Hemorrhoids

Hemorrhoids occur when the veins in the anus or lower rectum dilate and become inflamed, forming a network of varicose veins, known as hemorrhoidal plexuses.

There are two types of hemorrhoids based on their location:

• External hemorrhoids: They appear on the outside of the anus and are covered by skin, making it rare for them to bleed. When thrombosed, they appear purple or blue.
• Internal hemorrhoids: Also known as congestive internal hemorrhoids, they are located in the lower rectum and the inner part of the anus. They are prone to bleeding because they are only covered by mucosa, especially when they descend to the external area. There are four degrees:
• Grade I internal hemorrhoids: Small in size and cause itching but are generally not bothersome. They are not visible because they remain internal.
• Grade II internal hemorrhoids: Medium-sized and commonly bleed. They may prolapse (protrude) during defecation but reduce automatically.
• Grade III internal hemorrhoids: Itching, pain, and bleeding are common. Although prolapsed during bowel movements, they can be manually reintroduced without complications.
• Grade IV or prolapsed internal hemorrhoids: Large and often remain outside the anus. They cause itching, burning, pain, and bleeding.

In most cases, discomfort and hemorrhoids subside within a few days, and only symptom management is necessary. Only in more severe cases, typically grades III and IV, does treatment become more complex.

Symptoms

It is common for hemorrhoids, especially internal ones, to go unnoticed until symptoms appear. The most common symptoms include:

• Blood in the stool (hematochezia)
• Bleeding after defecation
• Itching in the anus
• Pain, especially during defecation
• Irritation

Causes

The primary cause of hemorrhoids is increased pressure in the rectum, which causes blood vessels to stretch and inflame. This pressure increase may be due to:

• Constipation, especially excessive straining during bowel movements
• Chronic diarrhea
• Pregnancy
• Spending prolonged periods sitting
• Lifting heavy weights

Risk Factors

Some factors that increase the risk of developing hemorrhoids include:

• Aging, as tissues weaken
• Pregnancy, due to increased pressure on the anus
• Irregular bowel movements
• Excessive straining during defecation

Complications

The main complication is the formation of blood clots in the skin covering hemorrhoids. This condition, called thrombosed hemorrhoids, is very painful but not serious and does not pose a health risk.

Prevention

Hemorrhoids can be prevented by adopting the following habits, which also help alleviate symptoms once they occur:

• Eat a high-fiber diet
• Drink plenty of water
• Exercise regularly
• Avoid sitting for prolonged periods, especially on the toilet

Which doctor treats hemorrhoids?

Specialists in digestive system disorders, as well as general practitioners, diagnose and treat hemorrhoids. In more severe cases, such as thrombosed hemorrhoids, proctologists (specialists in general surgery) are involved.