Hemorrhoids are large and very painful clusters of blood vessels located in the rectal area.
Hemorrhoids are very common in industrialized countries. The first symptoms typically appear in the early 20’s of a person’s life, but these symptoms of hemorrhoids are not clear until the 40’s.
According to some estimation, approximately 70% of the population from their 50’s onwards suffers to some extent from symptomatic hemorrhoids. Females suffer from hemorrhoids more frequently than males. One of the assumptions is that pregnancy and delivery produce increased pressure on the rectal and anal areas. Hemorrhoids are divided into two main groups: External Hemorrhoids (a bulge on the side of anus) and Internal Hemorrhoids (in the lower part of the rectum). Many patients suffer from pain caused by anal fissure which in turn is caused by hemorrhoids.
There is an intricate system of veins in the rectal and anal areas that are supposed to drain blood from the area. The factors increasing vein congestion are usually those increasing the pressure, such as increased intra-abdominal pressure or exertion during defecation. Prolonged sitting may also accelerate the formation of hemorrhoids.
Increased intra-abdominal pressure can be caused by the following factors:» Exertion during defecation usually caused by constipation.
» During Pregnancy – blood volume increases, while Progesterone weakens muscles, the uterus is heavyand there is pressure on the lower vena cava while lying on the back.
» Portal hypertension drains the hemorrhoids and can be caused by cirrhosis.
» Coughing and vomiting increase intra-abdominal pressure producing pressure on veins where the blood pressure is usually very low, stopping the flow.
» Strenuous physical activity.
» Psychological stress can also awaken hemorrhoids.
» Severe cardiac insufficiency can worsen hemorrhoids because of blood vessels’ problems and problems in venous blood drainage.
There are four main phases of hemorrhoids, as follows:1. Internal hemorrhoids – which are not directly felt.
2. Coming out during defecation and retracting unaided.
3. Coming out and not retracting, have to be thrust inside.
4. Those that come out and cannot be returned.
Each phase can be accompanied with bleeding. Pain is especially acute in the last phase.
Internal hemorrhoids form above the anal-rectal line. Sometimes internal hemorrhoids may grow to a degree till they pass the vein which is under the anal sphincter.