skin around the anus and can be painful, particularly if a blood clot forms thrombosed hemorrhoid. Risk factors include chronic constipation or diarrhea, straining during bowel movements, prolonged sitting, pregnancy, obesity, and low fiber diet. Symptoms include bleeding during bowel movements, itching, irritation, swelling, and a lump near the anus. Diagnosis is made through physical examination including anoscopy. Colonoscopy may be needed to rule out other causes of bleeding, particularly in patients over 45 or with alarm symptoms. Conservative measures include increased fibre intake, adequate hydration, sitz baths, and reducing straining. Topical treatments witch hazel, hydrocortisone cream provide symptomatic relief. Rubber band ligation is effective for internal hemorrhoids. Sclerotherapy, infrared coagulation, and surgical hemorrhoidectomy are options for refractory cases. Thrombosed external hemorrhoids are sometimes excised when seen early. Because rectal bleeding has other possible causes, it warrants medical assessment, and heavy bleeding is a medical emergency.