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Hemorrhoids
Common Names: Piles
Image Notes: Endoscopic image of internal hemorrhoids seen on retroflexion of the flexible sigmoidoscope at the ano-rectal junction.
Hemorrhoids (AmE), haemorrhoids (BrE), emerods, or piles) are varicosities or swelling and inflammation of veins in the rectum and anus.
Causes
The causes of hemorrhoids include genetic predisposition (weak rectal vein walls and/or valves), straining during bowel movements, and too much pressure on the rectal veins due to poor muscle tone or poor posture. Similarly, sitting for prolonged periods of time can cause hemorrhoids. Hypertension, particularly in the portal vein, can also cause hemorrhoids because of the connections between the portal vein and the vena cava which occur in the rectal wall - known as portocaval anastomoses. Anal sex can also stress the anus, particularly if too little lubricant is used, and lead to hemorrhoids.
Additional factors that can influence the course of hemorrhoids (mostly by increasing rectal vein pressure), especially for those with a genetic predisposition, are obesity and a sedentary lifestyle.
Both constipation and chronic diarrhea, which increase straining during bowel movements, may lead to hemorrhoids. Postponing bowel movements, and fiber-deprived diet both lead to constipation and thus may cause hemorrhoids.
Pregnancy causes hypertension and increases strain during bowel movements, and thus hemorrhoids are often associated with pregnancy.
Excessive consumption of alcohol or caffeine can both cause hemorrhoids. Both can cause diarrhea. Alcohol can also cause alcoholic liver disease leading to portal hypertension. Caffeine on the other hand can cause general hypertension.
Food
Dehydration can cause a hard stool or chronic constipation which can lead to hemorrhoidal irritation. An excess of lactic acid in the stool, a product of excessive consumption of milk products such as cheese, can cause irritation and a reduction of consumption can bring relief. Vitamin E deficiency is also a common cause.
Food considered "probiotic," such as yogurt with active culture, may help keep
the gut functioning normally and thus help prevent flare-ups, as will the consumption of fruit.
Types of hemorrhoids
- (I84.3-I84.5) External hemorrhoids are those that occur outside of the anal verge (the distal end of the anal canal). They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom from external hemorrhoids, is more commonly due to skin irritation.
- (I84.3) External hemorrhoids are prone to thrombosis: if the vein ruptures and a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.
- (I84.0-I84.2) Internal hemorrhoids are those that occur inside the rectum. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated.
- (I84.1) Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids:
- Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside the anus.
- If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.
Text and images are licensed under the GNU Free Documentation License. Material is used from the Wikipedia article "Hemorrhoid".
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