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Hemorrhoids

Hemorrhoids affect more than 75% of people striking men and women equally. Fortunately in most instances hemorrhoids or piles cause few if any symptoms. Actually hemorrhoids represent normal anal cushions that assist in maintaining bowel control during straining, coughing and heavy lifting. Additionally they add a layer of protection for the muscles comprising the anal sphincter. This tissue consists of sinusoids connecting small arteries to veins intermixed with some muscle fibers and connective tissue: collagen and elastic tissue. Many speak of them as akin to varicose veins. A closer analogy might be to the erectile tissue of the penis. In any event over the course of a lifetime the tethers binding these anal cushions in place loosen and become irritated. Hemorrhoids seem to be a normal circumstance of our existence and may be precipitated by pregnancy, diarrhea, constipation and a wide array of poorly documented factors. The concept that lack of fiber plays an integral role in their development once considered dogma now seems less likely. Internal hemorrhoids lack sensory nerves and are not associated with pain in the absence of a complication. Initially they may temporarily poke through the anal opening during or immediately following a bowel movement, but they retract spontaneously. With progression the prolapsed hemorrhoids may ultimately require manual replacement. When this becomes impossible, relief requires medical intervention. External hemorrhoids, covered by skin, may be especially painful; a situation exemplified by development of a blood clot – thrombosed hemorrhoid. Unlike blood clots in the leg, these do not dislodge and travel to the lungs. Discomfort however may instantaneously peak within the first 48 hours before spontaneously subsiding over a period of 7-14 days. Bleeding often accompanies hemorrhoids and must be differentiated from that associated with cancer of the colon, rectum or anus. Depending of circumstances and an individual’s age, this may require more thorough investigation. Known since ancient times, hemorrhoids even acquired a patron saint during the 6th century. Treatment by applying a variety of local agents minimally improves a situation that will ultimately resolve. Some provide temporary relief by coating and protecting the skin. Most of the topical salves, ointments and suppositories lack medical confirmation of their value. Rubber banding and infrared therapy along with other less invasive procedures have largely replaced the infamous traditional surgical approach.