Can hemorrhoids lead to discomfort in the groin area. What are the common causes of pain between the genitals and anus. How can you differentiate between hemorrhoid-related pain and other conditions affecting the perineum.

The Relationship Between Hemorrhoids and Groin Pain

Hemorrhoids are a common condition that affects millions of people worldwide. While they are typically associated with discomfort in the anal area, some individuals wonder if hemorrhoids can cause pain in the groin. Let’s explore this connection and shed light on the various factors that can contribute to pain in the perineal region.

Hemorrhoids themselves are swollen veins in the lower rectum and anus. They can be internal (inside the rectum) or external (under the skin around the anus). While hemorrhoids primarily cause symptoms in the immediate anal area, in some cases, the pain and discomfort can radiate to nearby regions, including the groin.

Can hemorrhoids directly cause groin pain?

In most cases, hemorrhoids do not directly cause groin pain. The discomfort associated with hemorrhoids is typically localized to the anal area. However, severe cases of hemorrhoids or complications may lead to referred pain that extends to the groin region. This is due to the interconnected network of nerves in the pelvic area.

Indirect effects of hemorrhoids on groin discomfort

While hemorrhoids may not be the primary cause of groin pain, they can indirectly contribute to discomfort in the area. Here’s how:

• Changes in posture or gait to alleviate hemorrhoid pain can put strain on the groin muscles
• Inflammation from hemorrhoids may spread to nearby tissues, causing general discomfort in the perineal region
• Anxiety and stress related to hemorrhoid symptoms can lead to tension in the pelvic floor muscles, potentially causing groin pain

Common Causes of Pain Between the Genitals and Anus

While hemorrhoids can contribute to discomfort in the perineal area, there are several other conditions that more commonly cause pain between the genitals and anus. Understanding these potential causes can help in proper diagnosis and treatment.

Chronic Prostatitis

Chronic prostatitis is a condition characterized by inflammation of the prostate gland that persists for an extended period. It can cause pain in the area between the scrotum and anus, known as the perineum.

Symptoms of chronic prostatitis include:

• Persistent pain or discomfort in the pelvic area
• Difficulty urinating or pain during urination
• Pain during ejaculation
• Lower back pain

Anal Fissures

Anal fissures are small tears in the lining of the anus. They can cause significant pain, especially during bowel movements, and may lead to discomfort in the perineal region.

Common symptoms of anal fissures include:

• Sharp pain during bowel movements
• Burning sensation in the anal area
• Visible tear or cut in the anus
• Small amount of blood on toilet paper after wiping

Spinal Stenosis

Spinal stenosis is a condition where the spaces within the spine narrow, putting pressure on the nerves that travel through the spine. This can cause pain that radiates to various parts of the lower body, including the perineum.

Symptoms of spinal stenosis may include:

• Numbness or tingling in the legs, feet, or buttocks
• Weakness in the legs
• Back pain
• Difficulty walking or standing for long periods

Differentiating Hemorrhoid Pain from Other Perineal Conditions

Given the variety of conditions that can cause pain in the perineal area, it’s important to be able to differentiate hemorrhoid-related discomfort from other potential causes. Here are some key factors to consider:

Location of pain

Hemorrhoid pain is typically localized around the anus, while conditions like prostatitis or pelvic floor disorders may cause more diffuse pain in the perineal region.

Timing of symptoms

Hemorrhoid pain often worsens during bowel movements and may be relieved by sitting in a warm bath. Other conditions may have different triggers or patterns of discomfort.

Associated symptoms

Hemorrhoids are often accompanied by itching, burning, and possibly bleeding during bowel movements. Other conditions may have unique symptom profiles, such as urinary symptoms in prostatitis or radiating pain in spinal stenosis.

Diagnosis and Treatment of Perineal Pain

Proper diagnosis is crucial for effective treatment of pain between the genitals and anus. Healthcare providers may use various methods to determine the cause of perineal pain:

Diagnostic procedures

• Physical examination, including a digital rectal exam
• Anoscopy or colonoscopy to visualize the anal canal and rectum
• Imaging studies such as MRI or CT scan to rule out structural issues
• Urinalysis and urine culture to check for infections

Treatment options

Treatment for perineal pain depends on the underlying cause. Some common approaches include:

• Topical creams or ointments for hemorrhoids or anal fissures
• Antibiotics for bacterial prostatitis
• Pain management techniques, including over-the-counter pain relievers
• Physical therapy to strengthen pelvic floor muscles
• Lifestyle modifications, such as dietary changes and increased fiber intake
• In severe cases, surgical intervention may be necessary

Preventing Hemorrhoids and Perineal Discomfort

While not all cases of perineal pain can be prevented, there are steps you can take to reduce your risk of developing hemorrhoids and other conditions that cause discomfort in this area:

Dietary considerations

A diet rich in fiber can help prevent constipation, which is a common contributor to hemorrhoids and anal fissures. Include plenty of fruits, vegetables, and whole grains in your daily meals.

Hydration

Staying well-hydrated helps maintain soft stools, reducing strain during bowel movements. Aim to drink at least 8 glasses of water per day.

Regular exercise

Physical activity promotes healthy bowel function and can help prevent conditions like chronic prostatitis. Aim for at least 30 minutes of moderate exercise most days of the week.

Proper bathroom habits

Avoid straining during bowel movements and limit the time spent sitting on the toilet. These habits can help prevent hemorrhoids and reduce pressure on the pelvic floor muscles.

When to Seek Medical Attention for Perineal Pain

While some cases of perineal discomfort can be managed at home, certain symptoms warrant prompt medical attention. Consult a healthcare provider if you experience:

• Severe or persistent pain that doesn’t improve with home remedies
• Rectal bleeding or blood in the stool
• Fever or chills accompanying perineal pain
• Difficulty urinating or painful urination
• Unexplained weight loss
• Changes in bowel habits that persist for more than a few weeks

Early intervention can lead to more effective treatment and prevent potential complications.

Alternative Therapies for Managing Perineal Pain

In addition to conventional medical treatments, some individuals find relief from perineal pain through alternative therapies. While scientific evidence may be limited for some of these approaches, they can be considered as complementary options under the guidance of a healthcare provider:

Acupuncture

This traditional Chinese medicine technique involves inserting thin needles into specific points on the body. Some studies suggest that acupuncture may help alleviate chronic pelvic pain and improve quality of life for individuals with conditions like prostatitis.

Herbal remedies

Certain herbs, such as witch hazel and horse chestnut, have been traditionally used to soothe hemorrhoid symptoms. However, it’s important to consult with a healthcare provider before using any herbal supplements, as they can interact with medications and may not be suitable for everyone.

Biofeedback therapy

This technique involves using sensors to monitor muscle tension and learning to control these muscles consciously. Biofeedback can be particularly helpful for individuals with pelvic floor disorders or chronic prostatitis.

Mindfulness and relaxation techniques

Stress and anxiety can exacerbate perineal pain. Practices such as meditation, deep breathing exercises, and progressive muscle relaxation may help manage pain and improve overall well-being.

Impact of Perineal Pain on Quality of Life

Chronic pain between the genitals and anus can significantly affect an individual’s quality of life. Understanding these impacts can help in developing comprehensive treatment plans and support strategies:

Physical limitations

Perineal pain can make everyday activities challenging, including sitting for prolonged periods, exercising, or engaging in sexual activity. This can lead to a more sedentary lifestyle and potential health complications.

Emotional and psychological effects

Chronic pain can contribute to feelings of anxiety, depression, and frustration. The intimate nature of perineal pain may also cause embarrassment and social isolation.

Sleep disturbances

Discomfort in the perineal area can make it difficult to find a comfortable sleeping position, leading to poor sleep quality and daytime fatigue.

Relationship challenges

Perineal pain can affect intimate relationships due to discomfort during sexual activity and the emotional toll of chronic pain.

Addressing these quality of life issues is an essential part of managing perineal pain. Healthcare providers may recommend a multidisciplinary approach, including pain management specialists, physical therapists, and mental health professionals, to provide comprehensive care.

Emerging Research and Future Treatments

As medical understanding of perineal pain and related conditions continues to evolve, new treatment options and diagnostic tools are being developed. Here are some areas of ongoing research that may shape future approaches to managing pain between the genitals and anus:

Microbiome studies

Researchers are investigating the role of the gut and urinary microbiome in conditions like chronic prostatitis and interstitial cystitis. This could lead to new probiotic or microbiome-based therapies.

Advanced imaging techniques

Improved imaging technologies may allow for earlier and more accurate diagnosis of conditions causing perineal pain, potentially leading to more targeted treatments.

Neuromodulation therapies

Techniques like sacral nerve stimulation are being explored for managing chronic pelvic pain syndromes. These approaches aim to modulate pain signals and improve muscle function in the pelvic region.

Regenerative medicine

Stem cell therapies and platelet-rich plasma (PRP) injections are being studied for their potential to promote healing and reduce inflammation in conditions like chronic prostatitis and anal fissures.

As research progresses, individuals suffering from perineal pain may have access to more effective and personalized treatment options in the future. It’s important to stay informed about new developments and discuss potential new treatments with healthcare providers.

In conclusion, while hemorrhoids can contribute to discomfort in the perineal area, they are not typically the primary cause of groin pain. Various conditions can lead to pain between the genitals and anus, and proper diagnosis is crucial for effective treatment. By understanding the potential causes, seeking timely medical attention, and adopting preventive measures, individuals can better manage and alleviate perineal pain, improving their overall quality of life.

Perineum Pain | Causes of Pain Between Genitals & Anus

The perineum pain between the genitals and anus can be commonly caused by anal fissures. Pain in the area between the scrotum and the anus can be caused by chronic or acute prostatitis. Read below for more information on causes and treatment options.

8 most common causes

Chronic Prostatitis

Anal Fissure

Spinal Stenosis

Hemorrhoids

Illustration of a health care worker swabbing an individual.

Piriformis syndrome

Illustration of a person thinking with cross bandaids.

Painful bladder syndrome (interstitial cystitis)

Illustration of various health care options.

Acute prostatitis

Illustration of a person thinking with cross bandaids.

Anal cancer

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5 possible pain between the genitals and the anus causes

The list below shows results from the use of our quiz by Buoy users who experienced pain between the genitals and the anus. This list does not constitute medical advice and may not accurately represent what you have.

Spinal stenosis

The spine, or backbone, protects the spinal cord and allows people to stand and bend. Spinal stenosis causes narrowing in the spine. The narrowing puts pressure on nerves and the spinal cord and can cause pain.

Next steps including visiting a primary care physician. For this condition, a physician might suggest further investigation including imaging of the spine. Treatments may include medications, physical therapy, or braces. For severe cases, surgery is sometimes recommended.

Rarity: Common

Top Symptoms: lower back pain, back pain that shoots down the leg, back pain that shoots to the butt, difficulty walking, thigh pain

Urgency: Primary care doctor

Piriformis syndrome

Piriformis syndrome

The two piriformis muscles, left and right, each run from the base of the pelvis to the top of the thighbone. The two sciatic nerves, left and right, are each attached to the spine and run down between the pelvic bone and the piriformis muscle to the back of each leg.

If the piriformis muscle is damaged through sudden trauma, or through overuse as in sports, the resulting inflammation or spasm of the muscle can trap the sciatic nerve between the pelvic bone and the muscle.

Piriformis syndrome is most often found in women over 30.

Symptoms include pain over one or both sides of the low back, and shooting pain (sciatica) down one or both legs.

Diagnosis is made through physical examination and sometimes imaging such as CT scan or MRI.

Treatment involves rest; over-the-counter, nonsteroidal anti-inflammatory drugs; physical therapy; therapeutic injections; and, rarely, surgery.

The best prevention is a good regimen of stretching before exercise, to help prevent damage to the piriformis.

Rarity: Common

Top Symptoms: pelvis pain, butt pain, pain when passing stools, leg numbness, hip pain

Symptoms that never occur with piriformis syndrome: involuntary defecation, leaking urine

Urgency: Primary care doctor

Painful bladder syndrome (interstitial cystitis)

Painful bladder syndrome, also called interstitial cystitis or IC, is a chronic condition of pain and discomfort in the urinary system.

The cause is unknown. It may be an autoimmune disorder and is often found with fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, or vulvodynia (pain in the outer female organs.) Some researchers feel the condition may be linked to a history of abuse.

Painful bladder syndrome is more common in women than in men, but can happen to anyone.

Symptoms vary and may include pressure and discomfort in the lower abdomen; pain during sexual intercourse; bladder pain; and a frequent urge to urinate.

A medical provider should be seen for these symptoms, because painful bladder syndrome can interfere with quality of life and lead to depression.

Diagnosis is made through patient history; physical examination; blood and urine tests; and sometimes cystoscopy. Women may have a pelvic examination and men may have a digital rectal examination.

There is no cure specifically for painful bladder syndrome, so treatment involves addressing the symptoms and making lifestyle changes.

Hemorrhoids

Hemorrhoids, or “piles,” are swollen veins in the anus or rectum. They may be located inside the rectum (internal) or outside the body at the anus (external.)

The condition is caused by straining during bowel movements and/or from increased pressure during pregnancy and childbirth.

Hemorrhoids are a common occurrence, especially in older people. Pregnant women are susceptible, as is anyone who has chronic constipation or is obese.

Symptoms include discomfort, pain, pressure, and itching. There may be small amounts of bleeding during bowel movements, though some hemorrhoids cause no symptoms at all.

Severe pain can indicate a thrombosed hemorrhoid, meaning a clot has formed within it. This is not serious but the pain can be debilitating and requires treatment right away. Also, rectal bleeding can also be a sign of more serious diseases such as diverticulitis or cancer and should always be diagnosed by a medical provider.

Diagnosis is made through physical examination and sometimes through colonoscopy.

Treatment begins with good hygiene, cold compresses, and over-the-counter pain relievers. Surgery may be done for some cases.

Chronic prostatitis

Chronic prostatitis is an ongoing inflammation or infection of the prostate gland, the small, walnut-shaped organ just below the bladder in men.

Prostatitis is most often due to common bacteria in the urine causing infection. It may also be caused by surgery or other trauma setting up an inflammation. In some cases, the cause remains unknown.

Men of all ages are susceptible. Risk factors include a past urinary tract infection; using a catheter for urination; or pelvic trauma from bike riding or horseback riding.

Symptoms include pain in the abdomen, low back, groin, and genitals; frequent need to urinate; pain, burning, and difficulty when urinating; urine that is cloudy or bloody; and painful ejaculation.

A medical provider should be seen for these symptoms, since a bacterial infection can spread and lead to scarring, pain, and infertility.

Diagnosis is made through urine tests, blood tests, and ultrasound or CT scan.

Treatment involves antibiotics for bacterial prostatitis, though if all the bacteria are not destroyed the disease can become chronic. Nonsteroidal anti-inflammatory drugs are also helpful.

Anal fissure

An anal fissure is a break, or tear, in the mucous membrane lining of the anus. The anus is the opening at the end of the digestive tract where stool leaves the body.

A fissure is caused primarily by constipation, which leads to straining to pass large hard stools; trauma caused by insertion of objects or by anal sex; and illnesses such as any type of inflammatory bowel disease or sexually transmitted disease.

Symptoms include pain and bleeding during and after a bowel movement; discomfort and difficulty with urination; and a visible tear, resembling a crack, in the anal tissue that may have a foul-smelling discharge.

Diagnosis is made through physical examination.

Treatment primarily involves relieving constipation, and the straining it causes, by adding fiber and more fluids to the diet; and easing anal irritation by soaking in a warm bath and gently cleansing the tissues of the anus. In some cases, medicated creams or suppositories may be prescribed.

Anal cancer

Anal cancer is a neoplasm, or tumor, growing in the tissues of the anus. The tumor may be malignant (cancerous) or benign (non-cancerous.)

Most anal cancers are linked to the human papilloma virus, or HPV. However, many people carry HPV and have no symptoms or illness of any kind.

Most susceptible are men who have sexual contact with men; women who have had cervical cancer; and anyone who has engaged in anal intercourse, had anal warts, or is HIV positive. Smoking and lowered immunity are also factors.

Symptoms include minor anal bleeding and itching, which may be attributed to hemorrhoids; pain or fullness in the anal region; and abnormal anal discharge.

It is important to see a medical provider about these symptoms so that if needed, treatment can begin as soon as possible.

Diagnosis is made through patient history; physical examination; anal swab; and biopsy. CT scan, ultrasound, or endoscopy of the anus may also be done.

Treatment involves some combination of surgery, radiation therapy, and chemotherapy depending on the needs of each individual patient.

Acute prostatitis

Acute prostatitis is a sudden-onset bacterial infection of the prostate gland in men.

Bacteria can spread to the prostate through a urinary tract infection, or through a sexually transmitted disease such as gonorrhea or chlamydia. Infection can also start after a medical procedure such as a urinary catheter insertion.

Most susceptible are younger or middle-aged men with a urinary tract infection or STD (sexually transmitted disease;) a pelvic injury from trauma or from bicycling or other sport; an enlarged prostate; or a recent prostate biopsy.

Symptoms include pain and difficulty when trying to urinate; pain on ejaculation; pelvic and abdominal pain; fever; chills; and nausea and vomiting.

These symptoms should be evaluated by a medical provider, because untreated prostatitis can lead to bacteremia of the blood (“blood poisoning,”) prostatic abscess, and infertility.

Diagnosis is made through patient history, urinalysis, blood tests, and a physical examination which usually involves a digital rectal examination. Prostatitis does not cause prostate cancer.

Treatment is done with antibiotics, usually as an outpatient.

Rarity: Rare

Top Symptoms: penis pain, fever, urinary changes, painful urination, chills

Urgency: Hospital emergency room

Questions your doctor may ask about pain between the genitals and the anus

• Do your symptoms worsen when sitting?
• Have you had any changes in your weight?
• Any fever today or during the last week?
• Are you sexually active?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

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Can Hemorrhoids Cause Vulvar Pain? Find Out Here

Overview

Hemorrhoids and vulvar pain are conditions that can affect the anal and groin area. Despite the proximity, there is no link between hemorrhoids and vulvar pain. Therefore, according to current knowledge, hemorrhoids cannot cause vulvar pain.

Hemorrhoids, also known as piles, are a common condition that affect the anal/rectal canal, mainly affecting adults. A study found that 38.93% of the general population are suffering from hemorrhoids.¹ The condition is described as a symptomatic enlargement and distal displacement of the normal anal cushions. Anal cushions are vascular structures that are related to the control of continence in the anal canal. Connective tissue surrounding these cushions deteriorates allowing destructive changes to the cushions, causing hemorrhoids. In addition, abnormal dilation and distortion of the vascular channel is found. This leads to uncomfortable symptoms of rectal bleeding and anal discomfort which will be examined further in this article.²

For diagnostic purposes, hemorrhoids are also graded based on their location and degree of prolapse. The location at which hemorrhoids occur can range from the inferior hemorrhoidal venous plexus (above the dentate line) or the dilated venules of this plexus (below the dentate line). Hemorrhoids in these areas are called internal hemorrhoids, characterised as painless and bright red bleeding, and external hemorrhoids, characterised by pain and swelling around the anus, respectively. There are also mixed hemorrhoids which occur in both areas. This grading allows better choosing of treatments and a comparison of therapeutic outcomes between the grades. 

There are four grades that range from the least severe, at grade I, to the most severe, at grade IV. Grade I involves anal cushions bleeding but not prolapsing. Grade II involves anal cushion prolapsing on straining but reduce when at rest. Grade III involves anal cushion prolapsing on straining or exertion and require manual replacement into the anal canal. Grade IV involves permanent anal cushion prolapsing and is irreducible.²

Once hemorrhoids have been clinically evaluated, treatment can take place which can involve four approaches: dietary and lifestyle modification, medical treatment, non-operative treatment and operative treatment. These approaches will be discussed in greater detail in a later section.²

Causes 

There is no known cause for hemorrhoids, but there are two causes thought to likely be involved. The first cause is constipation and straining when defecating, as hard stool and increased pressure are thought to damage the anal cushions. This damage eventually leads to the development of hemorrhoidal tissue. There is evidence to support this thinking, as a relationship between constipation and haemorrhoids is consistently found.³ 

Secondly, a link to diarrhoea has also been suggested, though this link is more tentative.² These are all conditions related to the anal canal which can affect the cushions, but there are other causes which can affect the cushions.

Pregnancy is also linked to hemorrhoids. Due to the locality of the vaginal canal to the anal canal, damage can occur to the cushions, which results in hemorrhoids. This usually occurs during the last trimester of birth and immediately after birth. One study found hemorrhoids occurred in relation to births of a baby greater than 3900g, and excessive straining during birth.⁴ In addition, dietary factors such as low fibre, spicy foods, and alcohol intake have been proposed. However, evidence for these factors is tenuous.²

To recap, there are several risk factors and causes related to hemorrhoids which include:

• Constipation and excessive straining
• Diarrhoea
• Pregnancy
• Low dietary fibre

Symptoms

The symptoms of hemorrhoids depend on the severity of the disease and type (internal or external). They can be painful or painless, and visible or not. However, the most common symptom of hemorrhoids is painless, bright red bleeding after visiting the toilet. This blood is bright red as the anal cushion tissue has direct contact with the arteries and veins in the body. The severity of symptoms can then increase from there.²

A prolapsing hemorrhoid may cause irritation or anal itching. As the tissue is mucosal, there can also be a production of mucus that can leave residue on underwear. These symptoms can be uncomfortable for patients and affect a person’s ability to sit down. A feeling of still needing to go to the toilet after defecating is also reported in patients with large hemorrhoids. 

To recap, there are several symptoms of hemorrhoids that can be painful:

• Bright red blood after pooing
• An itchy anus
• Feeling of still needing to poo, even if you have just been to the toilet
• Mucus production from the anus
• Presence of external hemorrhoids around the anus
• Pain around the anus

How is vulvar pain linked to hemorrhoids?

It has been established that pain can occur when suffering from hemorrhoids, but there is another type of pain in the same area that can occur in people assigned female at birth. This pain is known as vulvodynia which is a chronic pain or discomfort around the vulva, and the pain affects 7-15% of women. ⁵ This can have no identifiable cause and last for at least 3 months. It can make sitting for long periods or having sex very difficult. In addition, the pain can be localised or generalised and can be constant or occasional. 

Overall, the symptoms of vulvodynia include:

• Burning
• Soreness
• Stinging
• Rawness
• Painful intercourse
• Throbbing and itching

This pain can lead to several complications for a person, which include:

• Anxiety or depression
• Sleep disturbance
• Sexual dysfunction
• Relationship problems

But is vulvar pain linked to hemorrhoids? There is currently no research into this connection and there is no established link that hemorrhoids can cause pain specific to the vulva. However, external hemorrhoids could be considered as vulva pain due to their proximity.

Causes of vulvar pain

Although there can be no identifiable cause to vulvodynia, and sometimes no visible signs, there are possible contributing factors which create the pain. Generally these causes are related to a damaging of the nerves in the vulva. These causes include:

• Previous surgery
• Childbirth
• Trapped nerves
• Hormonal changes, such as low oestrogen
• Previous infections, such as HPV
• Pelvic floor dysfunction
• Psychological

Diagnosis

Hemorrhoids are diagnosed based on the patient’s history and a clinical examination. Assessment would include a digital examination and anoscopy of the anus. The anal area would also be inspected for symptoms, such as the presence of external hemorrhoids, while the digital examination would be able to detect the presence of internal hemorrhoids. Diagnosis would then be able to lead to treatment.

Before diagnosis of vulvodynia, the doctor will ask questions to understand the pain. These questions can cover topics such as the patient’s medical, sexual, and surgical history. In addition to this, a doctor might perform a pelvic exam or cotton swab test. A pelvic exam is when a doctor visually examines the genitals for signs of infection or other causes for the symptoms. If there is no visual evidence, your doctor might take a sample of your cells for an infection analysis.

Treatments

For hemorrhoids, there are several treatment approaches.² These include:

• Creams to ease pain, itching and swelling of the hemorrhoids.
• Treatment to help constipation and soften poo.
• Colds packs to ease discomfort.
• Dietary and lifestyle modification.

If these treatments do not work then you can opt for hospital treatment for hemorrhoids. However, these treatments do not always prevent the hemorrhoids from re-occuring. Treatments can be performed without surgery and include:

• Rubber band ligation- this cuts off the blood supply causing the hemorrhoids to die and drop off.
• Sclerotherapy- injection of a liquid that reduces blood flow leading to a reduction in hemorrhoid size.
• Electrotherapy- gentle application of an electric current to shrink the hemorrhoids.
• Infrared coagulation- infrared light used to cut blood supply making the hemorrhoids shrink.

Treatments can also make use of surgery and include:

• Hemorrhoidectomy- surgical removal of the hemorrhoids.
• Stapled hemorrhoidopexy- hemorrhoids are stapled back into the anal canal.
• Hemorrhoidal artery ligation- stitches are used to cut blood supply to the hemorrhoids to make them shrink.

For vulvodynia, treatment approaches aim to relieve the pain and often take a holistic approach by using a combination of medicines. Treatment options can include:⁵

• Medications, such as antidepressants, to lessen pain
• Biofeedback therapy- aims to reduce pain by teaching you how to relax the pelvic floor and control response to symptoms.
• Cognitive behavioural therapy
• Local anesthetics such as lidocaine ointment, often recommended to be applied before sex.
• Nerve blocks- injection of agents that block the nerve to relieve pain.
• Pelvic floor therapy- exercises which relax the muscles surrounding the vulva.
• Other lifestyle options such as use of a cold-pack
• Surgery 

When to seek medical attention

For hemorrhoids, a person should seek medical attention if there has been no improvement after a week of home treatment, and the hemorrhoids frequently appear. If this is the case, you can make an appointment with your GP. However, if a fever accompanies your hemorrhoids or pus leaks from the hemorrhoids then you should seek medical attention at a hospital as soon as possible. 

For vulvodynia, medical attention can be sought when pain is persistent in the area and lasts for several days. 

Summary 

Hemorrhoids are caused by damage to the tissue surrounding the anal cushions. These can be within the anal canal or present externally, and can be painful or painless. A common symptom is bright red blood after going to the toilet. After diagnosis, it can be treated with surgical or non-surgical options.

Vulvar pain is a condition known as vulvodynia which affects the opening of the vagina. The cause of the condition is often unknown. Nonetheless, it can be a particularly uncomfortable condition which can be treated with home remedies such as pelvic floor therapy.

Despite the two conditions occurring in the similar area of the body, there is no relation between the two.

References

1. Riss S, Weiser FA, Schwameis K, Riss T, Mittlbock M, Steiner G, et al. The prevalence of hemorrhoids in adults. International Journal of Colorectal Disease. 2012;27(2):215-20.
2. Lohsiriwat V. Hemorrhoids:: From basic pathophysiology to clinical management. World Journal of Gastroenterology. 2012;18(17):2009-17.
3. Kalkdijk J, Broens P, ten Broek R, van der Heijden J, Trzpis M, Pierie JP, et al. Functional constipation in patients with hemorrhoids: a systematic review and meta-analysis. European Journal of Gastroenterology & Hepatology. 2022;34(8):813-22.
4. Esmatullah, Baseera. Occurrence of Hemorrhoids and Anal Fissures through Pregnancy and Postpartum. Journal of Pharmaceutical Research International. 2021;33(43A):357-60.5.     Barnabei VM. Vulvodynia. Clinical Obstetrics and Gynecology. 2020;63(4):752-69.

Hemorrhoids in women – symptoms and treatment

Contents

1. Introduction 2. Hemorrhoids in women: causes 3. Symptoms of hemorrhoids in women 4. Stages of the disease 5. Classification of the disease 6. Diagnosis of hemorrhoids in women 7. Methods for the treatment of hemorrhoids 8. Prevention of hemorrhoids in women 9. Rehabilitation after hemorrhoids

In a healthy state, the cavernous cavities fill with blood when straining during defecation. This process ensures the passage of feces through the rectum and anus without injuring them. With the loss of elasticity of the walls of blood vessels, they are deformed and begin to hold the incoming blood.

When carrying a fetus, a woman experiences a huge load on all systems and the body undergoes changes. During childbirth, the body experiences tremendous pressure, which accounts for 80% of cases in a woman.

According to statistics, women develop hemorrhoids 4 times less often than men. Scientists attribute such gender discrimination to a natural feature of the capillary walls. In women, they are more elastic, and therefore they are able to withstand a large load under pressure without deforming.

Hemorrhoids in women: causes

They can be divided into general and inherent only to the female sex.

Common reasons include:

• fast foods and other junk food;
• Deficiency of foods rich in fiber, resulting in thickening of the feces, forcing the patient to push, increasing pressure on the blood vessels of the anus;
• bad habits, including sitting on the toilet for a long time reading;
• overweight;
• sedentary lifestyle and sedentary work;
• diarrhea or constipation;
• oncology;
• transferred operation;
• genetics;
• heavy physical activity.

One of the factors in the development of the disease, inherent only in women, is pregnancy. During this period, the enlarged uterus creates additional pressure on the rectum as a whole. Hormonal changes lead to weight gain, hypotension of the muscles of the anus and anus. As a result, when straining, popularly known “bumps” appear.

Symptoms of hemorrhoids in women

Symptoms can be divided into general and dependent on the degree.

So, the common features are:

1. Bleeding. It can be plentiful or insignificant (up to a few drops left on paper or underwear). Isolation of blood is noticed by the patient after defecation. With heavy bleeding, blood can be retained by the sphincter in the rectum and come out in clots. In the later stages, bleeding leads to anemia or persistent anemia that requires a blood transfusion.
2. Loss of “bumps”. Hemorrhoids cause inconvenience and discomfort. Periodically become inflamed and become a receptacle for thrombosis.
3. Itching and irritation. Occur when mucus gets on the delicate skin around the anus. Mucus is produced by goblet cells, which are located on the hemorrhoids. As the size of the node increases, the amount of mucus produced also changes. Itching and irritation without other symptoms may indicate helminths.
4. Burning, pain in the anus and perineum. The patient begins to experience them to 2 – 3 stages. These are the most common symptoms that cause significant discomfort to the patient and worsen the quality of life. During an attack, even a simple car ride becomes a real test for the patient. Sharp pain can signal the presence of anal fissures and their infection. On palpation, thrombosed hemorrhoids are enlarged, dense and painful.

In the acute period, patients notice swelling and pressure in the anus. May be accompanied by the urge to defecate and urinate. In the chronic form, an attack of acute hemorrhoids is caused by constipation, diarrhea, physical overstrain (for example, strong sneezing or laughter), stress.

Disease stages

In medicine, it is customary to classify the stages of the disease by degrees. Each of them has its own symptoms and therapy.

First

Accompanied by short-term bleeding, mild discomfort with any overvoltage. The patient may be offered sclerotherapy and photocoagulation, for example. But at the initial stage, preference is given to conservative (drug) therapy.

Second

It is characterized by prolapse of hemorrhoids, bleeding does not always occur. Dropped nodes are absorbed on their own. At the second stage, conservative methods of treatment are acceptable in combination with low-traumatic techniques. For example, sclerotherapy, photocoagulation, ligation.

Third

It is characterized by dystrophic changes in the sphincter, itching, burning, bleeding. Due to the weakening of the muscles of the anus, the fallen nodes have to be set independently. Medication alone is not enough at this stage. A complex of surgical and low-traumatic techniques is used.

Fourth

Knots are not set either on their own, or forcibly. With slight tension, bleeding may occur. The inflammatory process affects nearby tissues. The only effective way to treat hemorrhoids in the fourth stage is surgery.

Disease classification

Depending on the nature of the course, hemorrhoids can be acute or chronic. According to the place of deployment – internal, external and combined. According to the presence of complications – complicated and uncomplicated.

Internal hemorrhoids

Internal hemorrhoids are covered with cells identical to intestinal cells and are located above the comb line.

The nodes are painless and not visible. They are located inside the anal canal. It is possible to recognize the pathology at an early stage by small bleeding after a bowel movement.

Diagnosis without sigmoidoscopy is impossible. Due to the frequent absence of obvious symptoms, the disease rapidly flows into a chronic form.

After childbirth, 80% of women develop rectal varicose veins, and the more often a woman gives birth, the higher the chance of developing pathology.

The formation of internal hemorrhoids directly depends on the lifestyle and diet of a woman. A sedentary lifestyle and sedentary work (as well as increased physical activity and standing work) with improper nutrition without enough fiber cause hypertension of the venous vessels of the rectum and stagnation of blood in the small pelvis. As a result, irritation and thinning of the mucous membrane of the organ occurs. Blood begins to flow into the cavernous bodies, and septa that hold it are formed.

External hemorrhoids

Occurs below the comb line and is covered with cells similar to the dermis.

Manifested by the presence of nodes that protrude from the anus. Due to circulatory disorders, stagnation is formed. Stagnation leads to pain, thrombosis and inflammation.

With thinning of the skin on the seal (thrombus), the tissue breaks and the clot comes out along with a portion of blood.

Acute hemorrhoids

The form under consideration is characterized by thrombosis and phlebitis (inflammation). Since both processes are complex in medicine, it is customary to use the general term – thrombophlebitis.

With thrombophlebitis, the “bumps” become painful and dense. When defecation is dense fecal masses, the intensity of pain in the rectum and anus increases.

Chronic hemorrhoids

For the chronic form, acute pain is not typical. Patients are more likely to experience burning and itching in the anus. The disease develops imperceptibly, without much discomfort. If left untreated, it leads to a weakening of the tone of the sphincter muscles, degenerative changes in the ligamentous apparatus of the rectum, degeneration of the walls of blood vessels (including lymphatic ones).

Diagnosis of hemorrhoids in women

Diagnosis consists in excluding oncology, examining the anus, taking an anamnesis, and establishing the cause of development.

The examination includes a rectal examination. The proctologist feels the nodes and other abnormal formations. With inflammation and severe pain, a rectal examination may be rescheduled.

If the doctor decides that soreness and bleeding are not related to external hemorrhoids, the patient undergoes an anoscopy. During this procedure, a tube with a flashlight is inserted into the anus.

If there is suspicion that the source of bleeding is in other areas of the intestine, the patient is redirected to a gastroenterologist, where he undergoes a sigmoidoscopy or colonoscopy.

Additionally, ultrasound of the pelvic organs, ultrasound of the abdominal organs may be required.

In addition to the instrumental examination, the patient gives feces (for occult blood), KLA (the doctor is interested in the level of hemoglobin), OAM, a blood coagulation test. According to the results of the coagulogram, blood thinners may be prescribed.

Treatments for hemorrhoids

Directions for the treatment of pathology can be divided into medication, using minimally invasive techniques, surgical (radical) and complex (when several are used).

In each case, the treatment strategy is selected by the proctologist depending on the type of disease, its stage, the presence of complications and the individual characteristics of the patient.

In the initial stages, it is most often possible to resolve the issue with conservative therapy (drugs). For the speed of getting rid of the disease, minimally invasive techniques can be applied comprehensively. At stages III and IV, the patient is shown minimally invasive techniques and a full-fledged operation. Medication alone will not solve the problem. If hemorrhoids are in an acute form, then conservative therapy is first prescribed, and then surgical intervention.

Now about the treatment of hemorrhoids in women in more detail.

Conservative therapy

It consists in carrying out a set of activities:

1. Taking medication. It can be tablets, ointments, suppositories that relieve inflammation, swelling, pain, itching. The goals of the reception are the elimination of symptoms and consequences, the prevention of the re-development of hemorrhoids, the restoration of blood circulation, the prevention of thrombosis.
2. LFC. Special exercises disperse congestion and increase blood circulation in the pelvic area and lower intestine.
3. Stool normalization. For this purpose, the patient is given recommendations for establishing proper nutrition and a diet is prescribed. If the diet is not enough, then the patient is prescribed laxatives or fasteners.
4. Extra hygiene. In addition to daily washing, after defecation, patients are advised to use wet wipes (without alcohol), soft toilet paper, and a hygienic shower.
5. Clothing revision. To ensure normal lymph flow and blood flow, clothing should be loose, not tight. When choosing underwear, you should give preference to natural fabrics without tight elastic bands.

In case of ineffectiveness of conservative therapy and if you suspect the progression of the disease, you should immediately see your doctor.

Minimally invasive techniques

They are used at any stage as an independent therapy or as part of a complex one. Unlike classical surgery, they are distinguished by good tolerability and quick rehabilitation.

These methods can be:

• ligation – constriction of the stem of the hemorrhoidal node with a latex ring. In the absence of recharge, the knot dries out and falls off during defecation;
• sclerotherapy (sclerotherapy) – the introduction of a sclerosant into the node to stop the flow of blood into it;
• infrared wave coagulation – the use of infrared waves for the purpose of hyperthermia of the soft tissues of the node with its subsequent drying;
• deserterization – the legs of the node are stitched with threads, after which, left without replenishment, it dies, dries up and falls off.

Despite the high efficiency, the use of low-traumatic techniques will not protect against relapses and progression of the disease.

Surgical removal of hemorrhoids

The radical method of treatment is used at later stages, when conservative and minimally invasive techniques no longer help. The latter can be used additionally in combination with surgical techniques. These methods include:

• laser removal – the main advantages of the method are the speed of healing, the absence of postoperative complications, the complete restoration of nearby tissues;
• hemorrhoidopexy (Longo operation) – used to treat internal hemorrhoids. The point is to remove the soft tissues adjacent to the node, after which, when they heal, the wall is pulled up and the cavernous bodies fall off;
• radical hemorrhoidectomy (Milligan-Morgan operation) – nodes and adjacent deformed soft tissues are completely removed. After that, the leg of the hemorrhoid is tightened, and the mucous membrane (after treatment with an antiseptic) is left until complete self-healing (scarring). It is performed under general or strong local anesthesia. After the operation, the patient is under the supervision of doctors in the hospital;
• HAL-RAR method – the action on the “bumps” with ultrasound, as a result of which their blood supply is interrupted, followed by death. This method ensures the complete destruction of the nodes and the cessation of bleeding. Blood circulation in sclerosed nodes is not restored, which avoids progression and relapses.

Radical treatments are not for everyone. Absolute contraindications are violation of blood coagulation, diabetes, epilepsy and other dangerous diseases. In this connection, it is strongly recommended not to delay visiting a proctologist at the first symptoms.

Prevention of hemorrhoids in women

The most effective treatment is prevention.

To prevent the disease, it is important to follow the recommendations, especially during pregnancy:

• observe the drinking regimen;
• food should be rich in fiber and vitamins;
• use mild laxatives for constipation, and fasteners for diarrhea;
• do gymnastics regularly, but avoid overwork;
• timely treat diseases of the gastrointestinal tract and pelvic organs;
• avoid psycho-emotional overload and stressful situations;
• during childbirth, listen to the doctor’s recommendations and do not overdo it when trying.

Nature has prepared a woman for bearing and giving birth to offspring. Therefore, the venous vessels in women are more enduring than in men. If you follow simple rules, the likelihood of developing hemorrhoids in women is significantly reduced.

Rehabilitation after hemorrhoids

As a general rule, rehabilitation lasts 2-3 weeks. In difficult cases, it can take up to 8 weeks.

The main goal of rehabilitation is to restore stool and intestinal motility. The complex of measures will include the introduction of a diet and taking medications. Physical activity will be contraindicated for the patient, and it will also be impossible to sit for several days.

The general principles of rehabilitation after surgical removal of nodes include:

• bed rest for several days;
• you can not strain the press and get up abruptly;
• restoration of sports activities not earlier than after 2 weeks;
• additional hygiene required – cool hygienic shower after defecation;
• use of special devices for patients with sedentary work;
• abstinence from sexual intercourse for up to 3 weeks.

Depending on the situation, the doctor may recommend additional rehabilitation measures that can alleviate the patient’s condition.

FAQ

Proctological examination is performed with minimal discomfort for the patient. The diagnosis is made by the doctor, based on the testimony of sigmoidoscopy and anoscopy. These are absolutely painless procedures. Colonoscopy in some cases can be done with anesthesia. But it can not be carried out during pregnancy (with rare exceptions, with a direct threat to life and health).

Hemorrhoids are not the norm either at 20, or at 50, or even at 90, since hemorrhoids are a pathology! Risk factors for the development of the disease include: a sedentary lifestyle, constipation, poor nutrition, smoking, etc. And with the advent of smartphones and computers, the activity of young people has sharply decreased, and the time for reading during defecation and static sitting has increased.

Hemorrhoids are considered a chronic disease. By identifying the symptoms in the early stages and the correct behavior of the patient, an exacerbation can be avoided for a long period of time. But the disease tends to aggravate and progress if left untreated.

Most often, complications of hemorrhoids are manifested in the form of hemorrhoidal bleeding and thrombosis of the node. All this is accompanied by intense pain and causing significant discomfort. Frequent heavy bleeding leads to anemia, which may necessitate a blood transfusion procedure.

During this period, the doctor can interview and advise the patient. Only in life-threatening cases, a specialist will perform a rectoscopy or other instrumental diagnostic method.

Menstruation is a reason for transferring not only diagnostics, but also surgical methods of treatment, including minimally invasive ones.

similar symptoms and differences. Diagnostic methods

Hemorrhoids are one of the most common proctological problems. Every third person over the age of 40 is faced with varicose veins of the rectum. This is due to the constant action of negative factors inherent in modern society (a sedentary lifestyle, malnutrition, etc.). Along with the increase in the number of primary visits for hemorrhoids, statistics indicate an increase in cases of rectal cancer, so some patients tend to associate these two diseases.

How cancer is similar to hemorrhoids

To date, there are no studies that would confirm the relationship between hemorrhoids and rectal cancer. Nevertheless, they have a similar clinical picture, which fully justifies the suspicions that arise. Common symptoms for these diseases are:

• Red blood in the stool or bleeding after a bowel movement.
• Tenesmus (frequent urge to defecate, in which the need for it may not be).
• Sensation of incomplete emptying of the bowels after a bowel movement.
• Sensation of a foreign object in the rectum.
• Anemia on blood tests.
• Discharge of mucus from the rectum.

Often, patients are afraid of the increase in unpleasant symptoms due to the development of hemorrhoids: discomfort in the anus becomes more frequent, hemorrhoids begin to fall out, prolonged bleeding may begin due to their injury. Such a development of the disease leads the patient to the idea of ​​the presence of oncopathology of the rectum.

What is the difference between cancer and hemorrhoids

There are a number of differences between rectal cancer and hemorrhoids. Among them are:

• Cancers are more common in people over fifty, while hemorrhoids may appear at a younger age.
• In cancer, streaks of blood are found in the feces during defecation, while in hemorrhoids, bleeding can open without injury, on its own.
• In cancer, anemia is more severe, and the decrease in red blood cells and hemoglobin does not correspond to blood loss.
• In cancer of the rectum, a large amount of mucus is excreted in the feces.
• Bleeding in rectal cancer is noted at the beginning of the act of defecation, with hemorrhoids – at the end.
• With hemorrhoids, only the patient’s quality of life suffers, while his general condition remains unchanged. The appearance of excessive weakness and fatigue, unmotivated weight loss may indicate the development of a malignant process.

Only a doctor can make an accurate diagnosis and make a final verdict on the nature of the pathology after taking a detailed history and conducting the necessary studies.

Diagnostic methods for diseases of the rectum

In order to make sure that there is no tumor pathology, the doctor conducts a detailed survey of the patient and then proceeds to diagnostic measures. The examination plan may include the following methods:
1. Digital rectal examination. With hemorrhoids, varicose nodes are usually located close enough to the anus, which makes it possible for them to be palpated by a doctor. Hemorrhoids are palpated as elastic formations with clear, smooth contours that can be easily moved with a finger. A malignant tumor is a dense, without smooth edges, tuberous, soldered to the surrounding tissues and non-displaceable structure, which most often rises above the rest of the intestinal wall. Large oncological formations can completely close the intestinal lumen, thus causing intestinal obstruction.
2. Instrumental methods of diagnostics. These include anoscopy, sigmoidoscopy, irrigoscopy, CT, MRI, etc. Using these types of studies, you can visually assess the size of the pathological focus, its exact location, and study the condition of the surrounding tissues.

Although hemorrhoids are not as serious and life-threatening as rectal cancer, it is important to see a doctor at the first sign of it. Timely diagnosis and treatment of the disease help to avoid the development of decompensation, bleeding and the need for surgical treatment. Detection of a malignant tumor at an early stage greatly simplifies subsequent treatment and improves the further prognosis.