Hemorrhoids: Causes, Symptoms, and Treatment Options

Hemorrhoids-related

Hello Dr.
Ke! I work in a rural area of Japan, where medical care is not as convenient as in urban Taiwan.
I have been struggling with a long-term hemorrhoid issue and would like to seek your advice.
Here are the details:
Lifestyle: I wake up in the morning and have a bowel movement (soft stools, with few issues of constipation), exercise, and then have breakfast.
I also exercise in the afternoon, practicing boxing.
I have dinner at 6 PM.
I typically eat only two meals a day.

In the summer of 2011, my internal hemorrhoids began to enlarge and bleed, but they were not painful.
Around 2012, I learned to push them back in, and for a while, there were no issues.
The bleeding gradually stopped.

In March 2013, after having a bowel movement in the morning and pushing the hemorrhoids back in, I experienced severe pain on the left side of the anal area, which usually lasted from around 9 AM until about 1-2 PM.
This pain was particularly intense if I had an empty stomach or only a liquid breakfast after the bowel movement.

Doctors examined me and found hemorrhoids on both sides, with the largest one on the left side, corresponding to the painful area.
The other two hemorrhoids have never caused pain.
I have also noticed that I tend to have diarrhea in the mornings.
The pain subsides after I eat dinner at 6 PM.

Two Japanese doctors said I appear to have typical stage III hemorrhoids but did not explain the cause of the pain.
One Taiwanese doctor suggested that the pain is due to prolapse, while another mentioned that it might be caused by pressure on the rectum from pelvic descent.

On February 22, 2014, the left-sided hemorrhoid was ligated with a rubber band.
Although the condition improved, I still experience severe pain on the left side if I have a large bowel movement on an empty stomach.
On March 11, I underwent an endoscopy with a Japanese doctor, who said everything looked normal.
The ligated hemorrhoid has disappeared and is healing.
The pain may be due to intestinal irritation during diarrhea.

In summary, I experience pain in the left anal area when having a bowel movement on an empty stomach, but the pain decreases or disappears after eating.
My condition has remained the same before and after the ligation, and there is no bleeding.

What should I do? Is it possible that there are issues other than hemorrhoids (such as polyps, tumors, or cancer)? If so, which specialty should I consult, and what kind of examinations should I undergo? Thank you!

Shan Miao, 30~39 year old female. Ask Date: 2014/03/12

Dr. Ke Fangxu reply Surgery

If the endoscopy shows no abnormalities, the likelihood of polyps, tumors, or cancer is relatively low.
However, poor bowel habits can indeed worsen the symptoms of hemorrhoids.
It is recommended that you consult a proctologist or a gastroenterologist to correct your bowel habits and use hemorrhoid medications for a period of time.
If there is still no improvement, you may consider undergoing hemorrhoidectomy.

Reply Date: 2014/03/12

More Info

Hemorrhoids, commonly known as piles, are swollen veins in the lower rectum and anus that can cause discomfort and pain. They can be classified into two types: internal hemorrhoids, which occur inside the rectum, and external hemorrhoids, which develop under the skin around the anus. Understanding the causes, symptoms, and treatment options for hemorrhoids is essential for effective management, especially for individuals like yourself who have been experiencing ongoing issues.

Causes of Hemorrhoids
The development of hemorrhoids can be attributed to several factors:
1. Straining During Bowel Movements: This is one of the most common causes. Straining can occur due to constipation or diarrhea, leading to increased pressure on the veins in the rectal area.

2. Pregnancy: The increased pressure on the pelvic blood vessels during pregnancy can lead to the development of hemorrhoids.

3. Obesity: Excess body weight can put additional pressure on the pelvic veins, contributing to the formation of hemorrhoids.

4. Sedentary Lifestyle: Lack of physical activity can lead to poor circulation and increased pressure in the rectal area.

5. Aging: As people age, the tissues supporting the veins in the rectum and anus can weaken, making hemorrhoids more likely.

6. Chronic Coughing or Sneezing: Conditions that cause chronic coughing or sneezing can increase pressure in the abdominal area, leading to hemorrhoids.

Symptoms of Hemorrhoids
The symptoms of hemorrhoids can vary depending on their type and severity. Common symptoms include:
- Bleeding: Bright red blood during bowel movements, which can be alarming but is often not serious.

- Pain or Discomfort: Especially during bowel movements or when sitting.

- Itching or Irritation: Around the anal area.

- Swelling: Around the anus, which may be tender to the touch.

- Prolapse: Internal hemorrhoids can protrude outside the anus, causing additional pain and discomfort.

Treatment Options
Treatment for hemorrhoids can range from conservative measures to surgical interventions, depending on the severity of the condition:
1. Lifestyle Changes: Increasing fiber intake through diet or supplements can help soften stools and reduce straining. Staying hydrated and engaging in regular physical activity are also beneficial.

2. Over-the-Counter Remedies: Creams, ointments, or suppositories containing hydrocortisone or witch hazel can help relieve itching and discomfort.

3. Warm Baths: Soaking in a warm bath can provide relief from pain and discomfort.

4. Medical Procedures: If conservative treatments fail, procedures such as rubber band ligation, sclerotherapy, or infrared coagulation may be recommended. In more severe cases, surgical removal of hemorrhoids (hemorrhoidectomy) may be necessary.

Concerns About Other Conditions
Given your symptoms, particularly the pain associated with bowel movements and the history of bleeding, it is wise to consider the possibility of other conditions. While hemorrhoids are a common cause of rectal bleeding and pain, other issues such as anal fissures, polyps, or even colorectal cancer can present similarly.
If you are experiencing significant pain, especially if it worsens or is accompanied by other symptoms like weight loss, changes in bowel habits, or persistent bleeding, it is crucial to consult a healthcare provider. A gastroenterologist or a colorectal surgeon would be appropriate specialists to evaluate your symptoms further. They may recommend diagnostic procedures such as a colonoscopy or flexible sigmoidoscopy to rule out other conditions.

Conclusion
In summary, while your symptoms are consistent with hemorrhoids, it is essential to remain vigilant about any changes in your condition. Maintaining a healthy lifestyle, managing your diet, and seeking regular medical advice can help you manage your symptoms effectively. If you have concerns about the possibility of other underlying conditions, do not hesitate to seek further evaluation from a specialist. Your health and comfort are paramount, and addressing these issues early can lead to better outcomes.

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