Disclaimer: The ideas and suggestions written below are provided for general educational purposes only and should not be construed as medical advice or care.
It’s true! Hemorrhoids are a normal and important part of human anatomy. Every body on earth – men, women, children – has them. And just like other parts of our body, sometimes they get swollen or irritated. So if you are having some issues where the sun don’t shine – don’t fear. There are things that can help. Starting with accurate information. So let’s break it all down.
What are hemorrhoids?
Hemorrhoids are cushions of blood vessels and connective tissue located in the lower rectum and anus. They do a lot of important things down there including contributing to continence – aka, they help you hold your poo when you sneeze or cough. Important, indeed.
Hemorrhoids exist both inside and outside the back door (aka “internal hemorrhoids” and “external hemorrhoids”). When healthy, hemorrhoids are about the size of a pea and located under the skin, so they cannot be felt or seen.
What’s the difference between internal and external hemorrhoids?
External Hemorrhoids
- Located under the skin around and just inside the anus but below the dentate line, a sensitive anatomical boundary about 1.5-2cm up the anus (about the length of one’s thumbnail).
- This area has more nerve endings that sense pain, so when inflamed external hemorrhoids are more likely to cause pain and discomfort.
Internal Hemorrhoids
- Located under the skin inside the anal canal above the dentate line.
- Because they are positioned above the dentate line, they do not have the type of nerve endings that sense pain. So while they can cause discomfort when they become extremely swollen and/or prolapsed (aka “pop out” of the anus), pain is less likely to be a symptom of inflamed internal hemorrhoids. Bleeding however is common.
- Internal hemorrhoids are further classified into four grades based on the degree that they prolapse.
What are thrombosed hemorrhoids?
Thrombosed hemorrhoids occur when a blood clot, aka a thrombus, forms inside an internal or external hemorrhoid. This clot can partially or completely block blood flow, resulting in swelling and pain and typically cause the hemorrhoid to have a dark bluish-purple hue.
If you think you might have a thrombosed hemorrhoid, reach out to your doctor right away. There are treatment options available only during the first few days of symptoms.
What causes hemorrhoids to get inflamed?
There are a variety of conditions and behaviors that can lead to increased pressure in the anal veins that make up hemorrhoids, causing them to swell and be symptomatic:
- Straining during bowel movements, often due to constipation or hard stools.
- Prolonged sitting, including on the toilet, at a desk job or driving for long periods.
- Low-fiber diet can lead to constipation or hard stools, and therefore straining during bowel movements.
- Lack of physical activity can contribute to constipation and increased pressure in the anal area.
- Chronic diarrhea, which in addition to causing straining/prolonged sitting, can contain bile/gastric acid which can further irritate anal tissues.
- Any condition that increases intra-abdominal pressure, such as:
- late term pregnancy
- excess abdominal weight
- straining to have bowel movements or urinate
- frequent lifting of heavy objects
- Aging, since tissues in the anal area tend to weaken with age.
- Menopause, during which hormonal changes can lead to the loss of strength and elasticity of tissues, and weaken blood vessels making them more prone to swelling.
- Anal intercourse can irritate existing symptomatic hemorrhoids or contribute to their formation.
- Genetics. Some studies show that some people with a family history of hemorrhoids are more likely to develop them themselves due to potentially inherited weaknesses in blood vessel structure that can contribute to swelling and inflammation.
How can I treat my hemorrhoids?
There are a variety of ways to address the symptoms of problematic hemorrhoids including topical, over-the-counter (OTC) solutions, lifestyle modifications, as well as surgical procedures. It’s critical that you and your doctor correctly diagnose your anorectal condition – while hemorrhoids are the most common, there are other anorectal conditions that require different treatment approaches. Once you are certain you are dealing with hemorrhoids, learn more about treatment options here.
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