Hemorrhoids or piles are swollen veins located in the anus that cause itching and pain. Bleeding is the main sign for diagnosis. "Symptoms may worsen due to irritation from hard stools or chemical substances such as caffeine, teine, spices, alcohol or liquid acid feces , among others," explains Javier Martínez Alegre, coordinator of the Coloproctology Unit of the Surgery Department General and Digestive of Infanta Sofía Hospital , in Madrid.
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Creams and ointments
To relieve the symptoms, Martinez indicates that there are many creams and ointments in the market. " Only in the case of a hemorrhoidal crisis should we add these topical treatments to reduce edema and inflammation. In the case that the person has a significant pain we could add some analgesic, "he explains.
He warns that "many of the ointments and wipes that are sold contain soaps and corticosteroids, so their excessive use could cause itching and local dermatitis , worsening the symptoms of hemorrhoids."
The Spanish Society of Family and Community Medicine ( Semfyc ) also emphasizes that ointments can relieve, but not cure . They suggest not using them for more than a week, since, "in the long run, they can lead to atrophy of the skin of the anus".
Remedies
In addition to these treatments, Martinez gives a series of remedies and guidelines able to reduce the discomfort of piles.
Avoid constipation: " constipation causes overexertion in bowel movements and may increase pain," he says. To do this, suggests eating a diet rich in fiber and abundant fluids. Semfyc adds that, if you increase the volume of stools, they will be less time in the intestines and will have less pain when going to the bathroom.
Use laxatives moderately, if necessary: Martinez alludes to its moderate use, while Semfyc indicates that it is better not to use them without doctor's instructions. "They can cause belly pain and diarrhea , which would aggravate hemorrhoids," they say.
Perform sitz baths with warm water and soap: these baths consist of submerging the anus area in warm water, not too hot, for 10-15 minutes, 3 or 4 times a day. This calms the pain.
Clean with sponge or wet wipes: the coloproctologist states that these reduce the symptoms of hemorrhoids. Semfyc, for his part, insists that correct hygiene of the anus is essential. They recommend the use of a neutral soap, although they clarify that it is not good to wash it more than once or twice a day.
Do physical exercise frequently: Martinez stresses that sedentary lifestyle worsens the symptoms of hemorrhoids. "If you have to sit for many hours for your work, you should avoid sitting down and exercise regularly". Semfyc points out: "It is good to exercise, but you should avoid activities such as riding a bicycle, riding a horse or rowing."
Avoid the excess time to perform the deposition: you should go to the toilet when you need it, but you have to try not to sit too long in the toilet, or make many efforts to empty the bowels.
Reduce coffee consumption: also excess salt, spices, acids, chocolate, spicy and alcohol.
Even if they sting, do not scratch: if they rub or scratch the hemorrhoids they become more irritated.
Apply ice if they swell: Semfyc suggests putting ice in for a few minutes and, "if they get out of the anus, it is best to try to return them to their usual position with a light finger pressure".
Hemorrhoids
What is it
Hemorrhoids, also called piles, are veins inflamed excessively in the anus or lower rectal area . Generally they are not serious disorders and, as José María Enríquez-Navascués, head of the Department of General and Digestive Surgery at the Donostia University Hospital, explains, "they are a normal component of the human anatomy", although when they increase in pathological size or slip towards the outside, they cause discomfort such as itching, pain or burning , and even, sometimes, they can be accompanied by a rectal tumor, so they require an adequate diagnosis and treatment.
Hemorrhoids are pathological when the blood flow in the area is interrupted. It is considered that there is hemorrhoidal disease when varicose dilatations are detected in the hemorrhoidal veins.
Causes
According to Gonzalo Guerra Azcona, medical director of the Medical-Surgical Center for Digestive Diseases , in Madrid, "the exact cause of the inflammation of hemorrhoids is not known, but risk factors have been identified that predispose to suffer it." The main causes are:
Constipation : The hard and dry stools of constipation oppress hemorrhoidal veins and cause inflammation.
Diarrhea : Severe diarrhea can cause hemorrhoids because of irritation.
Pregnancy: The pressure exerted by the fetus on the rectal area, in addition to the efforts made during delivery , can cause the appearance of hemorrhoids.
Poor eating habits: A diet low in fiber , as well as the abuse of spicy, alcohol or coffee, are associated with the appearance of hemorrhoids.
Bad hydration: Drinking little water or liquids in general increases the risk of hemorrhoids.
Inadequate posture : Standing or sitting for periods of time is detrimental to this condition.
Great efforts during the realization of physical exercise.
Effort during bowel movements : The oppression of hemorrhoidal veins due to stress during bowel movements causes this inflammation.
Repression of the desire to go to the bathroom: Postponing the evacuation, can make, later, the defecation is more difficult and it is necessary to make more efforts of the advisable.
symptom
The most frequent clinical manifestations of hemorrhoids are:
Bleeding (live red blood) : Usually does not produce pain and is scarce. It usually originates after defecation.
Prolapse : It consists of a bulge that appears when hemorrhoids leave the inside of the anus and it is difficult to insert them again.
Secretion : Secretion of mucus from the anal mucosa is usual in internal hemorrhoids. It causes skin irritation, itching or burning, especially during defecation.
Pain : Internal hemorrhoids usually do not hurt, but external ones are especially annoying when they come out of the anus given the pressure of the anal ring.
Prevention
To avoid the appearance of hemorrhoids it is advisable to correct the causes that originate them. Some recommendations are:
- Drink two liters of water a day to prevent constipation.
- Avoid the intake of alcohol , as it impairs blood circulation, hindering digestion.
- Reduce the consumption of salt , since it favors the retention of liquids.
- Eat a diet rich in fiber , fruits, vegetables and whole products.
- Avoid the defecatory effort : In case of chronic constipation, War recommends consulting the specialist, since "it will give you the pharmacological and eating habits guidelines that will allow you to treat constipation while avoiding the appearance of hemorrhoids".
- Practice sports regularly to activate blood circulation and help improve intestinal transit.
- Avoid making great efforts in which the abdominal area has special importance.
Types
According to Marcos Rodríguez Martín, specialist in General Surgery and Gastroenterology at the Gregorio Marañón University Hospital, in Madrid, there are two types of hemorrhoids.
Internal hemorrhoids
They are hemorrhoids that bleed with the stool and those that prolapse through the anus. They are not painful unless accompanied by hemorrhoidal thrombosis. There are four grades to classify them:
Grade I: These are normal hemorrhoids.
Grade II: They are the hemorrhoids that leave the anus with the deposition and are introduced alone.
Grade II: They are the piles that leave the anus with the deposition and you have to help reintroduce them.
Grade IV: They are the internal hemorrhoids that come out through the anus and are always on the outside. They differ from external hemorrhoids in that the latter are covered by normal skin.
External hemorrhoids
External hemorrhoids are those that occur around the anus and that often accompany internal hemorrhoids or other processes such as anal fissure. External hemorrhoids do not bleed, although they can produce a sensation of heaviness and anal pain when thrombosed.
Diagnosis
Guerra argues that "to make a proper diagnosis, the main thing is to go to a specialist in the digestive system , because often the only symptom that may occur is bleeding, which is not only indicative of the presence of hemorrhoids, but also other diseases digestive problems such as colon cancer . "
Once in the consultation, the diagnosis consists first in the realization of a clinical history with the patient's medical history and the symptoms that it presents, for a later manual exploration by the doctor .
In cases in which the hemorrhoids are not external, but internal, the specialist will prescribe a colonoscopy for the confirmation of the disease.
Treatments
The treatment of hemorrhoids depends on the degree of inflammation or thrombosis of the affected vein of the rectal area.
In mild cases, "the most usual treatment usually consists of the application of ointments with local anesthetics and anti-inflammatories and the so-called sitz baths . This practice consists of bathing the affected area several times a day with warm water and salt, which helps to reduce inflammation of the hemorrhoid and, therefore, relieve symptoms ", says Guerra.
Similarly, the expert explains that "in severe cases, when the inflammation or strangulation of the rectal vein is very large, it is usually resorted to a surgical procedure called hemorrhoidectomy , a simple intervention and, usually, ambulatory, in the that hemorrhoidal packages are removed . " In case of bleeding, Enríquez-Navascués says that "the first thing is to check if it is only due to hemorrhoids; then, the most frequent is to perform a ligation or banding, a non-surgical procedure that is carried out in the consultation itself ".
"When an external hemorrhoid is very strangulated," says Guerra, "a minimal incision is made in the consultation and under local anesthesia, allowing blood to be expelled and removing the excess skin. This treatment consists of a practically painless process that does not require hospital discharge and the patient can be immediately incorporated into their daily routine. "
"When prolapse occurs frequently or causes discomfort, it should be treated surgically, " explains Enríquez-Navascués. Also, the specialist argues that "in case of a thrombosis in external hemorrhoids repeatedly, should be removed."
Other therapies used by specialists are:
Coagulation with infrared light : It is a heat treatment that coagulates the veins and reduces the size of the hemorrhoids.
Cryotherapy : The use of liquid nitrogen freezes the hemorrhoid and eliminates it.
Sclerosing injections : Scar substances are injected into inflammations, relieving symptoms.
Anopexia Circular Mucosa (AMC) : It is a treatment that uses a circular stapler that prevents blood flow and reduces prolapse.
Other data
Possible complications
Bleeding caused by hemorrhoidal inflation can lead to blood clots that sometimes cause the surrounding tissue to die . Occasionally, bleeding can be very intense due to iron-deficiency anemia, which would be the trigger for a prolonged loss of blood.
It is advisable to go to the doctor when the symptoms of hemorrhoids do not improve with home remedies, excessive bleeding occurs and you suffer from dizziness , dizziness or fainting.