Hemorrhoids are varicose veins in the anal area, i.e. veins that become distended for a variety of reasons including age, pregnancy, constipation, maybe prolonged sitting, and others that are not understood. They can occur internally in the rectum, or externally around the anus. Hemorrhoids cause symptoms if they develop clots (become “thrombosed”), or if internal ones prolapse to the outside.
Symptoms of external hemorrhoids include itching, slight bleeding, and pain if thrombosed. Internal hemorrhoids can bleed, but otherwise aren’t felt unless they prolapse. Bleeding from hemorrhoids is only severe in the rarest of cases.
Diagnosis is easy. We can see external hemorrhoids by simply looking; internal ones can be seen by an anoscope, a simple instrument inserted in the anus that can reach a few inches up the rectum. Exam takes a minute, is done in a clinic, and requires no anesthesia since it’s painless (unless there’s an Anal Fissure, implying a wrong diagnosis).
Patients might confuse various conditions for hemorrhoids, since they may not have thought or heard of them (see pictures below). They include:
- Anal Fissures
- Simple skin tags that are meaningless & don’t cause symptoms, unless they get feces stuck on them, which will itch
- Anal STDs from anal sex, especially Warts (tag-like structure with a cauliflower appearance), also herpes and others.
- Rectal prolapse, uncommon, when the rectum gets pushed to the outside from straining, can usually be eased back in, but may require surgery
- Anal cancer (very rare; mostly only among those with HIV)
- Abscesses, requiring antibiotics and often surgical drainage
- Anal Fistula: a false passage from the bowel to the outside, suggesting Crohn Disease.
Treatment aims at avoiding constipation, often by softening stools (even if they’re not hard), but avoiding anything that might cause diarrhea. Sitz baths are a mainstay: patients should sit in warm water for 5-10 minutes, at least a few times a day, even every hour if they feel like it. They shouldn’t fill a bathtub, because the aim is to only immerse the anus, to concentrate the heat there (this draws blood to the area, to facilitate healing). Extreme cases require surgery.