Hemorrhoids: Symptoms, causes and treatment

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HEMORRHOIDS are cushions made of blood vessels, connective tissue and muscle located on the anal canal. Functioning hemorrhoids help maintain fecal continence and ensure that no liquid escapes through the sphincter at the end of the digestive tract.
All people have hemorrhoidal tissue as part of their normal anatomy, according to the American Society of Colon and Rectal Surgeons. Only in a minority of people do hemorrhoids become enlarged or otherwise symptomatic.
“We believe the normal function of hemorrhoids is to prevent accidental leakage of stool,” said Dr. Syed Husain, a colorectal surgeon at The Ohio State University Wexner Medical Center. “They are present in everyone, but in some cases they get enlarged, and then they start causing symptoms.”
The exact prevalence of enlarged hemorrhoids is hard to measure because many opt for over-the-counter treatments instead of visiting the doctor. In the United States, about 10 million people — 4.4 percent of the population — self-report evidence of hemorrhoids each year, while doctors annually identify hemorrhoids in about 2.2 million outpatient evaluations, researchers reported in 2016 in the journal Clinics in Colon and Rectal Surgery. Caucasians suffer from a higher incidence of hemorrhoids than African-Americans, and increased prevalence of hemorrhoids is associated with higher socioeconomic status, doctors wrote in the report.
Problematic hemorrhoids are also more common in people between the age of 45 and 65, and about half of all adults have experienced at least one of the classic hemorrhoid symptoms by age 50, according to Harvard Medical School. Swollen hemorrhoids are usually a result of applying too much pressure to the lower rectum. This may happen if you’re straining to have a bowel movement, which can occur during chronic diarrhea and constipation, according to the Mayo Clinic. It may also happen if you sit on the toilet too long because when you sit on the toilet, your anus relaxes, allowing the veins around to fill with blood, which then puts pressure on those veins.
Pregnant women are also more susceptible to hemorrhoid problems because of the weight of carrying the baby and also from giving birth. Around 25 to 35 percent of pregnant women are affected in the third trimester, according to estimates from two studies conducted in France. Being very overweight, or standing or lifting too much can also make hemorrhoids worse.
People with swollen hemorrhoids don’t necessarily feel pain, though they may experience bleeding, anal swelling and discomfort. There are two types of hemorrhoids: internal and external. Internal hemorrhoids lie inside the rectum and the most common symptoms include painless rectal bleeding, prolapse or protrusion, pain and irritation, according to the Mayo Clinic.
“In some cases patients can also present with external swelling, a bulge that’s painful and they can feel that,” Husain said. External hemorrhoids are located under the skin around the anus.

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