Internal Hemorrhoids

Hemorrhoids (often described as “varicose veins of the anus and rectum”) are inflamed, bulging veins in and near the anus and rectum. There are two types: internal hemorrhoids (inside), which develop below the lining of the lower rectum, and external hemorrhoids (outside) which develop beneath the skin around the anus.

Some research estimates that 75% of people will experience some degree of hemorrhoids during their lifetime. Hemorrhoids affect both men and women, and while most cases are present in those between 45 and 65 years of age, hemorrhoids can affect people of all ages.

Internal hemorrhoids are classified in grades by their degree of prolapse (internal tissue that protrudes from the anal opening to the outside of the anus and can be seen/felt during a bowel movement or when cleaning/wiping):

• Grade I – No prolapse;
• Grade II – Prolapse spontaneously reverts back inside the anus;
• Grade III – Prolapse can be gently pushed back inside the anus by the patient;
• Grade IV – Prolapse cannot be pushed back inside the anus by the patient as it is too painful.

Causes and Risk Factors
Hemorrhoids can be caused by increased pressure in the abdomen which causes veins near the anus and rectum to swell. This kind of pressure can be caused by:

• Chronic constipation or diarrhea;
• Straining during defecation (this may cause a prolapsed hemorrhoid);
• Pregnancy and childbirth;
• Irregular bowel movement patterns;
• Sitting on the toilet for long periods;
• Obesity;
• Low-fiber diet;
• Anal intercourse.

Symptoms
The symptoms of internal hemorrhoids vary from person-to-person, but most commonly include rectal bleeding (typically painless) and protrusion of the hemorrhoid during bowel movements. If completely prolapsed, hemorrhoids can cause severe pain and often cannot be pushed back inside by the patient.

In addition to prolapsed hemorrhoidal tissue, a person may also experience:

• Bleeding after a bowel movement (bright red blood may be found on toilet paper, dripping into the toilet, or within the stool);
• Significant anal itching and irritation;
• Discomfort (feeling of stool being “stuck” at the anus);
• Leakage of feces;
• Mucous discharge.

Prevention
Regulating bowel movements through a diet containing fiber-rich foods, a fiber supplement and/or increased fluids will likely be recommended along with regular exercise to prevent constipation and straining, and also to reduce pressure on the veins near the rectum. Stool softeners may also be recommended for these purposes. You can also reduce pressure on the veins by avoiding long periods of standing and sitting (including on the toilet).

Refrain from straining or holding your breath when having a bowel movement to reduce pressure in the veins. Going to the washroom when you feel the urge can also help to reduce the need for straining.

Treatment
Hemorrhoids are not life-threatening, but can reoccur repeatedly if the underlying cause is not treated. Symptoms typically subside within a few days without medical intervention; however, oral and topical medications such as pills, suppositories, creams or gels can be used to help alleviate some of the pain and discomfort. Soaking in sitz baths after a bowel movement may also help to reduce pain. It is recommended to use moist toilettes or toilet paper (perfume and alcohol free) to prevent further irritation from occurring when cleaning the anal area.

For severe cases, internal hemorrhoids may require in-office or surgical therapies, including:

• Rubber-Band Ligation (for grade III hemorrhoids);
• Infrared Coagulation (IRC);
• Sclerotherapy;
• Hemorrhoidectomy (surgical removal of hemorrhoids).

Surgical removal of hemorrhoids will only be considered in very severe cases when other treatment options have failed.

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