Hemorrhoids are blood vessels found in the anal canal. The anal canal is at the end of the rectum and is the opening through which bowel movements pass from your body. Hemorrhoidal tissue is normal and is found in all individuals. Hemorrhoids cause problems when they become enlarged and produce symptoms. There are two types of hemorrhoids: external and internal, which refers to their location in the anal canal.
External hemorrhoids are located in the lower portion of the anal canal near the anal opening. They are covered by very sensitive skin. Clotting (thrombosis) of an external hemorrhoid is the most common complication seen. This is caused by pooling of blood and results in a clot or thrombosis. A thrombosed external hemorrhoid is painful and feels like a hard lump. Occasionally they can rupture and bleed. They may occur after prolonged sitting or straining such as with travel, constipation, heavy lifting, or childbirth.
Internal hemorrhoids are located in the upper portion of the anal canal where it joins the rectum. They are usually not seen on visual inspection of the anal area. Bleeding and protrusion (prolapse) during bowel movements are the most common symptoms. Internal hemorrhoids are usually painless. However, in some cases an internal hemorrhoid can cause significant pain if it becomes prolapsed and incarcerated out of the anal canal.
They are many theories on why hemorrhoids become symptomatic, but the exact cause is not known. Increased pressure in the hemorrhoidal tissue is thought to be a contributing factor. The increased pressure causes the hemorrhoidal vessels to dilate. The walls of the hemorrhoids become thin and the supporting tissue around the vessels is stretched and weakened. This results in bulging hemorrhoids that can prolapse and bleed. Things that cause increased pressure include:
What are the symptoms?
Symptomatic hemorrhoids which are associated with mild pain and swelling can usually be treated by:
Thrombosed External Hemorrhoids
A thrombosed external hemorrhoid is usually very painful. The treatment depends on the severity and duration of the symptoms. Rarely, if the pain is not severe, treatment with the above measures and pain medication may be all that is required. If the pain is significant or not improving, then the hemorrhoid can be removed in the office. The procedure is performed through a small incision using local anesthesia.
The treatment of internal hemorrhoids depends on the extent of the symptoms. For larger hemorrhoids that prolapse or bleed, several office procedures as well as surgery are available for treatment.
Rubber Band Ligation – This common office procedure is for the treatment of internal hemorrhoids that protrude with bowel movements. A small rubber band is placed around the hemorrhoid, cutting off its blood supply. This causes the hemorrhoid to die and fall off in several days. This procedure sometimes causes bleeding when the hemorrhoid and rubber band fall off and may produce some mild discomfort.
Injection Sclerotherapy – This method is used to treat bleeding hemorrhoids that do not protrude. A chemical is injected into the hemorrhoid and causes it to shrivel up. The procedure is painless.
Hemorrhoidectomy – This is a surgical procedure in which the hemorrhoids are removed. It is indicated for hemorrhoids that do not respond to office treatments, are too large for office treatments, or prolapsed hemorrhoids that cannot be pushed back inside. This simple procedure is as an outpatient under general, spinal, or epidural anesthesia. A period of rest and recovery is required after the surgery. Medications to soften bowel movements and pain medication are prescribed. Bowel movements do not affect healing. Warm soaks to clean the anal area and provide pain relief are also recommended. The recurrence rate after a hemorrhoidectomy is extremely low, making it the best method for the permanent relief of symptomatic hemorrhoids.
Infrared Coagulation (IRC) – This office procedure also used commonly, causes scarring and retraction of protruding hemorrhoids. It reduces symptoms of prolapse and bleeding. IRC treatment is painless and takes only a few seconds to perform.
Transanal Hemorrhoidal Dearterialization-Hemorrhidectomy (THD) – THD is an effective treatment for internal hemorrhoids using a minimally-invasive, doppler guided technique. The doppler is used to locate the source of the blood flow to the hemorrhoid. A suture is then placed to effectively cut off the blood supply. The internal hemorrhoids then shrink. Like the PPH, this hemorrhoid operation results in less pain than traditional procedures because it is performed above the “pain” line inside the anal canal.
Procedure for Prolapse and Hemorrhoids (PPH) – This innovative, minimally-invasive procedure was first introduced in the United States in October 2001. PPH is a surgical technique that reduces the prolapse of hemorrhoidal tissue. Using a circular stapling device, the procedure essentially “lifts up,” or repositions the tissue lining the anal canal, and reduces blood flow to the internal hemorrhoids. The internal hemorrhoids then typically shrink within four to six weeks after the procedure. This hemorrhoid operation results in less pain than traditional procedures because it is performed above the “pain” line inside the anal canal. This procedure also requires an anesthetic and is usually an outpatient procedure. The surgeons of Atlanta Colon and Rectal Surgery, PA were the first to perform this procedure in Atlanta, and continue to have the greatest experience with this new technique.
Hemorrhoids do not cause cancer and usually do not pose a danger to your health. However, the symptoms of hemorrhoids, especially bleeding, are similar to those of more serious illnesses such as colon cancer. Therefore, it is important to have symptoms such as rectal bleeding, evaluated by a colorectal surgeon so appropriate treatment can be initiated.