HEMORRHOIDS

Hemorrhoids are blood vessels in the anal canal.  They are supported by small muscles and suspending tissue.  As we age the muscles and suspending tissue degrade and allow the veins to droop causing the symptoms described below.   This process is extraordinarily common and many people suffer.  

As the suspending muscles and tissue degrade the veins become engorged because they are dependent on the surrounding tissue for a small amount of pressure to help blood return.  They now become exposed and thinned out such that any hard stool or straining can cause bleeding.  The bleeding is usually painless, bright red and can be copious.  The bleeding is distressing, can lead to anemia (low hemoglobin level), as well needless repeated investigations. 

With the descending tissue comes the mucus that cells in the are produce normally to easy the passage of stool.  As the mucus spreads on the tissue where nerve endings are present it causes itching.  It also promotes the growth of fungus on the anal verge also contributing to itching.

The tissue that is below its usual level allows the seepage of material along its course.

The straining that is frequently present helps to push the loosened tissue down to the anal canal and sometimes outside. The swelling will come and go often without any clear trigger. 

When the hemorrhoidal tissue descends below the anal verge this is called prolapse.  If the prolapsing tissue goes up without manual replacement the hemorrhoids are grade 2.  If the hemorrhoids require manual replacement, in other words the patient has to push them back up by hand, they are called grade 3.  

Hemorrhoids can cause pain and discomfort.  Very sharp pain with defecation is usually due to an anal fissure, and severe pain lasting days is usually due to thrombosis.    

The anal canal and lower rectum are very sensitive, and the tissue that is now filling the space causes one to feel that a bowel motion is imminent.  Even after defecation the sensation can persist due to the loosened floppy tissue.  

Once in a while a blood clot can form in the veins.  This causes severe swelling, is very painful and can last many days.  

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