Causes and symptoms of Hemorrhoids
Hemorrhoids are not normally serious and most cases will clear up on their own within a couple of weeks. However, sufferers often want prompt symptom relief and there are a variety of over-the-counter products that can help to reduce discomfort.
Hemorrhoids causes
Hemorrhoids are common in both men and women, with prevalence increasing with age. It is estimated that up to half the population will suffer from hemorrhoids at some point in their life.
Predisposing factors include chronic constipation, prolonged straining, and other conditions that raise intra-abdominal pressure and cause the haemorrhoidal vessels to enlarge, such as obesity and chronic cough. Haemorrhoids are common in pregnancy, and can be aggravated by pushing in labour, but the problem usually resolves soon after the birth.
People whose job involves heavy lifting form another risk group. There is also thought probably to be some genetic predisposition to haemorrhoids.
Certain prescription and over-the-counter drug treatments can cause constipation and should be considered as possible contributing factors. Overuse of stimulant laxatives, which can lead to constipation, might also need to be considered. Chronic diarrhoea can be another risk factor for development of haemorrhoids, because of irritation of the anal canal.
Contrary to schoolboy myths, haemorrhoids are not caused by sitting on hot radiators or cold floors.
Hemorrhoids symptoms
Haemorrhoids are often asymptomatic but they can cause itching, bleeding, discomfort, a feeling of incomplete evacuation after a bowel movement, and (less commonly) pain.
The most common symptom of internal haemorrhoids is bleeding, especially after a bowel movement when passage of the stool causes a small blood vessel in the anal cushions to burst. The blood is typically seen as small spots of fresh red blood on the toilet paper. Mucus discharge can occur with prolapsed haemorrhoids and this can cause irritation.
Non-prolapsed internal haemorrhoids are not painful, as the mucosa above the dentate line has no sensory pain fibres. Prolapsed internal haemorrhoids can be painful.
External haemorrhoids can form a swelling or hard lump around the anus. This is a thrombosed haemorrhoid and can be extremely painful.
Seeking medical advice for your hemorrhoids
Although mild haemorrhoidal symptoms can be relieved by self- medication, pharmacists should question patients about their symptoms to determine whether medical referral is needed. If self-treatment is chosen, patients should be encouraged to seek medical advice if their symptoms do not improve within about seven days.
Rectal bleeding is often due to haemorrhoids, but it can also be a symptom of more serious conditions and, ideally, all patients with rectal bleeding should be referred. Some might instead choose to self- treat, but referral is certainly recommended if the blood is mixed with the stool (as opposed to slight streaking on the surface) or if the blood is dark, as this indicates that it has come from higher up the gastrointestinal tract. Referral is also needed if there are additional "warning symptoms" such as nausea or abdominal pain, weight loss or recent change in bowel habit. Patients aged over 50 who have rectal bleeding should be referred because of the increased risk of colorectal cancer in this age group.
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