Hemorrhoids

Hemorrhoids (also known as haemorrhoids or piles) are varicosities or swelling and inflammation of veins in the rectum and anus. 

Types and symptoms of hemorrhoids

Two of the most common types of hemorrhoids are external and internal hemorrhoids. ICD-10 codes are provided below.

(I84.3-I84.5) External hemorrhoids are those that occur outside of the anal verge (the distal end of the anal canal). They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom from external hemorrhoids, is more commonly due to skin irritation.
(I84.3) If the vein ruptures and a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.
(I84.0-I84.2) Internal hemorrhoids are those that occur inside the rectum. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated.
(I84.1) Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids.
Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside of the anus.
If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside of the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.

Prevalence
Hemorrhoids are very common. It is estimated that approximately one half of all Americans have this condition by the age of 50. However, only a small number seek medical treatment. Annually, only about 500,000 people are medically treated for hemorrhoids, with 10 to 20% of them requiring surgeries.

Hemorrhoid Causes

The causes of hemorrhoids include genetic predisposition (weak rectal vein walls and/or valves), straining during bowel movements, and too much pressure on the rectal veins due to poor posture or muscle tone. Constipation, chronic diarrhea, poor bathroom habits (sitting for unusually long periods of time [e.g. reading on the toilet] or excessive cleaning attempts), pregnancy, postponing bowel movements, and fiber-deprived diet can also contribute.

Insufficient hydration (caused by not drinking enough water, or drinking too much of diuretic liquids such as coffee or colas) can cause a hard stool, which can lead to hemorroidal irritation.

An excess of lactic acid in the stool, a product of excessive consumption of milk products such as cheese, can cause irritation and a reduction of consumption can bring relief.

Additional factors that can cause hemorrhoids (mostly by increasing rectal vein pressure), especially for those with a genetic predisposition, are obesity and a sedentary lifestyle.

Recommended reading:  No More Hemorrhoids

Hemorrhoids Prevention

Prevention of hemorrhoids includes drinking more fluids, eating more dietary fiber, exercising, practicing better posture, and reducing bowel movement strain and time. Hemorrhoid sufferers should avoid using laxatives and should strictly limit time straining during bowel movement. Wearing tight clothing and underwear will also contribute to irritation and poor muscle tone in the region and promote hemorrhoid development. Some sufferers report a more comfortable experience without underwear or wearing only very lightweight panties etc.

Straining can be lessened by defecating in a standing position, knees slightly bent. This position seems to use the muscles of the abdomen to expel feces preventing a strain on the anus. Fluids emitted by the intestinal tract may contain irritants that may increase the fissures associated with hemorrhoids. Washing the anus with cool water and soap, may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluids.

Examination
After visual examination of the anus and surrounding area for external or prolapsed hemorrhoids, a doctor would conduct a digital examination. In addition to probing for hemorrhoidal bulges, a doctor would also look for indications of rectal tumor or polyp, enlarged prostates and abscesses.

Visual confirmation of hemorrhoids can be done using a medical device called an anoscope. This device is basically a hollow tube with a light attached at one end that allows the doctor to see the internal hemorrhoids, as well as polyps in the rectum.

If warranted, more detailed examinations, such as sigmoidoscopy and colonoscopy can be performed. In sigmoidoscopy, the last 25 inches of the colon and rectum are examined whereas in colonoscopy the entire bowel is examined.