Table of Contents
Hemorrhoids, which are also known as piles, are inflamed, enlarged veins around the anus or in the lower rectum. Most of the time, hemorrhoids begin as a deterioration of the proteins in the internal cushions that protect the lower reaches of the anal canal.
Blood vessels enlarge and fill with blood. They pull at surrounding muscles, and eventually the lining of the lower rectum prolapses, spilling outside the anus. Since the anus is not completely closed, hemorrhoids can cause:
- Incomplete defecation, "grass stains" after every bowel movement not matter how attentive the hemorrhoid sufferer is to personal hygiene.
- Rectal bleeding, most commonly noticed on toilet paper. Bleeding caused by hemorrhoids is typically bright, red, fresh blood. Bleeding from further up the rectal canal, caused by other conditions, is more likely to be dark brown.
- Itching, burning, and an uncomfortable feeling of pressure.
Pain that is actually caused by hemorrhoids only occurs when the swollen vein forms a thrombus, which looks like a blue knot, outside the rectum. Typically hemorrhoid pain is constant, day and night, building up for 24 to 48 hours and lasting up to 14 days until the coagulated blood in the hemorrhoid begins to flow again.
Hemorrhoids are often classified as "internal" or "external," depending on whether or not the enlarged vein has spilled outside the anus. Internal hemorrhoids cause bleeding, while external hemorrhoids cause pain. Internal hemorrhoids have a way of becoming external hemorrhoids as the disease progresses.
Who Gets Hemorrhoids?
World-wide, about 1 in 25 people of all ages has hemorrhoids. The condition can occur at any time of life, even in the womb, but it is most common between the ages of 45 and 65. In the United States, between 10 and 15 million people see doctors for treatment of the condition every year.
What Causes Hemorrhoids?
There is no doubt that hemorrhoids are more common in pregnancy. Pregnancy-related hemorrhoids typically disappear after the baby is born. In males and females who are not pregnant, however, the causes of hemorrhoids are not as clear.
- Straining during bowel movement doesn't necessarily cause hemorrhoids. People who have the condition typically have stronger perianal muscles than people who don't.
- A condition called portal hypertension doesn't necessarily cause hemorrhoids. Not everyone who has this vascular abnormality develops the ano-rectal problem.
- Prolonged sitting aggravates hemorrhoids when they occur, but doesn't seem to cause them.
- Obesity, liver disease, higher socioeconomic status, chronic constipation, chronic diarrhea, episiotomy, spinal cord injury, and slouching increase the likelihood of hemorrhoids.
- In the US, patients who come in for treatment of piles tend to be white males with higher incomes.
- Receiving anal intercourse, and, ironically, having traditional surgery for hemorrhoids seem to cause the disease.
The fact that surgery for hemorrhoids often seemed to make the problem worse has led to a precipitous decline in the number of people seeking surgical treatment. For about 20 years, doctors have preferred tying veins with rubber bands, heat treatment, and electric cauterization. A new technique, however, may make out-patient treatment a far more desirable option.