In today’s society, anorectal diseases have emerged as a quite common occurrence with progressive nature. Hemorrhoid is an ailment that affects all economic groups of the population including the young bracelet chain. Hemorrhoids are the veins in the anal canal and lower part of the rectum exhibiting normal anatomy. It’s when they become swollen and inflamed and turn into hemorrhoidal disease. They usually occur as a result of a sedentary lifestyle, altered dietary pattern, altered lifestyle, irregular bowel habits, low fiber diet, genetics, and pregnancy.
Hemorrhoids are categorized according to their origin relative to the dentate line (anatomical structure), which is typically located about 3 to 4 cm proximal to the anal verge.
There are two types of hemorrhoids:
1: Internal hemorrhoids:
These are found in the rectum at the lowest part of the large intestines and usually aren’t painful but may cause bleeding that shows up in the stool while wiping or in the toilet paper.
Internal hemorrhoids usually are left unnoticed, but may show the following symptoms:
- painless rectal bleeding as a sole sign.
- Irritation around the anal area.
- Straining during defecation with blood streaks in stools.
- After a long time when its size increases and protrudes outside the anal opening which can be pushed back inside the rectum manually.
2: External hemorrhoids:
These are located under the skin around the anus and can form a small, hard bulge there causing bleeding, painful swelling, and itching.
External hemorrhoids are way more common and frequently exhibit symptoms such as;
- Irritation and pain around the anus.
- Burning sensation around anal verge.
- Difficult in sitting with an uncomfortable feeling.
- A painful or irritated lump or a swollen area close to the anal verge.
- Blood on toilet tissue once wiping or in the toilet pot.
- Leaking stool once not attempting to own a bowel movement
Getting a detailed review of the signs and symptoms of the hemorrhoids, for its better prevention and early management.
Symptoms of Piles or Hemorrhoids
Following clinical manifestations are usually observed when having hemorrhoidal disease:
- Anal itching:
Anal itching due to swelling around the anus and seep mucus discharge, irritating the anal area.
- Irritation & discomfort:
Anal irritation & discomfort resulted from the urge to pass stool right after having a bowel movement. This uncomfortable feeling is caused by the bulging of hemorrhoids in the end portion of the large intestine or anal canal.
- Pain around the anal region:
This happens during prolonged straining can be due to both constipation and diarrhea, thus increasing the chance of inflaming the hemorrhoidal veins in and around the anus.
- Pain during bowel movements
- Hemorrhoids are usually painless.
- If pain is there, it marks the severity of the disease with other complications too.
- Large hemorrhoids bulging in and out from the anus might become painful if they are squeezed by the surrounding muscles that control the anus.
- Anal pain: Anal pain is not characteristic of hemorrhoids unless there is associated with thrombosis or other complications. Pain occurs due to the involvement of external hemorrhoidal plexus, over-stretching of skin, congestion, or associated acute anal lesions such as fissure in ano or an anal abscess.
- Discharge & pruritus: Generally, the mucus discharge is observed in permanently prolapsed hemorrhoids, which softens and excoriated the skin around the anal area.
- Constant mucus discharge from the anus with or without bleeding
- The mucous discharge is due to the engorged mucous membranes
Signs of Piles or Hemorrhoids
The following clinical prognostic signs are the indication of a hemorrhoidal condition:
- Lumps near the anus:
Lumps are formed when the anal area is either irritated by overstraining during defecation or itched and scratched vigorously causing a sore that gets inflamed and swelled up.
- It can be sensitive or painful because of nerve endings.
- Protrusion with spontaneous or self digital reduction is the main characteristic sign of hemorrhoids.
- Rectal bleeding:
After defecation or passing stools, if even a small amount of bright red to dark shade blood is noticed either in the toilet paper or toilet pot, that is rectal bleeding. Blood is usually the sole sign and symptom that an individual has interior hemorrhoids.
- A most common and earliest symptom
- Dripping in the toilet or seen on wiping after the defecation
- Bright red painless bleeding, especially at the end of defaecation may appear as streaks on toilet paper adhering to the fecal residue, or it may be a slow trickle for a short while following bowel movements.
- In the early stage, a steady drip of drip after defecation is observed.
- Rectal bleeding can lead to rectal pain, dizziness, fainting, and even anemia at a later stage.
- In the later stage, when hemorrhoids get more worsened, bleeding occurs even without defecation
Prolapsed piles are protruding mass that extends out of the anus on straining during defecation which usually disappears spontaneously. Prolapse is mainly characterized as:
- A later stage symptom.
- Prolapsed pile mass can be replaced digitally into the anal canal in the initial stage.
- In an advanced condition, the presence of the protruding mass in the anal region even without straining.
- Discomfort during sneezing, coughing, walking, lifting weights, and passing of flatus, leading permanently to the prolapsed pile stage.
Anemia is a lack of red blood cells or hemoglobin which is usually ignored with manifesting symptoms like fatigue, weakness, shortness of breath, dizziness, a tingling feeling in the legs due to blood loss from hemorrhoids in severe cases.
- Due to the long-standing stage of hemorrhoids leading to persistent and profuse bleeding.
- If anemia is severe, one feels more exertion, dizziness, pallor, and lethargy.
Grading of Hemorrhoids
The grading of hemorrhoids as per their clinical symptoms and position of mass or tag readily helps in choosing a treatment approach and also aids in comparing therapeutic outcomes among them. On the basis of their location and degree of prolapse, the classification of hemorrhoids is as follows:
- Grade 1 Piles:
Hemorrhoids are not bulging out, with painless bleeding as they are very small in size and lie inside the rectum. In some cases, they do increase in size and get converted into grade 2 piles.
- Grade 2 Piles:
Bulging out, but spontaneously regresses which means the piles are larger in size and sometimes it comes outside during passing the stools but goes back again itself after pressure is released.
- Grade 3 Piles:
Bulges out and need to be returned digitally or manual reduction by the patient i.e. piles are hanging outside from the anus while passing the stools and have to be inserted back with fingers.
- Grade 4 Piles:
Permanently bulge or prolapsed and can’t be returned digitally i.e. piles are permanently hanging out from the anal verge and can’t be pushed back inside.
‘All disease begins in the gut’ quote by Hippocrates defines the real cause of irregular bowel movements. There are various alternative treatments available to prevent and treat piles along with a healthy dietary and lifestyle regime, hemorrhoids can be treated effectively.