Hemorrhoids Also known as piles, they occur when the veins located in the lower rectum or in the anus become excessively dilated, thus becoming varicosities. These dilations, in addition to being annoying, can be painful.


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  • 1 Description
  • 2 Types of Hemorrhoids
  • 3 Causes
  • 4 Symptoms
  • 5 Grade hemorrhoids
  • 6 Diagnosis
  • 7 Treatment
  • 8 Complications
  • 9 Sources


Anatomically, hemorrhoids are plexuses, cushions, or pads of submucosal tissue where the venules and arterioles of the anal canal are contained. They are only pathological when the flow of blood in this area of ​​blood vessels is interrupted. We speak of hemorrhoidal disease when there are varicose dilations of the hemorrhoidal veins.

Together with the sphincters of the anus, hemorrhoids close the external outlet of the intestine. Hemorrhoids help the sphincter to remain closed, forming a kind of valve, even with increases in pressure, such as when sneezing or laughing. They generally thicken the mucosa in three “knots” that are found at the entrance of the vessels to the corpora cavernosa.


Types of Hemorrhoids

Three types of hemorrhoids are distinguished according to their situation with respect to the anal canal:

Internal Hemorrhoids : if the affected veins are located in the lower rectum area, above the anus, and are covered by mucosa.

External hemorrhoids : when they are located below the junction of the anus with the rectum.

Mixed hemorrhoids : if they affect both types of veins.



Hemorrhoids are very common, especially during pregnancy and after delivery. These result from increased pressure in the veins of the anus. This pressure causes the veins to swell, making them sore, particularly when you are sitting.

The most common cause is straining during defecation. Hemorrhoids can be caused by:

  • Straining during bowel movements.
  • Sitting for long periods of time.
  • Anal infections
  • Certain diseases, such as liver cirrhosis.



Some cases of mild hemorrhoids are asymptomatic, but the most common symptoms are:

Bleeding : usually occurs when defecating. It is usually scarce and is detected by traces of blood on the toilet bowl or stains on the toilet paper.

Prolapse : this is a lump that appears when hemorrhoids come out from inside the anus and it is difficult to insert them again.

Secretion : Mucus secretion from the anal mucosa itself is typical of internal hemorrhoids. It can cause skin irritation and cause itching (itching) or a burning sensation, especially during defecation.

Pain : internal hemorrhoids do not usually hurt, unlike external ones, which are particularly annoying when they come out of the anus due to the pressure of the anal ring.


Degree of hemorrhoids

Hemorrhoids are classified into 4 different grades depending on the degree of inflammation. Various symptoms appear in each grade:

Grade I

At this stage, hemorrhoids appear somewhat enlarged, but they are relatively small and not visible from the outside. They can disappear spontaneously or without specialized treatment and in most cases they do not produce any type of symptoms. Only with the help of a camera inserted through the anal canal to view the rectum (rectoscopy), can the doctor recognize the hemorrhoid to this degree.

Grade II

At this stage, the knots are larger and appear clearly with increasing pressure on the anus. During defecation they will be pushed out of the anus and then they will return to the interior of the anal canal. Hemorrhoids shrink inside the anus spontaneously.

Grade III

In this stage, hemorrhoids “fall” after defecation or even spontaneously outside the anal sphincter. There is then talk of a prolapse. Hemorrhoids will not disappear through the anal canal spontaneously. The affected person can push the hemorrhoids with their finger back into the anal canal.

Grade IV

In this last stage, the hemorrhoids are permanently outside the anus and cannot be reintroduced manually (fixed prolapse). In this degree, hemorrhoids are always visible. Generally, this leads to an anal prolapse, in which, in addition to the hemorrhoidal nodes, the mucosa also protrudes up to two centimeters outside the anus.



Often times, a doctor can diagnose hemorrhoids simply by examining the rectal area. If needed, the following tests may be done to help with the diagnosis:

  • Guayacol in stool (shows presence of blood)
  • Sigmoidoscopy
  • Rectoscopy



The discomfort caused by hemorrhoidal disease can be effectively reduced if during treatment the patient makes the stools soft. This helps that they can be removed without much effort. Treatment will depend on the severity of the symptoms.

Fight constipation A patient can do a lot to treat hemorrhoids. A few changes in lifestyle and a few home remedies can improve discomfort. If you are constipated, the following tips may help:

  • Get regular exercise.
  • Maintain a balanced diet rich in fiber, vegetables and fruit.
  • Avoid foods that produce gases.
  • Drink enough fluids. Between 1.5 and 2 liters a day.

Tip : taking wheat bran daily with plenty of fluids is very beneficial for treating constipation.

Correct anal hygiene

Maintaining proper hygiene in the anal area is very important in the treatment of hemorrhoidal disease. Sitz baths and the use of chamomile compresses can be very beneficial. It’s important to avoid soaps and wet wipes because they can irritate the skin and make healing difficult.

What to do with minor discomfort

In most cases, mild symptoms of hemorrhoids can be treated with ointments or suppositories. Some products contain cortisone, other natural substances. Adding lidocaine or witch hazel further reduces acute pain. These preparations are sold in pharmacies without a prescription. They relieve inflammation, reduce pain and improve itching. These products should not be used without medical supervision if discomfort persists for a long time or lesions appear on the skin.

What to do if the discomfort is severe

If the symptoms of hemorrhoids are severe, the ointments will not be enough for the treatment. There are different options. Grade I and II hemorrhoids can be eliminated by sclerotherapy, which consists of the injection of an irritating material (for example, phenol in 50% almond oil) into the submucosa to reduce vascularity and produce fibrosis (scarring), which prevents tissue prolapse and reduces symptoms.

Another technique is ligation using elastic bands (ligating = knotting). A small elastic rubber band is applied to the “neck or base” of the hemorrhoid, cutting off its blood supply. The hemorrhoid, together with the band, falls off after 3-5 days and a small scar is formed that prevents the tissue from continuing to prolapse and, therefore, continue to produce symptoms.

Another technique for treating hemorrhoids is infrared coagulation, which coagulates tissue proteins and evaporates water from cells, reducing blood flow to the region to which it is applied.

If these techniques are not successful, or the hemorrhoids are in more advanced stages, the technique of choice should be surgery.



The blood in the swollen veins can form clots and the surrounding tissue can die. Surgery is often needed to remove clotted hemorrhoids.

Heavy bleeding may also occur. Iron deficiency anemia can be caused by prolonged blood loss. However, it is unusual for significant bleeding to occur with hemorrhoids.


by Abdullah Sam
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