What Should You Know About Hemorrhoids
What are hemorrhoids?
Hemorrhoids are blood vessels located in the smooth muscles of the walls of the rectum and anus. They are a normal part of the anatomy and are located at the junction where small arteries merge into veins. They are cushioned by smooth muscles and connective tissue and are classified by where they are located in relationship to the pectinate line, the dividing point between the upper 2/3 and lower 1/3 of the anus. This is an important anatomic distinction because of the type of cells that line hemorrhoid, and the nerves that provide sensation.
What are the internal and external hemorrhoids?
Internal hemorrhoids are located above the pectinate line and are covered with cells that are the same as those that line the rest of the intestines. External hemorrhoids arise below the line and are covered with cells that resemble skin.
What are the symptoms of hemorrhoids?
Hemorrhoids become an issue only when they begin to swell, causing itching, pain, and/or bleeding.
What Are Grade 4 Hemorrhoids
Understanding hemorrhoids are to know and learn about what they are. Everyone has hemorrhoids, in actuality, and hemorrhoids are the rectal veins and blood vessels located outside the rectum, and inside of it.
Internal hemorrhoids are measured in grades. This type of hemorrhoid can attract specific complications, mainly a prolapse. A prolapse is slowly occurring, and in most cases of internal hemorrhoids, the prolapse is not a factor , or is relatively mild and can be treated easily by rubber band ligation .
Grade 4 hemorrhoids are described as irreducible piles, which have entirely prolapsed outside of the rectum. At this stage, non-operative procedures are not considered, and instead, doctors opt for an invasive surgical treatment approach.
Visibly, Grade 4 hemorrhoids can be seen protruding from the anal opening. They may look like a mixture of blood and flesh-colored lumps, swollen and coated in mucus. You may have a few clusters of prolapsed internal hemorrhoids protruding from the anal opening at once.
Unlike hemorrhoids categorized in Grades 1-3, Grade 4 hemorrhoids can no longer be pushed back inside of the rectum. Grade 4 hemorrhoids will need to be removed entirely from a type of surgical procedure.
Medical Procedures For Hemorrhoids That Wont Go Away
If hemorrhoids don’t go away with home treatments, medical procedures may be necessary.
If you visit your doctor with painful external hemorrhoids those located around the outside of the anus that are visible from the outside your doctor may offer to excise them during the office visit. You will be given a shot with a local anesthetic to numb the area before the procedure.
Doctor’s office procedures for internal hemorrhoids those located inside the rectum may include:
Rubber Band Ligation This is the most commonly performed hemorrhoid procedure in the United States. In this procedure, which can be used for grades 1, 2, and 3 internal hemorrhoids , the doctor places a small rubber band around the base of the hemorrhoid, which can be done when your doctor performs an anoscopy examination to better visualize the hemorrhoids. The rubber band cuts off the hemorrhoid’s blood supply.
The procedure typically causes the hemorrhoid to shrink and fall off within about a week, though several short visits to your doctor may be necessary to completely get rid of the hemorrhoid. Minor bleeding and a feeling of pressure may occur, but this can usually be alleviated with OTC pain relievers. This procedure is not associated with significant recovery time.
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Severe Hemorrhoids Vs Mild Hemorrhoids: Stages
Many physicians use a grading system to categorize hemorrhoids along four stages:
- First-degree hemorrhoids: Hemorrhoids that bleed, but do not prolapse. These are slightly enlarged hemorrhoids, but they do not protrude outside the anus.
- Second-degree hemorrhoids: Hemorrhoids that prolapse and retract on their own . These may come out of the anus during certain activities like passing stool, and then return back inside the body.
- Third-degree hemorrhoids: Hemorrhoids that prolapse and must be pushed back in by a finger.
- Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be pushed back in the anal canal. Fourth-degree hemorrhoids also include hemorrhoids that are thrombosed or that pull much of the lining of the rectum through the anus.
Consume More Fiber To Prevent Constipation And Straining
Its important to consume enough fiber to help get rid of hemorrhoids faster. Fiber helps relieve and prevent constipation which is a known cause of piles.
Research published in The Permanente Journal on treating hemorrhoids without surgery found that eating more fiber is essential. Scientists recommend to consume 30-35 grams of fiber a day to help treat hemorrhoids naturally. You can consume more fiber by increasing the amount of beans, vegetables, fruits, and whole grains in your diet.9
Along with increasing fiber intake to relieve hemorrhoid discomfort, you should drink enough water to reduce constipation.
You can also consume psyllium as it helps to prevent constipation and relieve the pain from enlarged hemorrhoids. Dr. Herman Villalba who has researched remedies for hemorrhoids, recommends using psyllium as a natural hemorrhoid reliever. The increased fiber in psyllium bulks up stool and softens them to prevent straining during a bowel movement.9
Fiber is a natural laxative
Fiber is also one of the best natural laxatives. A 2005 review of 7 randomized trials found that fiber has a laxative effects and it help treat painful hemorrhoids. Some studies suggest that fiber can help reduce, pain, itching and bleeding associated with hemorrhoids.17
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How Do I Know I Have Grade 1 Hemorrhoids
Grade 1 Hemorrhoids may also develop some symptoms like itching, small lumps, and also itching. Since its hard to notice, physicians diagnose them by taking physical examinations or the history of your symptoms.
When doctors talk about symptom history taking, they connect a series of your past symptoms and diagnose the grade of your hemorrhoids and their existence. The focused history of symptoms includes long-term constipation, constant straining to poop along with having hard bowel movements.
Conservative Treatments For Hemorrhoidal Disease
Studies have shown that more than 80 percent of patients will require no surgical intervention for hemorrhoidal disease if conservative measures are followed appropriately, which is why we begin there.
1. Typically, the first step is to measure fiber intake.
Does the patient get 20 to 30 grams of fiber per day? Fiber is needed to bind the stool, bulk it up, and soften it. Foods rich in fiber include avocados, beans, fruits , and vegetables . If the patient does not get enough fiber, it is important to consider dietary changes and add a supplement. Not all fiber supplements work the same, so it is important try different brands or types. For example, Metamucil gets mixed with a full glass of water and requires eight additional glasses of water a day. If the patient is not a regular water drinker, fiber gummies are a good alternative. The goal is for a patient to have a soft, easy-to-pass stool . Patients can start with one fiber gummy a day and work up to five safely to achieve the desired outcome. Benefiber, another viable option, can be mixed with other foods such as mashed potatoes or even soup.
As mentioned before, fiber without enough water may cause constipation, so consider the patients medical history and fluid volume. Fiber supplements can also cause a patient to bloat and have increased gas, but these symptoms tend to subside after a week of therapy while the body adjusts to it.
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Hemorrhoids In Immunocompromised Patients
In general any intervention or operation should be avoided, or performed with a careful consideration in immunocompromised patients because of an increases risk of anorectal sepsis and poor tissue healing in such cases. A conservative measure is the mainstay for the treatment of hemorrhoids in this group of patients. If required, injection sclerotherapy appeared to be a better and safer alternative to banding and hemorrhoidectomy for treating bleeding hemorrhoids. Antibiotic prophylaxis is always given before performing any intervention, even a minor office-based procedure, due to the possibility of bacteremia.
How Is Banding Used To Treat Grade 3 Hemorrhoids
Although banding is more often used for less significant hemorrhoids, i.e. level 1 and 2 hemorrhoids, some grade 3 hemorrhoids can be treated through a banding procedure, called rubber band ligation. In this procedure, a small rubber band is slipped over the hemorrhoid. It restricts blood flow to the tissue, so the hemorrhoid withers and falls off.
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Aloe Vera For Hemorrhoid Pain Relief
Aloe vera is a well-studied natural remedy to alleviate many irritating skin problems. You can also use aloe vera as a natural remedy for hemorrhoids by applying it to your anal area. Aloe vera helps to relieve irritation and also helps pass stool with less pain.
Many scientific studies have shown that aloe vera can help to relieve anal pain and hemorrhoids. For example, a 2018 review of many studies into natural treatments for hemorrhoids revealed that aloe vera has great potential when used as a home remedy for hemorrhoids.5
The results of a double-blind clinical trial on a cream for hemorrhoids containing aloe vera also found that it is effective for anal fissure pain.6
You can also use a mixture of coconut oil and aloe vera to cure external hemorrhoids. Please read this article on how to combine aloe vera and coconut oil to make your own lotion.
Peppermint Oil To Soothe Hemorrhoid Pain
Peppermint oil has a high menthol content that produces a cooling and refreshing sensation when applied to the hemorrhoids.
The European Journal of Dentistry reported that peppermint essential oil can have a cooling effect on hemorrhoids.11
You can use a blend of peppermint oil and coconut oil to help get rid of hemorrhoid pain fast.
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Signs & Symptoms Of Thrombosed Hemorrhoids
Thrombosed hemorrhoids are internal or external hemorrhoids in which a blood clot has developed. Symptoms that accompany a thrombosed hemorrhoid are often more severe than normal and can include intense itching, burning, pain, redness, and swelling. The area around the hemorrhoid may also take on a bluish color. Quick treatment of thrombosed hemorrhoids is necessary to prevent loss of blood supply and damage to the surrounding tissue.
How Is A Prolapsed Hemorrhoid Diagnosed
A prolapsed hemorrhoid may be easily visible during a doctors examination. They may also perform a digital exam.
During a digital exam, the doctor will insert a gloved, lubricated finger into your anus and up into the rectum to feel for hemorrhoids.
Internal hemorrhoids are graded based on the degree of prolapse:
|Internal hemorrhoid grade|
You may not need treatment from a doctor. There are several things you can do at home to relieve symptoms while the hemorrhoids swelling subsides:
- Try over-the-counter hemorrhoid products, such as topical ointments or suppositories that contain hydrocortisone.
- Eat more high-fiber foods, such as fruits, vegetables and whole grains, that can soften stool and ease straining during bowel movements.
- Soak in a warm bath for 10 or 15 minutes.
- Use a moist towelette or a similar damp wipe after a bowel movement, but make sure it doesnt contain alcohol or perfumes.
- Use ice packs around the hemorrhoid to reduce swelling.
If home care doesnt work and the hemorrhoid is bleeding or painful, a few treatment options are available. Treatment will depend on the type and grade of the prolapsed hemorrhoid.
Treatment options for prolapsed hemorrhoids are generally the same as treatments for other types of hemorrhoids.
Fewer than 10 percent of all hemorrhoid cases are treated surgically. Instead, your doctor will first consider less invasive treatments for prolapsed hemorrhoids.
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Whom Do Hemorrhoids Affect
Although most people think hemorrhoids are abnormal, almost everyone has them. Hemorrhoids help control bowel movements. Hemorrhoids cause problems and can be considered abnormal or a disease only when the hemorrhoidal clumps of vessels enlarge.
Hemorrhoids occur in almost everyone, and an estimated 75% of people will experience enlarged hemorrhoids at some point. However only about 4% will go to a doctor because of hemorrhoid problems. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.
Clearing Up Confusion About Hemorrhoidal Disease
Hemorrhoidal disease is a topic many people will have to address at some point in their lives. Conservative management may be the most powerful tool to treat symptomatic internal hemorrhoids. Management includes keeping stools soft through fiber rich foods, a fiber supplement, avoiding straining while defecating, not sitting on the commode more than five minutes at a time, increasing physical activity, and drinking 64 oz of water per day or more .
After three months of conservative measures, if the patient is continuing to experience hemorrhoidal disease symptoms, it could be time to consider rubber band ligation or a hemorrhoidectomy.
If you have questions about hemorrhoidal disease or would like to speak with a colorectal specialist, please call or request and appointment online.
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When To Seek Help
If you have symptoms of a prolapsed hemorrhoid, see a doctor.
Sometimes the hemorrhoid may retreat away from the skin on its own and not cause any more symptoms.
But if pain, itching and bleeding persist, see a primary care physician, proctologist , or gastroenterologist .
If you feel a lump around your anus, even if there are no other symptoms, you should see a doctor. You want to make sure that lump is actually a hemorrhoid and not a tumor or other health concern.
Symptoms Of Grade 4 Hemorrhoids
The symptoms are the most severe in grade 4 hemorrhoids cases and they sure are dangerous. From severe levels of bleeding sessions to unbearable pain that literally makes it hard for you to sit is one of the most obvious symptoms.
Rectal bleeding can be pretty bizarre in these cases and you can notice them dripping in your toilet bowl while passing stool. It is also present on your toilet paper right after wiping.
But another notable thing you may experience is besides blood from your stool, you might also notice a large discharge of mucus.
Other symptoms include severe discomforts like irritation, itching, stinging, or burning sensation around your anus. Another most visible symptom is seeing hemorrhoid protruding right from your anal canal to the outside.
Thats because in grade 4 hemorrhoids, your hemorrhoids are permanently prolapsed and there is no going back except to reduce your hemorrhoids manually by a physician or .
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Best Prolapsed Hemorrhoid Surgery Options
There are surgical options available to treat grade IV prolapsed hemorrhoids. When prolapsed hemorrhoids cannot be manually pushed back into place, surgery is often needed.
Minimally invasive options are available to treat prolapsed hemorrhoids. These can be done at a doctors office and involve cutting off the blood supply to your hemorrhoid to rid you of the problem. The most common is the rubber band ligation.
In severe cases, surgery under anesthesia may be necessary. The most common surgery to treat prolapsed internal hemorrhoids is the hemorrhoidopexy. This is commonly referred to as stapling.
Performed in a hospital, hemorrhoidopexy is also referred to as a procedure for prolapse and hemorrhoids . During the surgery, a medical-grade stapler is used to attach the prolapsed hemorrhoidal tissue in place on your rectal wall.
The blood flow is cut off to the hemorrhoids and your anal tissue will shrink back into place. This surgical procedure has a high success rate and is less painful than other hemorrhoid surgeries, like the hemorrhoidectomy.
Is Grade 4 Hemorrhoid Surgery Safe
The most challenging aspect in Grade 4 hemorrhoids is that at this point, the condition has eliminated other means of treatment. Usually, in milder cases of hemorrhoids, rubber band ligation is considered after doctors advise a change of diet, first. Band ligation is a non-operative therapy.
For hemorrhoids that are Grades 1-3, non-operative treatments are considered first, but for Grade 4 hemorrhoids, a hemorrhoidectomy is needed. The complications following this intensive ad invasive surgery is higher than that of the rubber band ligation treatment.
However, the chances of hemorrhoids becoming a reoccurring issue following a hemorrhoidectomy are proven to be low.
Side effects of a hemorrhoid surgery are:
- Inability to urinate or pass stools
- Bladder or bowel incontinence
If you have had hemorrhoid surgery and are experiencing any of these side effects, then you should tell your doctor immediately. The sooner you communicate with your doctor, the less of a risk that these side effects will procure worse complications.
Surgeries can be useful if you also work on your toilet habits and your diet. Your doctor will ask you to meet a daily-required intake of fiber and to strive to have softer stools that are less stressful for your body to pass.
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Can Natural Home Remedies Treat And Prevent Hemorrhoids
Regardless of the size or swelling of a hemorrhoid, no treatment is required if symptoms do not exist. Prevention is perhaps the most effective treatment. Diet and adequate hydration are very important to maintain normal bowel movements. Hemorrhoid symptoms can occur with the passage of hard stool and constipation, as well as diarrhea and frequent bowel movements. People with constipation may require a high-fiber diet, adequate hydration, and stool softeners. Those with too frequent bowel movements may require antidiarrheal medications and diet adjustments. These preventive measures decrease the amount of straining that is required to have a bowel movement, thus decreasing the pressure within the blood vessels to prevent swelling. The internal hemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm.
Grade 1 hemorrhoids are treated symptomatically. There can be some spasm of the anal muscles. Warm sitz baths, sitting in a warm tub for 20 minutes, two or three times a day may be helpful. Avoiding spicy food may also prevent anal itching. Over-the-counter medications may be helpful.