Hemorrhoid
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1- Introduction
2- Anatomical Overview
3- Causes
4- Treatment
Introduction
Internal hemorrhoids (piles) are prolapses of rectal mucosa (more specifically of the “anal cushions”) containing the normally dilated veins of the internal rectal venous plexus. Internal hemorrhoids result from a breakdown of the muscularis mucosae, a smooth muscle layer deep to the mucosa. Internal hemorrhoids that prolapse into or through the anal canal are often compressed by the contracted sphincters, impeding blood flow.
Anatomical Overview
Normal Anatomy
- Anal Canal: The last part of the digestive tract, approximately 2-4 cm long, which ends at the anus.
- Hemorrhoidal Cushions: These are normal, vascular structures made of blood vessels, connective tissue, and some muscle fibers. They are found in three main locations in the anal canal:
- Left lateral (3 o’clock position)
- Right anterior (11 o’clock position)
- Right posterior (7 o’clock position)
Types of Hemorrhoids
Internal Hemorrhoids:
- Located inside the rectum, above the pectinate (or dentate) line.
- Covered by mucosa, a type of smooth, moist tissue.
- Typically painless due to their location in the area with visceral innervation (less sensitive).
External Hemorrhoids:
- Located below the pectinate line, covered by anoderm (a type of skin).
- These are supplied by somatic nerves, making them more sensitive and often painful.
- Visible and palpable as lumps around the anus.
Pathophysiology
- Engorgement: Increased pressure in the hemorrhoidal veins can cause them to swell.
- Prolapse: Prolonged straining can cause internal hemorrhoids to extend beyond the anus.
- Thrombosis: Blood can clot within an external hemorrhoid, causing a thrombosed hemorrhoid.
- Inflammation: Irritation and swelling can lead to inflammation, causing discomfort and bleeding.
Causes
- Straining during bowel movements
- Sitting for long periods of time on the toilet
- Chronic diarrhea or constipation
- Obesity
- Pregnancy
- Low-fiber diet
- Heavy lifting
Treatment
Conservative Treatments:
- High-fiber diet: Eating more fruits, vegetables, and whole grains to soften stool.
- Hydration: Drinking plenty of fluids.
- Topical treatments: Over-the-counter creams and suppositories containing hydrocortisone or witch hazel.
- Warm baths: Soaking the anal area in plain warm water for 10-15 minutes two to three times a day.
- Pain relief: Oral pain relievers such as acetaminophen, ibuprofen, or aspirin.
Medical Procedures:
- Minimally Invasive Procedures: Rubber band ligation, sclerotherapy, or coagulation (infrared, laser, or bipolar).
- Surgical Procedures: Hemorrhoidectomy (surgical removal of hemorrhoids) or hemorrhoid stapling.