What are hemorrhoids?

Hemorrhoids are swollen or inflamed varicose^a veins in the lower rectum or anus. Almost everyone suffers from hemorrhoids at some time in their lives.⁽²⁾

What are the hemorrhoids' points of origin?

Internal hemorrhoids originate in the inner part of the lower rectum. This type of hemorrhoids lacks nerve cells. This is why internal hemorrhoids are painless.

External hemorrhoids develop below the rectal opening or surrounding the anus. They are situated under the skin, and the presence of nerve cells make these hemorrhoids very painful.

Most hemorrhoids are internal but both types of hemorrhoids can be present at the same time in the same person.

What are the hemorrhoids' common signs and symptoms?

Internal hemorrhoids are painless with light red rectal bleeding with stools, itching, burning, mucus discharge or excessive moisture, visible bulge (prolapsed) mass, thrombosis (obstruction due to blood clot).

Prolapsed hemorrhoids are internal hemorrhoids that stick out through the anus when the stool is passed or when a person stands, and are usually painful. Thrombosed hemorrhoids appear as blue, shiny masses, and are very painful. Thrombosed external hemorrhoids could occur within the first day after delivery. ⁽³⁾

External hemorrhoids usually present with mild discomfort, pain after bowel movement or itching. Bleeding may occur if a hemorrhoidal vein breaks because of a sudden increase in pressure or scraping. Other complaints are incomplete defecation (a sensation that you have not emptied completely after a bowel movement), weakness or fatigue with anemia. In general, all signs and symptoms worsen with diarrhea or constipation. If you experience any of these symptoms, you should consider consulting your health care professional.

What are predisposing or risk factors for hemorrhoids?

The most common predisposing factors are:

• Constipation
• Low-fiber diet
• Sitting for long periods of time
• Obesity
• Pregnancy
• Episiotomy^b
• Rectal surgery
• Poor pelvic musculature
• Loss of rectal muscle tone
• Familial tendency

What causes hemorrhoids?

The real cause is unknown. The mechanism is believed to be repeated excessive pressure in the anal or rectal veins.⁽⁴⁾

a) Varicose: Affected by a condition causing the veins to become dilated and swollen.

b) Episiotomy: Vaginal incision to enlarge the space at the outlet.