Hemorrhoids

Hemorrhoids are varicose dilations of the hemorrhoidal veins located in the upper and middle region of the anal canal. They are one of the most widespread but also most neglected conditions: they appear in about 8 in 10 people, in men and women equally. Although they often go unnoticed, hemorrhoids should be evaluated by a specialist at the first signs — both because their symptoms can be confused with more serious conditions and because, over time, the disease can severely impact the body. The good news: hemorrhoids can be treated today with minimally invasive methods, without classic surgery.

What types of hemorrhoids exist?

Hemorrhoids are divided into several categories, according to their mechanism of appearance, their position, their course and the stage of the condition.

By mechanism of appearance

There are two categories: primary hemorrhoids — the majority of cases — and secondary hemorrhoids, which reveal the manifestation of another health condition or, on the contrary, can mask it: liver cirrhosis, the presence of a tumour in the pelvis, rectal or colon cancer. This is precisely why the specialist diagnosis is essential. Hemorrhoids can also be congenital (hereditary) or acquired (appearing over time).

By location

External hemorrhoids form through the dilation of the lower rectal venous plexus, and internal ones from the upper rectal venous plexus. In rare cases there are also interstitial hemorrhoids, with the hemorrhoidal nodules positioned below the transition fold (Hilton’s white line).

By clinical course

The clinical course can be a long process free of complications, or it can unfold in acute flare-ups. Chronic hemorrhoids have a fluctuating course: itching sensations or the feeling of a foreign body, the elimination of blood during defecation; there are 4 stages of chronic hemorrhoids, according to their manifestation and severity. Acute hemorrhoids (hemorrhoidal thrombosis) are a complication of the chronic process: strong, pressing pain, oedema and redness in the anal region, sometimes fever and difficult defecation.

What symptoms do hemorrhoids cause?

Anal itching and the feeling of anal-rectal heaviness are the main symptoms of the presence of hemorrhoids:

• Itching (anal pruritus) — located between the buttocks or at the edge of the anus, caused by the mucus that irritates the skin or by infections with microorganisms associated with the condition. The pruritus can be so intense and persistent that it irritates the skin.
• The feeling of anal-rectal heaviness — the internal hemorrhoidal cluster behaves like a foreign body: continence becomes difficult, intestinal transit disorders appear, and the loss of a few drops of blood is possible, followed by a feeling of anal tension.
• Bleeding — located on the surface of the stool, with bright red blood. These emissions can be unpredictable or even permanent and can cause anaemia.
• Prolapse of the internal hemorrhoids — their exit outside the anal canal; rarely, spasms of the sphincter muscle can also occur. In strangulated hemorrhoids, blood circulation is reduced — strangulation and prolapse are conditions of great severity, requiring specialist medical intervention.

What are the causes and risk factors?

A person can have hemorrhoids even with a healthy life, but they most often appear in connection with certain health conditions or lifestyle habits:

• frequent constipation or diarrhoea and incorrect bowel habits
• standing for too long or prolonged periods of sitting
• a sedentary lifestyle
• intense and prolonged physical activity, lifting weights or barbells
• low-fibre diets
• poor local hygiene or the irritation produced by overly spicy food
• overweight and obesity
• associated conditions: heart failure, cirrhosis, pelvic tumours, hernias, genito-urinary prolapse, certain spinal cord injuries, prostate conditions
• pregnancy and labour
• advancing age and genetic inheritance

How can hemorrhoids be prevented?

The appearance of hemorrhoids can be prevented through a balanced lifestyle: a fibre-rich diet, which speeds up intestinal transit, quantitatively moderate meals, hydration and regular movement. It is preferable to avoid alcohol, coffee and cigarettes — all of which are contributing factors for the condition. The same measures also reduce the risk of recurrence after treatment.

How are hemorrhoids treated?

The classic surgical approach can be replaced today, in many cases, with minimally invasive, less painful treatments with short hospitalisation:

• The steam method — an intervention of about 10 minutes for large hemorrhoids, internal or external
• Foam sclerotherapy — eliminating small formations by injecting a substance that blocks the blood flow
• Cryotherapy — eliminating the hemorrhoids through controlled freezing

The most suitable method is recommended by the specialist doctor following the consultation — details on the Hemorrhoid treatment page.

Frequently asked questions

When should I see a doctor?

At the first signs: bleeding on defecation, pain, persistent itching, lumps or the feeling of a foreign body. An early diagnosis rules out serious conditions and allows treatment with the gentlest methods.

Do hemorrhoids heal on their own?

Acute flare-ups can improve temporarily, but the venous dilations that have formed do not disappear spontaneously. Without changing the risk factors and, if needed, treatment, the disease progresses in flare-ups, with ever more advanced stages.

Are hemorrhoids dangerous?

Hemorrhoids themselves are not life-threatening, but their complications can be serious: anaemia through repeated bleeding, painful hemorrhoidal thrombosis, prolapse and strangulation. In addition, their symptoms can mask serious diseases — which is why the medical evaluation is mandatory.