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


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  • 1 Description
  • 2 Types of Hemorrhoids
  • 3 Causes
  • 4 Symptoms
  • 5 Degree of 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. Hemorrhoidal disease is referred to when there are varicose dilation of the hemorrhoidal veins.

In conjunction with the sphincters of the anus, hemorrhoids close the external outlet of the intestine. Hemorrhoids help the sphincter stay closed, forming a kind of valve, even with increases in pressure, such as sneezing or laughing. They generally thicken the mucosa into three “knots” 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, 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, causing them to hurt, particularly when you are sitting.

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

  • Effort during bowel movements.
  • Sit 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 bowl or stains on the toilet paper.

Prolapse : This is a lump that appears when hemorrhoids leave the inside of the anus and it is difficult to insert them again.

Discharge : The discharge of mucus from the anal mucosa itself is typical of internal hemorrhoids. It can cause skin irritation and cause itching (burning) or burning sensation, especially during defecation.

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


Hemorrhoids grade

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

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 symptom. Only with the help of a camera inserted through the anal canal to observe the rectum (rectoscopy), can the doctor recognize the hemorrhoid in this degree.

Grade II

At this stage, the knots are larger and appear clearly with increasing pressure in the anus. During defecation they will be pushed out of the anus and then back into the anal canal. Hemorrhoids shrink into the anus spontaneously.

Grade III

At this stage, hemorrhoids “fall” after defecation or even spontaneously out of the anal sphincter. Then there is talk of a prolapse. Hemorrhoids will not go away through the anal canal spontaneously. The affected person can push the hemorrhoids with his finger back into the anal canal.

Grade IV

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



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

  • Stool guaiac (shows presence of blood)
  • Sigmoidoscopy
  • Rectoscopy



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

Combat Constipation A patient can do a lot to treat hemorrhoids. A few changes in lifestyle habits and some home remedies can improve discomfort. If you experience constipation, the following tips may be helpful:

  • Exercise regularly.
  • Maintain a balanced diet rich in fiber, vegetables and fruit.
  • Avoid foods that produce gases.
  • Drink enough liquid. Between 1.5 and 2 liters a day.

Tip : daily taking wheat bran with plenty of liquid is very beneficial to treat constipation.

Correct anal hygiene

Maintaining proper hygiene of 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 is important to avoid soaps and wet wipes because they can irritate the skin and make healing difficult.

What to do in case of minor discomfort

In most cases, mild hemorrhoid symptoms 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 alleviate inflammation, reduce pain and improve itching. These products should not be used without medical supervision if discomfort persists for a long time or skin lesions appear.

What to do if the discomfort is severe

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

Another technique is elastic band ligation (tie = knot). A small elastic rubber band is applied to the “neck or base” of the hemorrhoid, cutting off its blood supply. The hemorrhoid, along 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 the proteins in the tissue and evaporates the water from the cells, decreasing the blood flow of the region to which it is applied.

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



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 the product of prolonged blood loss. However, it is unusual for significant bleeding to occur with hemorrhoids.


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