What are the complications of hemorrhoids?

Complications of hemorrhoids can include the following:

• Blood clots in external hemorrhoids.
• Skin tags—extra skin left behind when a blood clot in external hemorrhoids dissolves.
• Infection of a sore on external hemorrhoids.
• Strangulated hemorrhoid—when the muscles around your anus cut off the blood supply to an internal hemorrhoid that has fallen through your anal opening.
• Anemia.

Causes:

The causes of hemorrhoids include:

• Straining during bowel movements.
• Sitting on the toilet for long periods of time.
• Chronic constipation or diarrhea.
• A low-fiber diet.
• The weakening of the supporting tissues in your anus and rectum happens with aging.
• Pregnancy.
• Often lifting heavy objects.
•  Age.
• Hereditary (runs in the family).

Signs and symptoms:

The symptoms of hemorrhoids depend on the type you have.

If you have external hemorrhoids, you may have:

• Anal itching.
• One or more hard, tender lumps near your anus.
• Anal ache or pain, especially when sitting.

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

If you have internal hemorrhoids, you may have:

• bleeding from your rectum–bright red blood on the stool, on toilet paper, or in the toilet bowl after a bowel movement.
• hemorrhoid that has fallen through your anal opening, called prolapse.

Internal hemorrhoids that are not prolapsed most often are not painful. Prolapsed internal hemorrhoids may cause pain and discomfort.

Although,

hemorrhoids are the most common cause of anal symptoms, not every anal symptom is caused by hemorrhoids. Some hemorrhoid symptoms are similar to those of other digestive tract problems. For example, bleeding from your rectum may be a sign of bowel diseases such as Crohn’s disease, ulcerative colitis, or cancer of the colon or rectum.

You should seek a doctor’s help if you:

• Still have symptoms after 1 week of at-home treatment.
• Have bleeding from your rectum.

Risk Factors:

1. Strong:

I. age between 45 and 65 years:

• Incidence of hemorrhoids peaks between 45 and 65 years of age and declines after age 65 years.

II. Constipation:

• The presence of chronic constipation associated with straining at stool is associated with the repetitive elongation of the hemorrhoidal cushions and disruption of the supporting elements. This leads to the enlargement and engorgement of the hemorrhoidal tissue.

III.  Space-occupying pelvic lesion or pregnancy:

• Pregnancy is often associated with the development of hemorrhoidal symptoms that develop progressively throughout the pregnancy.
• Pathologic pelvic lesions, such as large ovarian cysts, can also encourage the development of hemorrhoidal symptoms. In both situations, there is an increase in intra-abdominal/pelvic pressure with a concomitant decrease in venous return causing increased anal vascular engorgement.

2. Weak:

I. hepatic insufficiency:

• There is little evidence that hepatic insufficiency or portal HTN contributes to the formation of hemorrhoids, but these conditions can result in rectal varices.

II. ascites

•  An increase in intra-abdominal pressure can be a contributing risk factor.

Complications Can Include:

• Ulcers near your ankles or varicose veins: These are typically painful and you’ll want to seek medical advice.
• Blood clots: Varicose veins can sometimes, although rarely, result in blood clots which may appear as severe swelling. If sudden swelling appears, again, seek medical care quickly.
• Bleeding. Occasionally, veins very close to the skin may burst.

Diagnosis:

Treatment:

How can You treat Your hemorrhoids?

You can most often treat your hemorrhoids at home by:

• Eating foods that are high in fiber.
• Taking a stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).
• Drinking water or other nonalcoholic liquids each day as recommended by your health care professional.

• Not:

  • Straining during bowel movements.
  • Sitting on the toilet for long periods of time.
  • Taking over-the-counter pain relievers such as acetaminophen, ibuprofen, naproxen, or aspirin
  • Sitting in a tub of warm water, called a sitz bath, several times a day to help relieve pain

Applying over-the-counter hemorrhoid creams or ointments or using suppositories—a medicine you insert into your rectum—may relieve mild pain, swelling, and itching of external hemorrhoids. Most often, doctors recommend using over-the-counter products for 1 week. You should follow up with your doctor if the products:

• Do not relieve your symptoms after 1 week.
• Cause side effects such as dry skin around your anus or a rash.

Most prolapsed internal hemorrhoids go away without at-home treatment. However, severely prolapsed or bleeding internal hemorrhoids may need medical treatment.

How do doctors treat hemorrhoids?

Doctors treat hemorrhoids with procedures during an office visit or in an outpatient center or a hospital.

Office treatments include the following:

A. Rubber band ligation:

• Rubber band ligation is a procedure that doctors use to treat bleeding or prolapsing internal hemorrhoids.
• A doctor places a special rubber band around the base of hemorrhoids.
• The band cuts off the blood supply.
• The banded part of the hemorrhoid shrivels and falls off, most often within a week.
• Scar tissue forms in the remaining part of hemorrhoids, often shrinking hemorrhoids.
• Only a doctor should perform this procedure—you should never try this treatment yourself.

B. Sclerotherapy:

 A doctor injects a solution into internal hemorrhoids, which causes scar tissue to form. The scar tissue cuts off the blood supply, often shrinking hemorrhoids.

C. Infrared photocoagulation:

A doctor uses a tool that directs infrared light at internal hemorrhoids. The heat created by the infrared light causes scar tissue to form, which cuts off the blood supply, often shrinking hemorrhoids.

D. Electrocoagulation:

 A doctor uses a tool that sends an electric current into an internal hemorrhoid. The electric current causes scar tissue to form, which cuts off the blood supply, often shrinking hemorrhoids.

The outpatient center or hospital treatments include the following:

A. Hemorrhoidectomy:

A doctor, most often a surgeon, may perform a hemorrhoidectomy to remove large external hemorrhoids and prolapsing internal hemorrhoids that do not respond to other treatments. Your doctor will give you anesthesia for this treatment.

B. Hemorrhoid stapling:

 A doctor, most often a surgeon, may use a special stapling tool to remove internal hemorrhoid tissue and pull a prolapsing internal hemorrhoid back into the anus. Your doctor will give you anesthesia for this treatment.

Sometimes complications of hemorrhoids also require treatment.