Hemorrhoids, a condition where the rectal and anal veins weaken and distend because of impaired venous blood flow, can cause one or more layers of the rectum to protrude or stick out through the anus. This condition is termed a prolapse. Although the occurrence of this condition and hemorrhoids does not occur frequently, the protrusion of the rectum necessitates a physician consultation. Prolapse associated with hemorrhoid development usually occurs in cases of prolonged rectal and anal venous swelling. Moreover, it was found that the incidence of rectal prolapse is higher in larger internal hemorrhoids.

One kind of lump – you could deal with it. But having two types of lumps? That’s a different story! There is nothing more distressing and embarrassing than to find more than one lump or swelling sticking out of your anus. Moreover, since both conditions can occur in the same area, how can you possibly know which is which? In the succeeding parts, prolapse is further discussed to give you a clearer idea about this condition.

Rectal prolapse, as mentioned, is the protrusion of the rectum wall outside the anus. In this condition, one portion of the rectum telescopes into its immediate adjacent segment, the anus.

The exact cause of prolapse is not completely understood. It is likely that the prolapse is a multifactorial disease, meaning, it is brought about by the interplay of many causes. It is associated with:

• pinworm and whipworm infections
• malnutrition
• malabsorption
• cystic fibrosis
• anal trauma
• constipation

Prolapse is manifested by rectum protrusion during walking or moving a bowel. A sensation of rectal fullness is also commonly reported with a feeling of incomplete bowel evacuation and rectal incontinence.

Prolapse commonly coexists with hemorrhoids – the hemorrhoids do not cause the protrusion of the rectum.

One possible explanation for their coexistence is that both conditions are associated to constant straining that could cause the weakening of the muscles that support the positioning of the rectum. Though they have the same signs and symptoms, they are two separate medical conditions. Prolapse affects a segment of the large intestine above the anus, whereas, hemorrhoids occur in the area near the anal ring. The diagnosis of rectal prolapse is determined by the medical history, manifestations and visual examination of the rectum.

In normal anatomy, the rectum is the located in the latter portion of the large intestine. More specifically, it is located above the anal canal. Through the muscles and ligaments, the rectum is securely fixed and properly positioned. But it in cases where the muscles and ligaments weaken, the rectum’s attachment to the body is also compromised.

During its early stage, the rectum is still attached to the body, but because the connection is not strong as before, the inner lining of the rectum mucosa protrudes from the anus. As the rectum mucosa gets more prolapsed, the ligaments and muscles continue to weaken, which subsequently result in the protrusion of the entire wall of the rectum.

If you have a hemorrhoid with concurrent rectal prolapse, it’s a little assuring to know that complete prolapse of the rectum rarely occurs in hemorrhoids.

The occurrence of hemorrhoids is brought about by various conditions and risk factors, but all converge into one crucial consequence: the impairment of the venous return from the anal canal. As the venous blood flow is increasingly impeded, the pressure in the blood vessels builds up, bulging and weakening the rectal walls – and from there, the hemorrhoid is born!

A thrombosed external hemorrhoid is not actually considered a true hemorrhoid. A rapid increase in venous pressure in the rectum caused by heavy lifting, coughing or straining can rupture an external hemorrhoidal vein. This subsequently results in pooling of the blood and formation blood clot underneath the skin. Because of this, it appears as a red to deep blue hematoma, which is the most distinguishing characteristic of this hemorrhoid type. The severe pain of a thrombosed hemorrhoid is frequently attributed to the spasm of the anal internal sphincter. Moreover, itching, a burning sensation and swelling could accompany this condition.

Though these hemorrhoids are both humiliating and painful to patients, the good news is, it can be treated based on the intensity and the timing of the pain. Some hemorrhoids resolve on their own since the body has this ability to repair the damage. But it is essential to see your doctor right away.

Sitz baths, increased fiber intake and anti-inflammatory medications might do the trick but you have to understand that this certain hemorrhoid type necessitates proper treatment and management, prescribed by your physician. In some cases, the physician might recommend an immediate excision within the first 72 hours after the onset of severe pain.

With severe pain, a surgical excision of the entire hematoma is done using a local anesthesia. This is the most effective and quickest way to control your pain. If the hemorrhoid is prolonged and not appropriately treated, infections can set in. Once the bacteria gains access to the blood stream, it can be lethal.

There is no doubt that if you have a hemorrhoid, you won’t openly gossip about it to anyone – and that might also include your physician. These kind of hemorrhoids, when left untreated, can be life-threatening since it can infect your blood, affecting every major organ in your body. Enduring thrombosed hemorrhoids in exchange for your life is not worth it at all. So you’d better set aside those shy bones if you want to have a healthier life. Your physician knows what’s best for you. They are trained not to laugh at your condition but to treat and alleviate your pain.

They can cause a lot of pain simply because of the multitude number of pain-sensing nerves surrounding the anus. In addition, another factor that makes them more painful than an internal hemorrhoid is the placement of the former, which is in the part of the skin that is constantly moving and shifting as we walk, bend, squat or sit. This, in turn, aggravates the already inflamed haemorrhoid.

Like internal hemorrhoids, external hemorrhoids can be accompanied with itchiness and burning sensations, mainly due to the mucus excreted by the hemorrhoid as part of its healing process. That is why individuals with hemorrhoid frequently experience a leaky butt, though not all of them dare admit it!

It is a relief, though, that the leak is not caused by the rupturing of the walls of the rectal veins.

The burden does not end there. Unfortunately, an unrelenting and irritating burning sensation is also felt when mucus touches the cut part of hemorrhoid. It is the same kind of burning sensation that you feel when perspiration gets into your fresh open wound.

Upon anal inspection, an external pile appears as tensed grape-like mass of abnormal growth in view around the outer anal canal. Using the naked eye, it is sometimes difficult to differentiate between the two types of hemorrhoids, most especially when the internal hemorrhoid becomes prolapsed or protrudes out of the anus. But if a physician uses a protoscope he can visualize them more closely.

Internal hemorrhoids are covered by columnar mucosa of the skin, while external ones by squamous mucosa.

There are some cases that the walls of the rectal veins bulge and rip apart. Blood pools under the skin and then forms into a hard, painful lump. The lump appears to have black, blue or dark purple or deep red tint. This is because the mass becomes filled with clot. It also has a shiny appearance due to the stretching of the skin. This lump is called a thrombosed or clotted hemorrhoid.

This occurs when an external hemorrhoid becomes strangulated – meaning that its blood supply has been cut off. A thrombosed hemorrhoid is associated with increased swelling, and therefore, will generate more pain. The pain usually peaks after 48 to 72 hours, and then gradually goes away over 7 to 10 days.

It may bleed a little for a few days and may gradually shrink to become a small excess skin. This small area of excess skin is called a ‘skin tag’. Several skin tags can give the anus a ruffled appearance. Skin tags usually do not cause discomfort but they can make cleaning your bottom after bowel movement harder due to the added crease they create. Smaller fecal particles may get lodged between the creases.

It is important to note that it is possible that you may get both internal and external hemorrhoids all at the same time.

You can differentiate what type of hemorrhoid you have by knowing their location, description and the symptoms they produce. There are two types of hemorrhoids namely, internal and external hemorrhoids.

Internal hemorrhoids are hemorrhoids that are located inside the anus. They may lie far up inside the rectum, around 2 to 4 cm above the opening of the rectum so that you cannot see or feel them. They are usually painless due to few pain-sensing nerves in that location. This is also indicative that what you have is not severe.

Not so severe hemorrhoids may range from painless to producing mild discomfort, most especially when the stool accidentally brushes off with your hemorrhoid while defecating.

Usually, bleeding is the only sign that they do exist. Then, when you see a streak of bright red blood on the surface of your stool after defecating, you should suspect that you have internal piles, and that an appropriate consultation should be made.

Aside from bleeding, other signs of internal piles are itching and burning sensation of the anus and rectum. There is also the feeling of a need to defecate even after just finishing a round of painstaking bowel movement.

Internal hemorrhoids often are small swollen veins in the wall of the anal canal. They usually occur when the tissues supporting the veins in the anal canal weaken and get swollen, as tissues bulge into the anal canal.

These kinds of hemorrhoids can also be large, sagging veins that bulge out of the anus. When they protrude outside the anus, they can become very painful and irritated, most especially when squeezed by the anal muscles, most especially during the course of elimination.

When they protrude or get prolapsed , they are sometimes difficult to distinguish from external hemorrhoids. If the pain becomes severe, it may indicate that the blood supply to the hemorrhoids is severely reduced by the sphincter muscle of the anus, or worse has been totally cut off. At this point in time you can say that your hemorrhoids have gone bad! If this is the case, emergency treatment is highly recommended.

For treatment purposes, internal piles are graded according to their size and severity:

• Grade 1 shows a small swelling and located high up the anus. This is the common type and may enlarge further to grade 2 or higher
• Grade 2 is a hemorrhoid larger than grade 1. It may partly protrude the anus when you poop, but quickly ‘springs back’ inside again.
• Grade 3 protrudes from the anus, but can still be pushed back inside the anus with your finger.
• Grade 4 is often quite large and permanently protrudes from the anus and cannot be pushed back inside. This is the type that complicates into a thrombosed hemorrhoid.

Overall, even though internal hemorrhoids are not visible, painless and relatively harmless, it is a lot safer if you seek professional medical help, since bleeding is involved. You have to be 100% sure that the only cause of the bleeding is the presence of internal hemorrhoids and not some other existing disease.

The procedure is done together with colonoscopy under anesthetic. Colonoscopy is done to locate the hemorrhoids inside the rectum since they are high up your rectum and are not readily visible. A small instrument called a protoscope is used to insert a latex rubber band inside your rectum. The rubber band is then placed around the neck of the internal haemorrhoid to cut off its blood supply.

Pain here is bearable since the location of internal hemorrhoids is nowhere near pain-sensing nerves. This is also why an external hemorrhoid is not a candidate for rubber band ligation. It would be painful to do this to an external hemorrhoid because its location is near pain-sensing nerves.

You will also be asked by the surgeon whether the rubber bands feel too tight. If they are painful, a medicine may be injected into the banded hemorrhoid to numb them.

After manual strangulation of a hemorrhoid, it should shrink and fall off on its own within a few days. When the wound becomes dry, a scar will form in place. This scar is important for it will hold nearby veins and prevent them from bulging and forming into another hemorrhoid.

After 3 weeks, you’ll be re-assessed to determine how successful the procedure has been. Three weeks are allotted to give time for the manually strangulated hemorrhoid to shrink, fall off, bleed and the wound to dry off.

Bleeding may take about 10 days to stop. Because of this, it is not advisable to do the procedure if you are going to travel afterwards. Ample rest and proper cleaning is needed to avoid irritation and infection. Heavy lifting is avoided to avoid exacerbation and promote healing.

People respond differently to banding. Some are able to immediately resume to normal activities, except activities that involve lifting heavy objects, while others may take 2 to 3 days to recover.

The advantages of rubber band ligation over other treatment options are:

• no hospitalization is required
• minimal pain is felt
• shorter recovery period, therefore shorter time off from work.

It also has its disadvantages and limitations and they are:

• it may require more than one course of treatment to get rid of the hemorrhoid
• it is not applicable for treatment of external hemorrhoids
• success rate is only 60 to 80%

Rubber band ligation is the most common fixative procedure done to treat hemorrhoids. However, a variety of other surgical procedures may be an option. Each procedure has its own pros and cons to take into consideration. It is best to know all your options and study their details to be able to weigh and choose the best option for you.

There’s nothing more unnerving and distressing than having to endure all the signs and symptoms of hemorrhoids every single day. Worst, there’s no greater embarrassment than to have a hemorrhoid sticking out of your anus. It is definitely a physical and psychological torture!

Out of desperation, maybe you have considered to have a surgical procedure for their removal. Though it is a good option, the removal of hemorrhoids is usually the last resort to resolve the hemorrhoids.

Most hemorrhoids, usually the milder types, heal on their own. Moreover, some procedures that remove hemorrhoids, such as hemorrhoidectomy, are associated with significant pain. And for these reasons, conservative management is initially done to make the hemorrhoids go away. But if all else fails, hemorrhoid removal through surgical means could be the only feasible option for you. Before deciding on whether to have a hemorrhoid removal or not, it is important to know more about these so that you are able to make the possible preparations and readjustments in your lifestyle.

There are various ways on how to remove the hemorrhoid.

Hemorrhoid removal through the process of hemorrhoidectomy is usually indicated for individuals with internal hemorrhoids that bulge out from the anus during bowel movements and/or with hemorrhoids that seem to protrude out of the rectum at all times. Hemorrhoidectomy is also recommended to patients who have failed every nonoperative or conservative therapy that was prescribed and in those who display significant manifestations from external hemorrhoids, such as the formation of clots, or skin tags.

Chronic bleeding and anemia and painful external thrombosed hemorrhoids are also recommended for removal. The hemorrhoid is excised using a scalpel, a cautery or a laser. The latter uses an infrared beam to cauterize the tissues. Using a traditional scalpel, the removal of hemorrhoids is achieved by surgically excising the hemorrhoid tissue. The tissues are clamped, tied off and removed. A newer method called the stapled hemorrhoidectomy attempts to remove the hemorrhoid by excising a band of prolapsed anal tissue through the using of a stapling device. The band is pulled into the device, removing the excess tissue, as the remaining tissue is stapled back to its correct location.

Sclerotherapy is a technique that involves the injection of chemical irritants into the blood vessels surrounding the hemorrhoids to induce inflammation, formation of excess tissues and scarring. The entire technique results in the shrinkage and falling off the hemorrhoid.

Hemorrhoidolysis or Galvanic Electrotherapy causes the shrinkage of a hemorrhoid tissue by the application of a small probe of electrodes. The resulting electrolysis results in complete and shriveling and drying up of the hemorrhoids.

Rubber band ligation is the most commonly used technique used in the United States as it involves lesser pain and risks with a 60 to 80% success rate. This procedure removes the hemorrhoid by tying up a small elastic band around the internal hemorrhoid, cutting off its blood supply. The hemorrhoid dries up, shrinks and falls off a few days after the procedure, in about a week. Bleeding ensues after the hemorrhoid falls off but it spontaneously resolves by itself. Only one or two hemorrhoids are removed at a time but the banding can be redone after 4 to 6 weeks.

Hemorrhoidectomy is appropriate when you have the following:

• very large internal hemorrhoids, internal hemorrhoids that still cause problems after fixative procedures
• large external hemorrhoids that cause significant discomfort and pain
• both internal and external hemorrhoids
• had other treatments for hemorrhoids that have failed

Like any other surgical procedure, hemorrhoidectomy has its own risks. Pain, bleeding, and urinary retention are the most common side effects. The least common risks are divided into early problems or abnormalities that occur a few days after the surgery and late problems – those that occur months after the surgery.

Early problems are as follows:

• bleeding from the anal area
• hematoma or collection of blood in the surgical area
• incontinence or inability to control bladder or bowel
• infection of the surgical area
• fecal impaction or stool trapped in the anal canal

Late problems include:

• narrowing or stenosis of the anal canal
• recurrence of hemorrhoids
• fistula – which is the abnormal passage that forms between the anal or rectal canal
• rectal prolapsed – which happens when the rectal lining protrudes out of the anal opening like a protruding hemorrhoid.

There is a special preparation done before hemorrhoidectomy is performed. A day before the surgery, the nurse will give you an enema to cleanse your colon. Special preparations are mainly done to prevent the occurrence of infections after your surgery.

Keep in mind that the gastrointestinal tract consisting of the large intestine to the anus is inhabited by many bacteria. In this area, they are the harmless non-visible organisms that merely feed on food scraps to survive, but once they gain access to the other parts of your body, they turn into the most aggressive infection-causing machines overnight.

Before the hemorrhoid operation, you will either be given a general or spinal anesthesia so that you will not feel any pain. In a general anesthesia, you are asleep during the entire procedure, while in spinal anesthesia, you are numb form waist down to your toes. You are conscious and able to talk the whole time during the procedure.

The procedure involves making an incision on the tissue surrounding the hemorrhoid. Before hemorrhoid removal can take place, the swollen veins inside it are tied up to prevent bleeding. The incised area may be sewn or left open. Medicated gauze is used then placed over the incised wound. The incision can be done using either a knife, cautery pencil, or a laser. Lasersare often advertised as they are less painful and encourage faster healing, but these claims have not been proven. What is known is that lasers are more expensive than the traditional technique, takes longer to perform and can cause deep tissue injury.

After the surgery, you can expect some pain. Some bleeding is normal, especially on the first defecation. Straining is still avoided up to this point to prevent hemorrhoids from coming back.

For this, conservative management is applied at home. Follow up exams with your surgeon are done 2 to 3 weeks after surgery to check for your progress and complications.

Hemorrhoidectomy may provide better long-term results than fixative procedures that basically use the principle of cutting off blood flow to the hemorrhoid. However, surgery is more expensive, has greater risk of complications, and usually is more painful.

One common cause of pain is the presence of a hemorrhoid. About half of the population by age 50 would have experienced rectal pain due to hemorrhoids.

Imagine you are in a formal function or in a public place, and then you suddenly had an attack of butt pain. You look around but there is no place to run for cover. You struggle not to touch and scratch your butt.

Has this happened to you?

Wouldn’t you vow to find out what is the cause of your pain and stop it?

How about starting now…

Hemorrhoids develop when the normal veins within your anus become abnormally enlarged or dilated. It can form above the anal opening where it is not visible or within the anal opening where it is visible.

When they are not visible, they are called internal hemorrhoids. Internal hemorrhoids range in size from a slight swelling under the wall of the anal canal to large sagging masses. The bigger they are in size, the more they are prone to prolapse or protrude out of the anal opening. A prolapsed hemorrhoid is considered a severe case of internal hemorrhoid.

Visible hemorrhoids are called external hemorrhoids. They appear grape-like and shiny due to the stretched skin. External hemorrhoids can become severe when it bleeds, pools in the skin and forms into a clot – producing a hard and painful lump. This lump is called a clotted or thrombosed hemorrhoid . You wouldn’t wish to have this kind of hemorrhoid. Find out why…

Most small internal hemorrhoids do not produce pain and are generally asymptomatic. They are sometimes left unnoticed and heal on their own even without any medical or conservative intervention. They are mostly painless because there is limited number of pain-sensing nerves above the anal opening.

However, external hemorrhoids can be responsible for most butt pain caused by hemorrhoids. This is because, aside from the numerous pain-sensing nerves within the anal canal, the location of external hemorrhoids is in the part of the skin that is constantly moving and shifting as we walk, bend, squat or sit. This makes every movement painful and uneasy.

The pain caused by external hemorrhoids can range from mild discomfort to extreme ones. Strangulated hemorrhoids are responsible for most excruciating rectal pains. You feel this kind of pain because blood supply is cut off from the hemorrhoid, depriving it with oxygen and in turn gangrene may set in.

Itchiness and burning sensations can also trigger rectal pain. These are the common problems faced by most people with hemorrhoids, and it is the very feeling of embarrassment felt by many. It is embarrassing because, in order to relieve the discomfort or the pain caused by itching, your instinct is to scratch the area. More so it is a “no, no” to scratch the insides of your butt just to relieve it, especially in public!

Whatever forms your rectal pain is, always remember that there are a lot of ways to relieve it (such as a Sitz Bath ) and most relief measure are just within your reach. You just have to know what your options are.

Do you believe in the power of water to heal? If water does have the power to heal, would you try it?

This kind of bath use dates back from the ancient Egyptian, Greek and Roman civilizations with Hippocrates prescribing bathing in spring water as treatment for illnesses.

This is a European tradition for both wellness and relaxation. People have been wise to see the power of water to heal.

The word ‘sitz’ was derived from the German verb ‘sitzen’, meaning to sit. It is a form of hydrotherapy that makes use of water to soothe pain, swelling and treat different kinds of diseases. It is also called a hip bath because only the hips and buttocks are soaked in water or saline solution.

It comes in two forms – warm and cold baths. Yes, some like it hot, some like it cold! Warm and cold baths have different therapeutic effects. To reduce swelling and promote blood circulation, a warm bath is done.

A warm bath is one of the easiest and most popular treatments to relieve pain and swelling caused by hemorrhoids. This is usually advised by doctors for mild to moderate cases of hemorrhoids as a relief measure at home.

The logic behind its ability to relieve pain and swelling is that heat promotes blood circulation. Blood circulation promotes oxygenation of tissues, thereby relieving pain. Swelling is reduced when the trapped blood is mobilized by heat, therefore promoting blood circulation.

When doing a sitz bath at home, fill the tub with warm water to a height just enough to immerse your hips down while on sitting position. Check first the water temperature before sitting in the tub. You may add Epsom salt to your bath to hasten healing.

Now sit in the tub and do this for about 15 to 20 minutes. You may need to refill the tub with a fresh batch of warm water to maintain the right temperature of the water until the 20 minutes is complete.

If 20 minutes is up, stand up slowly to avoid falling down due to dizziness. Do not forget to pat dry the rectal area. Use a soft cotton towel to dry the rectal area and use gentle patting strokes when drying to avoid irritating the affected skin.

When doing this kind of bath, do not forget to apply safety measures to avoid accidents and complications. Here are some safety measures you must can note:

• use a bath mat beside the tub to avoid slipping when going in and out of the tub;
• do not soak for more than 30 minutes per day;
• make sure you are hydrated before the bath.

Although using sitz bath for hemorrhoid treatment is usually effective, it is not the only means to an end – meaning in order to treat your mild to moderate case of hemorrhoid, sitz bath alone cannot do this. If you want to heal faster, you also have to incorporate conservative management such as lifestyle modifications and practice basic prevention.

Whenever you get constipated, you have a greater tendency to strain real hard just to get rid of the poop. Maybe it is time to modify your diet:

• Is it rich in fiber?
• Do you drink enough water a day?

Diet plays a big role in the prevention of constipation. Eating a well balanced diet rich in fiber, around 20 to 35 grams each day, and drinking at least 8 glasses of water and liquids such as fruit and vegetable juices, and clear soups and broths, can greatly help the formation of softer, bulkier stools.

Good examples of high fiber foods are:

• beans
• whole bran cereals and grains
• asparagus
• Brussels sprouts
• carrots
• cabbage

You can make your own list of foods rich in fiber and make your own meal plans. Do you know that by just doing this you have avoided 3 contributing factors that cause hemorrhoids?

These factors are:

• constipation
• diarrhea
• straining during bowel movement

It is like hitting 3 birds with one stone. This is why diet plays a big role in hemorrhoid prevention.

Aside from diet modifications, other lifestyle changes that keep your body and mind active can encourage regular bowel movements. Playing or discovering a new sport is a great start! They not only prevent bouts of constipation, but they can be beneficial to your overall health. It is also a fun way to lose weight. Remember, being overweight is also a factor that causes hemorrhoids.

What is there to lose?

When lifting heavy objects, it is necessary to remember proper positioning or alignment of body. This prevents putting too much pressure on your waist and down below, which includes your rectum. Always bend in your knees when lifting and never twist your waist. Also, exhale when you lift – do not hold your breath. Holding your breath adds pressure on the rectum.

When you have a severe cough, in order to reduce pressure in the rectum, place your hand over your diaphragm while coughing, palm facing you. This will support your lower body including your rectum as you cough, thereby reducing pressure on it.

Having a regular bowel movement and maintaining a good toilet habit are also keys to hemorrhoid prevention. Good toilet habit is not doing anything while defecating. Avoid reading. This is usually the thing we love to do while having evacuating our poop. When you do something while passing stool, you don’t notice that you’ve been sitting too long. Remember, prolonged sitting contributes to the formation of hemorrhoids.

If your job requires prolonged periods of sitting and standing, keep in mind that there are some ways that can prevent the occurrence and the exacerbation of hemorrhoids. If you sit most of the time, try to stand and walk around for 5 minutes at least once every hour. For jobs that require standing most of the time, make sure you also get ample time to sit down and relax your lower body. Variation is the key here, and excess is bad for the health.

And remember, a warm Sitz Bath can help to alleviate painful hemorrhoid symptoms.

These pointers may be simple but they can greatly help hemorrhoid prevention.

Have YOU thought of a plan now?