Hemorrhoids: Symptoms, Causes & Treatment

Hemorrhoids are enlarged veins in or around the anus and lower rectum. They come in two main types: internal hemorrhoids (located inside the rectum, usually not visible) and external hemorrhoids (located beneath the skin around the anus, often visible). This is a very common condition affecting millions worldwide, including residents of Jordan and the Arab region.

Hemorrhoids develop when increased pressure in the anal area causes the natural veins to dilate and swell. This leads to bright red bleeding (typically on toilet paper or in the toilet), severe itching, pain, and a sensation of a lump around the anus. Symptoms worsen with chronic constipation and straining during bowel movements. Most cases are mild to moderate and manageable with lifestyle modifications and simple topical treatments.

While hemorrhoids are generally not dangerous, persistent pain and bleeding can affect quality of life. It's important to consult a doctor if symptoms persist or worsen, as rectal bleeding may indicate other conditions requiring medical evaluation.

Hemorrhoid symptoms vary based on type and severity. Internal hemorrhoids may cause no initial symptoms, but bleeding is usually the first sign. External hemorrhoids produce more noticeable symptoms and intense itching. Note that hemorrhoid symptoms may resemble more serious conditions, so medical consultation is essential for proper diagnosis.

• Bright red blood on toilet paper or in the toilet after bowel movements
• Intense itching around the anus
• Pain or discomfort in the anal area, especially when sitting or defecating
• A lump or swelling around the anus (may be visible or palpable)
• Moisture or mucoid discharge from the anus
• Irritation and redness of the surrounding area
• Feeling of incomplete evacuation even after bowel movements
• Significant bleeding in severe cases, potentially causing anemia
• Sharp and sudden pain if blood clots form within external hemorrhoids
• Involuntary leakage of fluids or stool

• Chronic constipation: Constipation makes stool hard, requiring more straining during bowel movements, which increases pressure on anal veins.
• Repetitive straining: Attempting to pass hard stool or prolonged toilet sitting increases anal pressure.
• Chronic diarrhea: Causes repeated irritation and inflammation of anal veins.
• Sedentary lifestyle: Physical inactivity leads to constipation, a major hemorrhoid risk factor.
• Low-fiber diet: Low dietary fiber causes hard stool and constipation.
• Prolonged sitting: Long periods of desk work or driving increase pressure in the anal area.
• Heavy lifting: Straining from lifting heavy objects increases abdominal pressure.
• Pregnancy and childbirth: Hormonal changes and pelvic pressure cause vein dilation.

• Advancing age: Risk increases after age 50, though hemorrhoids are common at all ages.
• Family history: Genetic predisposition increases hemorrhoid risk.
• Pregnancy: Pregnant women are more vulnerable, especially in the third trimester.
• Obesity: Excess weight increases pressure on veins.
• Chronic liver disease: May elevate venous pressure.
• Sedentary occupations: Jobs requiring prolonged sitting increase risk.
• Food sensitivities: Some foods may trigger repeated diarrhea.
• Digestive disorders: Such as IBS and inflammatory bowel disease.
• Excessive laxative use: Can cause chronic diarrhea.
• Alcohol consumption: May contribute to constipation or diarrhea.

Hemorrhoid diagnosis is based on clinical examination and patient medical history. Most hemorrhoid cases are diagnosed without complex tests. However, if bleeding is severe or persistent, the doctor may order additional tests to rule out more serious conditions.

• Visual and physical examination: The doctor visually inspects the anal area and palpates for external hemorrhoids beneath the skin.
• Digital rectal examination (DRE): The doctor inserts a gloved, lubricated finger into the rectum to check for internal hemorrhoids or other problems.
• Anoscopy: A small illuminated instrument inserted through the anus to visualize the rectum, used when bleeding is acute or persistent.
• Colonoscopy: In cases of severe or continuous bleeding, this may be performed to rule out tumors or other serious colon conditions.
• Blood tests: May be ordered to assess hemoglobin levels if severe, continuous bleeding causes anemia.
• Ultrasound imaging: Rarely used unless the doctor suspects additional complications.

Medications and Topical Treatments

• Creams and ointments: Contain hydrocortisone or lidocaine to relieve pain, itching, and inflammation. Apply directly 2-4 times daily.
• Rectal suppositories: Provide temporary pain and itching relief and reduce internal inflammation.
• Oral painkillers: Such as acetaminophen or ibuprofen for pain in acute cases.
• Stool softeners: Such as polyethylene glycol or psyllium to soften stool and reduce straining.

Medical Procedures

• Rubber band ligation: A non-surgical procedure where a tight rubber band is placed around the hemorrhoid base, cutting blood supply. The hemorrhoid falls off within 1-10 days. Highly effective for internal hemorrhoids.
• Sclerotherapy: A chemical injection causes the hemorrhoid to shrink. Suitable for small to medium internal hemorrhoids.
• Infrared coagulation: Heat treatment to destroy hemorrhoid tissue. Quick and relatively painless.
• Hemorrhoidectomy: Surgical removal of hemorrhoids in severe or recurrent cases unresponsive to other treatments. Most effective but requires longer recovery.
• Transanal Hemorrhoidal Dearterialization (THD): Modern technique that cuts blood supply while preserving tissue.

Lifestyle Changes

• Increase fiber intake: Eat vegetables, fruits, whole grains, and legumes daily to soften stool and reduce constipation. Target 25-35 grams of fiber daily.
• Drink water and fluids: Consume 2-3 liters of water daily to soften stool.
• Avoid straining and prolonged toilet sitting: Don't strain excessively and leave the toilet after 5-10 minutes even if bowel movement is incomplete.
• Regular physical activity: Walk or exercise moderately 30 minutes daily to improve bowel movement.
• Warm baths: Sit in warm water for 10-15 minutes several times daily to significantly relieve pain and itching.
• Avoid strong laxatives: Use only natural or gentle laxatives, as strong ones may cause diarrhea that worsens symptoms.
• Maintain hygiene: Gently clean the area with warm water or moist wipes instead of rough toilet paper.

• Anemia: In cases of severe and persistent bleeding, repeated blood loss may reduce red blood cell count, causing fatigue, weakness, and paleness.
• Tissue infection: The hemorrhoid area may develop bacterial infection, especially if there are open wounds or scratches.
• Thrombosed external hemorrhoids: Blood clot formation within external hemorrhoids causes severe pain and acute swelling. May require surgical drainage.
• Anal fissures: Small tears in the anal tissue from repeated straining cause sharp pain and may increase bleeding.
• Chronic skin conditions: Continuous itching and moisture may cause chronic skin inflammation or fungal infection in the area.
• Prolapsed hemorrhoids: Protrusion of internal hemorrhoids outside the anus causes pain and severe discomfort.
• Psychological and social complications: Chronic pain and itching affect quality of life, causing anxiety and embarrassment, and may impact physical activity and social relationships.

• Eat a high-fiber diet: Increase consumption of vegetables, fruits, whole grains, and legumes to prevent constipation and naturally soften stool.
• Drink adequate water: Consume 2-3 liters of water daily to ensure adequate stool hydration.
• Don't delay bowel movements: Respond immediately when you feel the urge to defecate to prevent stool hardening.
• Avoid prolonged toilet sitting: Don't use the toilet as a place to read or work; leave within 5-10 minutes.
• Exercise regularly: Daily walking or moderate physical activity improves bowel movement and prevents constipation.
• Avoid straining: Don't strain excessively and avoid breath-holding during defecation.
• Use clean toilets: In Jordan and public areas, avoid using dirty toilets and use clean facilities.
• Avoid strong laxatives: Use only natural or gentle laxatives when needed, as strong ones may cause diarrhea that worsens symptoms.
• Maintain a healthy weight: Weight loss reduces pressure on veins and prevents hemorrhoids.
• Avoid trigger foods: Reduce spicy, fatty, and processed foods that may cause diarrhea or constipation.