Hemorrhoids

Hemorrhoids are considered a disease when accompanied by the following clinical signs: bleeding during or after bowel movements, anal pain during defecation, an anal “lump” (thrombosed hemorrhoid) causing variable degrees of pain, itching, and sometimes a white mucus anal discharge.

Hemorrhoids are caused by constant or recurrent pressure on the anus. This pressure usually results from prolonged straining during bowel movements due to constipation. Other factors may increase the risk of hemorrhoids such as diarrhea, heavy lifting, poor posture, prolonged sitting or standing, pregnancy, anal intercourse, obesity, and certain sports like horseback riding or cycling.

In the presence of certain symptoms, the following exams should be performed:  rectal exam (with gloved hands, the doctor inserts a finger into the rectum to examine the hemorrhoids); anoscopy, in which the patient is in the genupectoral position (kneeling on the examining table) while the doctor examines the rectum using an anoscope (a narrow tube equipped with a light).  

Medications can be prescribed to relieve pain (painkillers or anti-inflammatory drugs); improve intestinal transit (laxatives); alleviate venous insufficiency (venotonic drugs); reduce edema and soothe local inflammation (suppositories and creams).

Methods aimed at cutting off the hemorrhoids’ blood supply may be chemical (sclerotherapy), thermal (photocoagulation, or coagulation therapy) or mechanic (rubber band ligation). Each of these techniques causes scar tissue to form which then holds the anal canal veins in place.

Surgery is used if the above methods fail, or for patients with severe hemorrhoids.