Hemorrhoids

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What is it about ?

Hemorrhoids are “varicose veins” in the veins located under the lining of the anus called hemorrhoidal veins.

They often appear following strong pushing efforts, for example in case of constipation or with hard stools, after childbirth or in case of persistent cough.

Hemorrhoids are mild, but they can cause unpleasant symptoms. They often go away on their own, but they can also come back. In some cases, a blood clot forms in the hemorrhoids (thrombosed hemorrhoids), which is (very) painful

What is its frequency?

Hemorrhoids are a particularly common condition. About 3 in 10 adults have had hemorrhoids1.

How to recognize them?

The blood loss is the main sign of the presence of hemorrhoids. Bleeding is generally limited; you notice a tiny bit of blood on the toilet paper after using the toilet or in your underwear. Sometimes blood flows into the toilet bowl after defecating. Itching or an uncomfortable feeling around the anus is also common.

We distinguish four levels severity of hemorrhoids.

  • Level 1: hemorrhoids remain inside the anus, they are not visible on the outside.
  • Level 2: hemorrhoids are visible when pushing, but disappear when released.
  • Level 3: Hemorrhoids come out, but you can still push them inside with your finger.
  • Level 4: it becomes impossible to push the hemorrhoids inwards, they are permanently visible from the outside.

In the presence of a thrombosed hemorrhoid, we have a lot of pain around the anus. In this case, you may not be able to sit down. A hard, dark red swelling is visible along the anus.

How is the diagnosis made?

  • Most doctors first do a simple inspection to see if hemorrhoids are visible from the outside and if there is no other cause for the complaints. During the examination, the doctor asks you to push.
  • He will then proceed to a internal review. The doctor will feel with his finger if there are internal hemorrhoids. At the same time, he can also check that there is no tumors at the exit of the rectum. In men, the doctor may also examine the prostate.
  • It sometimes checks the inside of the anus with a small metal rod. In case of doubt, he will direct you for a complementary colon endoscopy (colonoscopy).

What can you do ?

Good intestinal transit, with loose stools, is very important. Therefore, make sure that your diet is sufficiently varied and rich in fiber: eat a lot of fruits and vegetables, and in particular a lot of raw vegetables, and always drink enough. Regular physical activity is also important.

If you have trouble going to the bathroom and your stools are hard, you can take a temporary laxative. Discuss it with the doctor.

See your doctor if you are over 50 and start to lose bright red blood. The presence of mixed blood in the stool is an important warning signal. It may indeed be the first sign of an intestinal tumor.

What can your doctor do?

Hemorrhoids that do not cause inconvenience do not require special treatment.

Medicines occupy only a limited place in treatment. It is especially important to treat constipation, possibly with an appropriate laxative.

  • In the event of bothersome hemorrhoids, the application of a cream can sometimes be sufficient. It is also possible to strangle them with an elastic ligature. This intervention is performed by the general practitioner or a specialist (gastroenterologist). The ligated hemorrhoids fall out after a week.
  • Sometimes a sclerosing fluid (atrophicant) is injected into the hemorrhoid (sclerotherapy).
  • Larger hemorrhoids that come out of the anus can be cut in a small procedure.
  • A blood clot is removed under local anesthesia.

Want to know more?

Sources

  • 1 Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ. 2008; 336: 380-3.