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Causes, Diagnosis and Treatment of Symptomatic Hemorrhoids

Hemorrhoids, often known as piles, are bulging veins in the anus and lower rectum. You may feel or notice small round lumps on your anus when they are hanging outside the anal canal. This "cushioning" helps us maintain continence by allowing us to pass motion without leaking faeces. But we detect them only when there is bleeding, pain, prolapse, or discharge. They may bleed, or slip out of place during bowel movements. Hemorrhoids are very common and affect one in every three Singaporeans, and can often disrupt a person’s everyday routine.


What are the types of hemorrhoids?


Internal: These form in the rectum and do not generally cause pain or discomfort. When strained, some may protrude out of the anal canal. The protruding hemorrhoids can be spontaneously returned, or physically forced back into the anal canal in moderate situations. In more acute cases however, these protruding hemorrhoids cannot be pushed back into the anal canal.

External: External hemorrhoids form around the anus and are distinguished by a lump at or surrounding it. They are not reducible and can cause pain, itching, and bleeding. They are susceptible to the formation of painful blood clots (thrombosis).


What causes hemorrhoids?

A variety of factors might lead to symptomatic hemorrhoids. These are frequently associated with any condition that raises intra-abdominal pressure, such as:

Persistent straining: When you sit for a long time on a toilet seat straining, this eventually increases pressure in your anus area, which causes the veins there to get engorged. The engorged vein (which is the hemorrhoid) can become painful, itchy, and sometimes bleed.


Pregnancy: Hemorrhoids seem to be very prevalent during pregnancy, especially in the third trimester, when the uterus expands and exerts pressure on the pelvis and veins surrounding the anus and rectum. The hormone progesterone, which rises during pregnancy, relaxes the walls of the veins, making them more prone to widening and causing hemorrhoid symptoms.

Inadequate fibre intake: Consuming a low-fibre diet may raise the risk of a person developing constipation. Constipation and straining irritates the rectum and anus veins, making passing stool difficult. If you do manage to pass stool, it's usually solid and compact – exacerbating the problem.

Obesity: Similar to pregnancy, having additional weight in the abdominal area puts much strain on your anal veins (similar to pregnancy), which puts people who are obese and overweight at a higher chance of developing hemorrhoid symptoms.

Genetics: Genetics could play a part in developing hemorrhoid symptoms - a visit to the doctor may warrant a question if anyone else in the family suffers from the condition, or if you are unsure about your symptoms. However, given how common the condition is, it is often difficult to estimate the correlation between genetics and symptomatic hemorrhoids.


How can we treat symptomatic hemorrhoids?


The treatment of symptoms is determined by the type and severity of a patient’s condition. Doctors often recommend and employ a variety of methods starting with conservative approaches like introducing lifestyle changes and non-surgical treatments before progressing to surgical treatments.

Hemorrhoid surgery is only required when symptoms persist after more conservative treatments have been employed.


How can we prevent Hemorrhoids?


Ultimately, the easiest technique to prevent hemorrhoids is to keep your faeces soft and formed, so that they can flow smoothly without much straining. You can attempt the following methods to alleviate hemorrhoid symptoms or prevent them from enlarging:

  • Pass a bowel as soon as you have the urge

  • To keep stools soft and formed, drink plenty of water and have an adequate intake of fibres in your daily diet

  • When passing stool, don’t strain or hold your breath, as this can increase the pressure in the rectum veins.

  • Eating a healthy diet filled with fibre can help to relieve, treat and even prevent symptomatic hemorrhoids.

  • As with most cases, if you are unsure about the symptoms that you are experiencing, it is always better to consult with your doctor.


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