Hemorrhoids - Causes, Diagnosis and Treatment

Many people have hemorrhoids but they are often so small that they present no symptoms.  However, others suffer from considerable pain and discomfort.


Hemorrhoids are clusters of veins in the anus, just under the membrane that lines the lowest part of the rectum and anus.  While they can produce several uncomfortable symptoms for their sufferers, they are never dangerous nor life threatening.  Much of the pain and discomfort is from the so called “piles” which may appear at the opening of the anal passage after you have been straining when having a bowel movement.  These piles can resemble soft lumps in bunches.  There is also a mucus covering to these bunches which can become damaged easily from a bowel movement and even bleed.  If these piles or bunches become hard and even start protruding from the anus, then we say a thrombosis has occurred.  The sufferer can then experience severe pain and discomfort.  A particularly unpleasant symptom of hemorrhoids is itchiness.  You will be very tempted to scratch but this will only make the symptoms even worse.


Hemorrhoids have a very long history and are well documented through the centuries because they are so common.  The earliest reference dates back to 2250 BC when King Hammurabi of Babylon described the symptoms.  Throughout time, various herbal and other remedies have been used.  For example between 41 and 68 AD, Aloe Vera was the herb of choice and a hundred years later, the Roman physician Galen used ointment, laxatives and leeches. He also wrote about using a thread to tie off piles and cause them to shrivel up.


In more modern times, Bozzini used an aluminum tube in 1806 to see the genitourinary tract while 30 years later, St Marks Hospital was founded in London to provide treatments for hemorrhoids.  1888 saw the expansion of surgical procedures for hemorrhoids into a combination of excision and ligation.  Hemorrhoidectomy was introduced there in 1935 while J. Barron developed an out-patient procedure in 1963 using rubber bands to tie up hemorrhoids.  In 1970, cryotherapy, infrared coagulation, diathermy and laser cauteries were all introduced.  The very latest procedure known as stapled hemorrhoidectomy was first presented in Italy by A. Longo in 1997.


In the US, the prevalence of hemorrhoids is estimated at 4.4% in the general population with a higher incidence amongst those who are white, those who are from higher socioeconomic strata, and those from rural areas.  It is thought that hemorrhoids occur equally between men and women.  External hemorrhoids are more commonly in young and middle aged adults.  The prevalence of hemorrhoids increases with age, of if your parents had hemorrhoids, with a peak in those aged between 45 to 65 years.  There is an increase in hemorrhoids in pregnancy which is possibly due to the direct pressure on the rectal veins and from giving birth.  For most pregnant women, such hemorrhoids are a temporary problem.  It is therefore estimated that some 50% of all adults will suffer from hemorrhoids at some time in their life with more than 1 million new cases each year in the US alone. 


If you think you are suffering from hemorrhoids, it is wise to visit your doctor for a definite diagnosis which he will conduct by a visual examination of the anus, followed by an internal examination during which he carefully inserts a gloved and lubricated finger into the anus.  Your doctor may also use an anoscope, which is a small and hollow lighted tube, which allows him to see into the anal canal.  A further examination can be done using a sigmoidscope or colonoscope which is a flexible instrument that allows inspection of the lower colon or the entire colon.  This thorough evaluation is important when bleeding from rectum or there is blood in the stool because the presence of blood may be a symptom of other digestive diseases, and your doctor needs to rule out any other causes before confirming a diagnosis of hemorrhoids.  Once a diagnosis has been made, your doctor will advise you on the best course of treatment.


Such treatment is often a combination of a change in your habits or lifestyle together with either over-the-counter medications or natural treatments.  If you can persevere with this combination, the chances are high that you will successfully treat your hemorrhoid condition.  Unfortunately, when hemorrhoids are not treated in the early stages and lifestyle changes not adopted, more extensive hemorrhoid treatment may become necessary.


There are 6 types of hemorrhoids treatments of which 3 surgical methods are used for severe external hemorrhoids:



The same 3 are used for severe internal hemorrhoids but in addition 2 non surgical methods also carried out by a medical practitioner are used:



A further new surgical method is used for internal hemorrhoids and that is called a stapled hemorrhoidectomy.


Prevention of hemorrhoids is obviously very important.  If you have never suffered from hemorrhoids, ensure a healthy lifestyle to keep it that way.  If you have already been treated for hemorrhoids, there is a tendency for them to recur unless you change your habits.  Apart from pregnancy, the main causes of hemorrhoids are a low bulk diet, straining on the toilet when making a bowel movement, sitting for long periods or being constipated.  Prevention is as follows:


·         Drinking lots of liquids especially water while eating a healthy diet with plenty of fruit, vegetables and fiber to avoid constipation. 

·         Adding these fruits to your diet which are especially helpful for preventing and relieving hemorrhoids – pure fruit juice with no additives, cherries, blackberries, blueberries, cantaloupe melons, red and black currants, pomegranate juice, oranges, bananas and papayas.

·         Taking regular exercise.

·         Being careful not to push or strain when having a bowel movement.  Don’t sit on the toilet for longer than a couple of minutes, don’t read and avoid holding your breath.  The squatting position is the best.

·         Avoiding sitting or standing for too long at a time.  Change your position frequently.


Hemorrhoids can be a small or a massive problem for many but with early treatment, a change in your lifestyle and habits and maintaining that change, hemorrhoids can become history in your life.  Make sure you pass on the same habits to your children too so that they can avoid hemorrhoids when they are adults.


NDDIC Hemorrhoids Fact Sheet


Hemorrhoids at Amoils