Hemorrhoids, commonly called as piles, are swollen veins in the anal and lower rectal region, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or around the anus (external hemorrhoids).
Hemorrhoids occur due to increase in pressure on the veins around the anus which can be caused by:
- Straining during bowel movements
- Prolonged sitting on the toilet
- Chronic constipation or diarrhea
- Poor fiber intake
- Weakening of the supporting tissues in the anus and rectum (occurs in pregnancy/ aging)
- Frequently lifting heavy objects
The symptoms of hemorrhoids depend on whether they are external or internal. External hemorrhoids are associated with anal itching, one or more hard, tender lumps near anus & anal pain which aggravates on sitting. Too much straining, rubbing, or cleaning around the anus may make the symptoms worse. Most often, symptoms of external hemorrhoids go away within a few days.
Internal hemorrhoids are associated with b leeding from rectum – presence of bright red blood in the stool, on toilet paper, or in the toilet bowl after a bowel movement, prolapse, which is a hemorrhoid that protrudes through the anal opening.
Hemorrhoids can be diagnosed based on medical history & physical examination of the area around the anus. Digital rectal examination may be required to check for internal hemorrhoids. Chronic loss of blood from the internal hemorrhoids may lead to nemia.
TONE method & Role of fiber intake
Since shearing action of passing hard stool on the anal mucosa may cause damage to the anal cushions and lead to symptomatic hemorrhoids, increasing intake of fiber or providing added bulk in the diet might help eliminate straining during defecation. Insoluble fiber particles (e.g., wheat bran) stimulate secretion of water and mucous by a mechanically irritating effect on large bowel mucosa whereas soluble gel-forming fiber (e.g., psyllium) has a high capacity to hold water that resists dehydration in the large bowel. The Dietary Guidelines for Americans, 2020–2025 recommends a dietary fiber intake of 14 grams per 1,000 calories consumed. For example, for a 2,000-calorie diet, the fiber recommendation is 28 grams per day.
Eating more high fiber, low fat, whole foods can often reduce or prevent the symptoms of hemorrhoids as fiber seems to increase stool weight, reduce the time feces spends in the colon. It increases water retention in the colon, resulting in softer stools that pass more easily & also decreases the pH levels in the colon, which also reduces colon transit time, or the time it takes for food to pass through the colon
The root cause of hemorrhoids resides in three deranged defecation habits (DDH), namely increased straining, prolonged defecation-time, and frequent bowel-motions. These DDH are responsible for the development of new hemorrhoids, progression of existing one and hemorrhoidal rupture (bleeding). This can be corrected with the help of the "TONE" mnemonic.
TONE stands for exact treatment goals: T, three minutes at defecation; O, once-a-day defecation frequency; N, no straining during passing motions; E, enough fiber. TONE can be implemented by proper counseling and by prescribing fiber supplement appropriately (5-6 teaspoonfuls of psyllium husk with 600 mL of water daily.
Taking warm baths several times a day to help relieve pain. This could be a regular bath or a sitz bath. Using over-the-counter hemorrhoid creams, ointments, or suppositories to relieve mild pain, swelling, and itching of external hemorrhoids.
References:
- Haemorrhoids | National Health Portal of India (no date). Available at: https://www.nhp.gov.in/haemorrhoids_mtl (Accessed: 14 March 2022).
- Haemorrhoids (piles) - Illnesses & conditions | NHS inform (no date). Available at: https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/haemorrhoids-piles (Accessed: 14 March 2022).
- Hemorrhoids - Symptoms and causes - Mayo Clinic (no date). Available at: https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268 (Accessed: 14 March 2022).
- Piles (haemorrhoids) - NHS (no date). Available at: https://www.nhs.uk/conditions/piles-haemorrhoids/ (Accessed: 14 March 2022).
- The Hemorrhoid Grading System | Hemorrhoid Grade 1, 2, 3, 4 - Hemorrhoid Treatment Options (no date). Available at: https://www.gothemorrhoids.com/hemorrhoid-grading-system (Accessed: 14 March 2022).
