AN UNCOMFORTABLE TOPIC, HEMORRHOIDS

Even though more than half of the adult population suffers from hemorrhoids - with burning, itching, discomfort, pain, bleeding, and protruding piles from the rectum during bowel movements - it never becomes a topic of conversation except in doctors’ offices. Maybe because it entails the private parts of a person or maybe it is deemed unimportant and common hemorrhoid related complaints.

It is a big mistake to self-diagnose oneself, because some serious illnesses like rectal cancers, anal fissures, fistulas and STDs could manifest the same way.

Since knowledge is strength, and it helps us to make the right decisions, let’s refresh our knowledge about hemorrhoids in Q and A format for more thinking and better understanding.

Q – What are hemorrhoids?

A - Hemorrhoids are nothing more than dilated veins (varices) of the lower rectum.

Q – What is the mechanism (pathogenesis) of developing hemorrhoids?

A – It is not clear. It’s thought that there must be some structural failure to support upright posture of humans. But there are many distinct risk factors thar promote hemorrhoids formation.

Q – What are the main risk factors that promote hemorrhoid formation?

A – They are multiple and can be listed as follows:

1.     Chronic constipation and prolonged straining and sitting long time on toilet to have a bowel movement.

2.     Sedentary lifestyle and sitting down many hours without any physical activities.

3.     Diet that lacks enough fiber and water intake.

4.     Increased intra-abdominal pressure (Aging multiple pregnancies, heavy weightlifting, morbid obesity).

5.     Aging.

6.     Anal sex.

Q – How many types of hemorrhoids are there?

A – Generally two types of hemorrhoids exist

            1 – External hemorrhoids: They protrude outside of the  rectum and they are located below the dentate lines, where skin intersect with rectal mucosa, and covered with squamous epithelium of the skin that contain nerve endings and pain receptors.

             2 – Internal hemorrhoids: They are located above the dentate lines, covered with rectal mucosa which contain no nerve ending, and they do not protrude outside of the rectum.

Q – How hemorrhoids are graded according to their severity?

A – They are graded into 4 groups. Grades 1 and 2 are considered mild hemorrhoids and can be managed conservatively. Grades 3 and 4 are considered serious hemorrhoids and need specialist care for management. Grading of hemorrhoids done as follows:

        !. Grade I. Rectal bleeding with bowel movements, no protrusion from the anus.

        2. Grade II. It protrudes with BM but, go back in by itself.

        3. Grade III. It protrudes with BM but only push back in manually.

        4. Grade IV. It permanently protrudes, can’t be pushed in manually.

Q – How are hemorrhoids diagnosed?

A – They should only be diagnosed by a physician by digital rectal examination, and visual examination by doing sigmoidoscopy.

Q – How should hemorrhoids be treated?

A – Depending on seriousness grading, grade 1 and 2 hemorrhoids can be treated symptomatically by the patients, by taking preventative measures, preventing constipation with excess fiber intake, drinking plenty of water, taking stool softeners, becoming physically more active, trying not to bear down too much and not sitting on the toilet too long to have a BM. In addition, using proper OTC medications (cream or suppository) and taking warm sitz baths for 10 to15 minutes after each BM could help.

 If all these measures fail, and grade 3 and 4 hemorrhoids require intervention by a specialized Colo-rectal surgeon for appropriate treatments.