What are the key differences between colon cancer and hemorrhoid symptoms. How can you tell if stomach pain is related to internal hemorrhoids or something more serious. What are the risk factors and warning signs to watch out for with hemorrhoids and colon cancer.

Understanding Hemorrhoids: Causes, Types, and Symptoms

Hemorrhoids are swollen, dilated blood vessels located in the lower rectum and anus. They occur when there is increased pressure in the blood vessels of the anorectal area, often due to factors like pregnancy, heavy lifting, or straining during bowel movements. Constipation can contribute to this strain and pressure.

There are two main types of hemorrhoids:

• Internal hemorrhoids: Form above the junction between the anus and rectum
• External hemorrhoids: Form below the anorectal junction

Both types can remain inside the anus or protrude outside. External hemorrhoids typically form a visible lump on the anus, while internal hemorrhoids are often not visible but can cause bleeding.

Common Symptoms of Hemorrhoids

The symptoms of hemorrhoids can vary depending on whether they are internal or external:

• Bleeding during bowel movements (especially with internal hemorrhoids)
• Pain or discomfort, particularly with external hemorrhoids
• Itching or irritation in the anal area
• A feeling of fullness or pressure in the rectum
• Visible lumps or swelling around the anus (external hemorrhoids)

Can hemorrhoids cause stomach pain? While hemorrhoids themselves typically do not cause stomach pain, the discomfort and pressure they create in the rectal area can sometimes be mistaken for lower abdominal pain. Additionally, the straining associated with hemorrhoids can lead to abdominal discomfort.

Differentiating Hemorrhoid Symptoms from Colon Cancer

While hemorrhoids are generally benign, it’s crucial to distinguish their symptoms from those of more serious conditions like colon cancer. Both conditions can cause rectal bleeding, which is why it’s important to consult a healthcare professional for proper diagnosis.

Key Differences in Symptoms

How can you tell if your symptoms are from hemorrhoids or potentially colon cancer?

• Bleeding: Hemorrhoid bleeding typically occurs during bowel movements and appears bright red. Colon cancer bleeding may be darker in color and occur more frequently.
• Pain: Hemorrhoids can cause discomfort, especially when thrombosed, but the pain is usually localized. Colon cancer may cause more persistent abdominal pain or cramping.
• Changes in bowel habits: While hemorrhoids can cause some changes, colon cancer often leads to more significant and lasting changes in bowel habits.
• Weight loss: Unexplained weight loss is more commonly associated with colon cancer than hemorrhoids.
• Fatigue: Persistent fatigue is more likely to be a symptom of colon cancer, possibly due to chronic blood loss.

Are there any symptoms that definitively indicate colon cancer rather than hemorrhoids? While no single symptom can definitively diagnose colon cancer, certain red flags should prompt immediate medical attention:

• Blood in stool that appears dark or tarry
• Persistent changes in bowel habits lasting more than a few weeks
• Unexplained weight loss
• Severe abdominal pain or cramping
• Feeling like the bowel doesn’t empty completely

Diagnosis and Evaluation of Hemorrhoids

Proper diagnosis of hemorrhoids is essential for appropriate treatment and to rule out more serious conditions. Healthcare providers typically use the following methods to diagnose hemorrhoids:

Physical Examination

A doctor can often diagnose external hemorrhoids through a visual inspection of the anus. They may also perform a digital rectal exam to feel for abnormalities inside the rectum.

Anoscopy

An anoscope is a short, rigid tube used to examine the anal canal and lower rectum. This tool allows the doctor to visualize internal hemorrhoids and assess their severity.

Sigmoidoscopy or Colonoscopy

In cases of rectal bleeding or to rule out other conditions, a doctor may recommend a sigmoidoscopy or colonoscopy. These procedures use a flexible tube with a camera to examine the colon and rectum more thoroughly.

How accurate are these diagnostic methods for identifying hemorrhoids? While visual inspection and anoscopy are generally very accurate for diagnosing hemorrhoids, colonoscopy remains the gold standard for ruling out other colorectal conditions, including cancer.

Treatment Options for Hemorrhoids

The treatment of hemorrhoids depends on their severity and the symptoms they cause. Many cases of hemorrhoids can be managed with conservative treatments and lifestyle changes.

Conservative Treatments

• Fiber supplements and stool softeners to ease bowel movements
• Sitz baths to soothe the affected area
• Over-the-counter creams and suppositories for pain relief
• Ice packs to reduce swelling

Minimally Invasive Procedures

For more persistent or severe hemorrhoids, several minimally invasive procedures are available:

• Rubber band ligation: A small rubber band is placed around the base of the hemorrhoid to cut off its blood supply
• Injection sclerotherapy: A chemical solution is injected into the hemorrhoid to shrink it
• Infrared photocoagulation: Infrared light is used to create scar tissue, cutting off the blood supply to the hemorrhoid

Surgical Options

In rare cases where conservative treatments and minimally invasive procedures are ineffective, surgical removal of hemorrhoids (hemorrhoidectomy) may be necessary.

What is the success rate of these treatments for hemorrhoids? Conservative treatments are often effective for mild to moderate hemorrhoids. Minimally invasive procedures have success rates of 70-80% for most patients. Surgical hemorrhoidectomy has a very high success rate but is reserved for the most severe cases due to its longer recovery time.

Preventing Hemorrhoids and Reducing Recurrence

While not all cases of hemorrhoids can be prevented, several lifestyle changes can help reduce the risk of developing hemorrhoids or experiencing recurrences:

• Increase fiber intake through diet or supplements
• Stay hydrated by drinking plenty of water
• Exercise regularly to promote good bowel function
• Avoid straining during bowel movements
• Don’t sit on the toilet for extended periods
• Maintain a healthy weight

How effective are these preventive measures in reducing the risk of hemorrhoids? While no prevention method is 100% effective, studies have shown that increasing fiber intake and maintaining good bowel habits can significantly reduce the risk of hemorrhoid development and recurrence.

When to Seek Medical Attention for Hemorrhoid Symptoms

While many cases of hemorrhoids can be managed at home, certain symptoms warrant prompt medical attention:

• Persistent bleeding during bowel movements
• Severe pain or discomfort that doesn’t respond to over-the-counter treatments
• Large, painful external hemorrhoids
• Any rectal bleeding, especially if you’re over 40 or have a family history of colorectal cancer
• Changes in bowel habits lasting more than a few weeks

What are the potential complications of untreated hemorrhoids? While hemorrhoids are generally not dangerous, leaving them untreated can lead to complications such as:

• Anemia from chronic blood loss
• Strangulated hemorrhoids, where the blood supply is cut off
• Infection of thrombosed external hemorrhoids
• Difficulty with hygiene and increased risk of skin irritation

Colon Cancer: Risk Factors and Screening Recommendations

While hemorrhoids are a common and usually benign condition, it’s important to be aware of the risk factors for colon cancer and follow appropriate screening guidelines.

Risk Factors for Colon Cancer

• Age: The risk increases significantly after age 50
• Family history of colorectal cancer or polyps
• Personal history of inflammatory bowel disease
• Obesity
• Sedentary lifestyle
• Diet high in red and processed meats
• Smoking and heavy alcohol use

Screening Recommendations

The American Cancer Society recommends that people at average risk of colorectal cancer start regular screening at age 45. Several screening options are available, including:

• Colonoscopy every 10 years
• Stool-based tests (such as FIT or gFOBT) every year
• CT colonography every 5 years
• Flexible sigmoidoscopy every 5 years

How effective is early screening in preventing colon cancer deaths? Regular screening can prevent many colorectal cancer deaths by detecting precancerous polyps or cancer at an early, more treatable stage. Studies have shown that colonoscopy screening can reduce the risk of dying from colorectal cancer by up to 70%.

Living with Hemorrhoids: Management and Quality of Life

For many people, hemorrhoids can be a recurring issue that requires ongoing management. Here are some tips for living comfortably with hemorrhoids:

• Maintain good hygiene practices, using gentle, unscented wipes or washing with warm water after bowel movements
• Use a donut cushion when sitting for long periods to relieve pressure on the anal area
• Apply cold compresses or take warm baths to alleviate discomfort
• Wear loose, breathable clothing to reduce irritation
• Consider using over-the-counter hemorrhoid creams or suppositories for symptom relief
• Practice pelvic floor exercises to improve muscle tone in the anal area

Can hemorrhoids impact your overall quality of life? While hemorrhoids are not life-threatening, they can significantly affect comfort and daily activities. However, with proper management and treatment, most people can maintain a good quality of life despite recurring hemorrhoids.

Emotional and Psychological Impact

It’s important to acknowledge that hemorrhoids can have emotional and psychological effects. Some individuals may experience:

• Embarrassment or anxiety about symptoms
• Stress related to managing the condition
• Concerns about intimacy or physical activities

If hemorrhoids are causing significant distress, it may be helpful to speak with a healthcare provider or counselor for support and coping strategies.

In conclusion, while hemorrhoids and colon cancer can share some similar symptoms, they are distinct conditions with different implications for health and treatment. Being aware of the differences, knowing when to seek medical attention, and following recommended screening guidelines can help ensure proper diagnosis and care. With appropriate management, most people with hemorrhoids can effectively control their symptoms and maintain a good quality of life. However, any persistent or concerning symptoms should always be evaluated by a healthcare professional to rule out more serious conditions.

Hemorrhoids – Digestive Disorders – Merck Manuals Consumer Version

By

Parswa Ansari

, MD, Hofstra Northwell-Lenox Hill Hospital, New York

Reviewed/Revised Jan 2023

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Topic Resources

Hemorrhoids are dilated, twisted blood vessels located in the wall of the lower rectum and anus.

• The swollen vessels are caused by an increase in pressure.

• Lumps form inside or outside of the anus, which can cause pain or bleeding.

• The diagnosis is based on an examination of the anus and rectum, often with an anoscope, sigmoidoscope, or colonoscope.

• Most hemorrhoid symptoms go away without treatment, but fiber, stool softeners, and sitz baths can help relieve them.

• Some hemorrhoids are treated with a rubber band procedure, injection sclerotherapy, or infrared photocoagulation or sometimes surgery.

The rectum is the section of the digestive tract above the anus where stool is held before it passes out of the body through the anus.

The anus is the opening at the end of the digestive tract where stool leaves the body.

(See also Overview of the Anus and Rectum Overview of the Anus and Rectum The anus is the opening at the end of the digestive tract where stool leaves the body. The rectum is the section of the digestive tract above the anus where stool is held before it passes out… read more .)

Hemorrhoids occur when the blood vessels in the lower rectum or anus become enlarged.

Internal hemorrhoids are hemorrhoids that form above the junction between the anus and rectum (anorectal junction).

External hemorrhoids are hemorrhoids that form below the anorectal junction.

Both internal and external hemorrhoids may remain in the anus or protrude outside the anus.

Increased pressure in the vessels of the anorectal area leads to hemorrhoids. This pressure may result from pregnancy, frequent heavy lifting, or repeated straining during bowel movements (defecation). Constipation Constipation in Adults Constipation is difficult or infrequent bowel movements, hard stool, or a feeling that the rectum is not totally empty after a bowel movement (incomplete evacuation). (See also Constipation… read more may contribute to straining.

External hemorrhoids form a lump on the anus. If a blood clot forms (called a thrombosed external hemorrhoid), the lump becomes larger and is more painful and more swollen than a hemorrhoid that is not thrombosed.

Internal hemorrhoids often do not cause a visible lump or pain, but they can bleed. Bleeding from internal hemorrhoids typically occurs with bowel movements, causing blood-streaked stool or toilet paper. The blood may turn water in the toilet bowl red. However, the amount of blood is usually small, and hemorrhoids rarely lead to severe blood loss or anemia.

Hemorrhoids may discharge mucus and create a feeling that the rectum is not completely emptied after a bowel movement. Itching in the anal region (anal itching Anal Itching Itching of the anus (the opening at the end of the digestive tract where stool leaves the body) and the skin around the anus (perianal skin) is called anal itching or pruritus ani. (See also… read more or pruritus ani) is usually not a symptom of hemorrhoids, but itching may develop if hemorrhoids make proper cleansing of the anal region difficult.

Hemorrhoids may become inflamed or thrombosed. Internal hemorrhoids may bleed.

A doctor can readily diagnose swollen, painful hemorrhoids by inspecting the anus and rectum.

An examination with an anoscope (a short, rigid tube used to view the rectum) is done to evaluate painless or bleeding hemorrhoids. People who have bleeding from the rectum may require a sigmoidoscopy or colonoscopy (see Endoscopy Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). In addition to examinations, doctors can use endoscopy to do biopsies and give treatment. Endoscopes… read more ) to rule out a more serious condition, such as a tumor.

• Stool softeners and sitz baths

• For external thrombosed hemorrhoids, removal of blood clot

• For internal hemorrhoids, injection sclerotherapy, rubber band ligation, or infrared photocoagulation

• Sometimes surgical removal

Usually, hemorrhoids do not require treatment unless they cause symptoms. Taking stool softeners or bulking the stools with fiber supplements (such as psyllium) may relieve straining with bowel movements. Hemorrhoid symptoms can sometimes be relieved by soaking the anus in warm water in what is known as a sitz bath. The soaking is accomplished by squatting or sitting for 10 to 15 minutes in a partially filled tub or using a container filled with warm (not hot) water placed on the toilet bowl or commode.

For external thrombosed hemorrhoids, especially those that cause severe pain, a doctor may inject a local anesthetic Local anesthesia and regional anesthesia Surgery is the term traditionally used to describe procedures (called surgical procedures) that involve manually cutting or stitching tissue to treat diseases, injuries, or deformities. However… read more to numb the area and cut out the blood clot or hemorrhoid, which sometimes relieves the pain more rapidly.

Taking acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) can help alleviate the pain of a thrombosed hemorrhoid. Local anesthetic ointments or witch hazel compresses also may help. Pain and swelling usually diminish after a short while, and clots disappear over 4 to 6 weeks.

For bleeding internal hemorrhoids, a doctor can inject a substance that causes scar tissue to form and destroy the hemorrhoids. This procedure is called injection sclerotherapy. An alternative to injection sclerotherapy is infrared photocoagulation. During this procedure, an infrared light is used to treat bleeding hemorrhoids.

Large internal hemorrhoids and those that do not respond to injection sclerotherapy can be tied off with rubber bands (a procedure called rubber band ligation). The band causes the hemorrhoid to wither and drop off painlessly. One hemorrhoid is treated about every 2 weeks.

Banding a Hemorrhoid

Surgery to remove the hemorrhoids may be used if other treatments do not work. However, hemorrhoid surgery (called hemorrhoidectomy) may result in severe pain, as well as urine retention and constipation.

Another technique is called circumferential stapled hemorrhoidopexy, in which a circular surgical stapler is used. This technique causes less pain after it is done, but it may result in a higher rate of complications than conventional surgical hemorrhoidectomy, and hemorrhoids may return.

Other methods to destroy internal hemorrhoids, such as Doppler-guided hemorrhoid artery ligation, are being tried. In this method, hemorrhoid arteries are identified using ultrasonography and tied off with a suture, thus reducing the blood supply to the hemorrhoids.

Treatments using lasers, freezing probes, or an electrical current (electrocoagulation) are unproved. Rubber band ligation is still the standard treatment.

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Hemorrhoid Symptoms & Treatment | Advocate Health Care

Hemorrhoids affect many people in this country. Most of us have heard about them but some of us may not be entirely sure what they are. At Advocate Health Care, we can offer tips on how to deal with hemorrhoids yourself and suggest when you may want to seek care from one of our expert gastroenterologists.

What is a hemorrhoid?

A hemorrhoid is an inflamed or swollen vein in the skin around the outside of the anus (the opening that allows bowel movements to exit the body) or inside the colon. Hemorrhoids inside the colon are called internal hemorrhoids. Those outside the body are called external hemorrhoids.

External hemorrhoids may be reddish or skin colored. Internal hemorrhoids are formed on mucous membranes that line the inside of the colon, so they are usually reddish.

Sometimes hemorrhoids have blood clots inside them. They may take on a blue, purple, black, grey or dark brown color, depending on your normal skin tone. These are called thrombosed hemorrhoids and they can be very painful.

You usually won’t see an internal hemorrhoid. You may not know you have it unless a health care provider tells you about it after an exam or after a procedure like a colonoscopy. Sometimes you’ll see an internal hemorrhoid if part of it gets pushed out through the anus (prolapsed) during a bowel movement. A prolapsed hemorrhoid usually goes back inside the body when the straining is over. If it doesn’t, you may be able to gently push it back inside.

Any kind of hemorrhoid is likely to be uncomfortable, annoying and sometimes extremely painful.

Hemorrhoid causes and hemorrhoid risk factors

Some of the things that can contribute to hemorrhoids are:

• Straining during bowel movements
• Lifting heavy objects frequently at work or at home
• Eating foods low in fiber
• Having chronic diarrhea or constipation
• Being obese
• Smoking

• Being pregnant
• Being older than 50
• Anal sex
• Sitting for long periods of time (either for work or while on the toilet)
• Having a family history of hemorrhoids

Hemorrhoid symptoms

Internal hemorrhoids often have no symptoms. Or you may notice bright red blood on toilet paper or in the toilet bowl after a bowel movement. Hemorrhoids are a common cause of rectal bleeding, but be sure to check with your doctor about any bleeding because it can also be a symptom of anal fissures, ulcerative colitis, Crohn’s disease or some types of cancer. Hemorrhoids don’t cause any of these other conditions and the treatments for each of them are different.

External hemorrhoids are harder to ignore. You may notice a hard, tender lump and an itchy feeling. Your anus may ache, especially when you’re sitting. There may also be bleeding or swelling. For most people, these hemorrhoid symptoms go away after a few days as long as they avoid straining or too much cleaning or rubbing around the anus.

Complications from hemorrhoids

Complications from hemorrhoids are rare, but can include:

• Thrombosed hemorrhoid: When a blood clot forms inside an internal or external hemorrhoid. May cause extreme pain.
• Skin tags: Skin that remains after a blood clot inside a hemorrhoid is reabsorbed.
• Infection
• Strangulated hemorrhoid: When part of an internal hemorrhoid prolapses (comes out through the anus) and its blood supply is cut off by the muscles of the anus. This can be very painful.
• Anemia: Caused by chronic blood loss.

How to prevent hemorrhoids

You can prevent or treat hemorrhoids with self-care methods like drinking enough water and eating foods that are high in fiber (beans, nuts, seeds, whole grains, fresh fruits and vegetables). At the same time, minimize eating red meats and processed foods as well as alcohol consumption. Don’t smoke.

Avoid straining during bowel movements. Avoid too much heavy lifting. Walking can help your digestion so that your bowel movements are softer and easier to pass. Always use the toilet as soon as you feel the urge.

Home treatments for hemorrhoids

The tips for prevention can also help if you develop hemorrhoids. You can add some of these strategies:

• Sitting in a shallow bath of warm water (sitz bath) several times a day can relieve pain
• Taking a stool softener or a fiber supplement
• Taking over-the-counter nonsteroidal pain relievers to relieve pain
• Using over-the-counter hemorrhoid creams, ointments or suppositories
• Applying ice packs to reduce pain and swelling

Seek medical help if you have severe pain, bleeding or hemorrhoid symptoms that don’t resolve after a week of at-home treatments. There are other causes for rectal pain or bleeding, and the treatments for them are different than the treatments for hemorrhoids.

Hemorrhoid diagnosis

Your health care provider will perform a thorough physical, including asking about your general health history and any hemorrhoid symptoms. They’ll ask about any treatments you’ve already tried and whether you feel they’ve helped.

They’ll check the appearance of any external hemorrhoids. They may do a digital rectal exam by putting on gloves, applying lubrication and inserting a finger into your rectum to feel for tenderness or lumps and check muscle tone.

They may use an anoscope (short plastic tube) or a sigmoidoscope (flexible lighted tube) to observe more of the colon.

Using all these methods and whatever else is needed, they’ll verify whether you have hemorrhoids or another condition.

Nonsurgical treatment for hemorrhoids

Your doctor may start by suggesting treatments you can try such as some of the ones listed above. They may also suggest prescription medications that are more effective than remedies available over the counter.

Bleeding and persistent hemorrhoids can be treated with minimally invasive procedures such as:

• Rubber band ligation: Your doctor puts one or two small medical-grade rubber bands around the base of a hemorrhoid to cut off its blood flow. You may need more than one banding treatment to get rid of a hemorrhoid. The treated hemorrhoid shrinks and falls off. 
• Sclerotherapy: A chemical is injected into the hemorrhoid to cut off blood supply and cause the hemorrhoid to shrink. Any pain is minimal.
• Cryotherapy: Your doctor applies a cooled gas or liquid to freeze the external hemorrhoid, which then shrinks and falls off.

Surgical treatment for hemorrhoids

Surgery is usually recommended for large hemorrhoids, bleeding or prolapsed internal hemorrhoids, or those that haven’t responded to other treatment. These are usually outpatient procedures but sometimes require an overnight hospital stay. Procedures include:

• Excisional hemorrhoidectomy: This is surgical removal of hemorrhoids. Your doctor makes incisions around the hemorrhoid and removes it while you’re under general anesthesia. You may have pain after the procedure and may need to take it easy for as long as two weeks, but the surgery has a high rate of lasting success.
• Stapled hemorrhoidopexy: This doesn’t involve an incision. Instead, using a device inserted through a tube into your anus, your doctor removes tissue around the hemorrhoid. The hemorrhoid is lifted, and the tissue is stapled back into place. Blood flow to the hemorrhoid is cut off, and it shrinks within four to six weeks. Stapled hemorrhoidopexy takes about 30 minutes under general anesthesia. It’s usually less painful than hemorrhoidectomy and lets you get back to your regular activities faster.

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Treatment of internal hemorrhoids in the proctology clinic

There are two main options: external and internal hemorrhoids. There are some nuances in the diagnosis and treatment. At the same time, the internal one is more difficult to diagnose in the early stages.

How to identify internal hemorrhoids

First, it should be noted that all people without exception have hemorrhoidal plexuses inside the walls of the anal canal. Every person is born with hemorrhoidal plexuses. At the beginning of life, they are small and perform a very important function: they ensure complete closure of the anal canal at rest. So that we don’t have to worry about something leaking from the inside out. The internal plexuses serve as a kind of soft “padding” inside the muscular ring of the anal canal. In addition, when the anal canal needs to be greatly expanded, for example, during the emptying of the rectum, it is the internal hemorrhoidal plexuses that provide protection to the muscles. This is the norm. But the increase in these plexuses, which begins to bring discomfort to its “owner”, can already be called hemorrhoids.

A similar increase in volume can also occur with external plexuses, which are also initially located under the skin outside the anal canal since prenatal development. Read about the diagnosis and treatment of external hemorrhoids on a separate page. Therefore, they separate “internal” and “external” according to where the enlarged plexuses were originally located – inside the anal canal (internal hemorrhoidal plexuses) or outside the anal canal (external hemorrhoidal plexuses). And not by where they are at the time of examination of the patient by a coloproctologist.

Secondly, there are not so many characteristic symptoms for internal hemorrhoids. Internal hemorrhoids are manifested by the fact that it is the internal nodes that increase, which are initially located inside the anal canal from the moment of birth, in the area of ​​\u200b\u200bthe transition of the anal canal to the rectum. Therefore, in the early stages, the disease may not give itself away. But as the plexuses grow further, they can no longer “fit” inside the canal, their retaining system in the form of ligaments stretches, and these nodes can, as it were, “move out” from the inside of the anal canal to the outside. Most often this occurs during the emptying of the rectum during straining. And a person can pay attention to this by feeling a swelling, a “bump”, in general, something “extra” in the anal canal. At this stage, it is very important to correctly diagnose and understand what it really is: a prolapsed node or a thrombosed external hemorrhoid, or a completely different disease, such as an abscess or a fistula of the rectum. This can only be done by a doctor, a coloproctologist, during an examination. Therefore, it is very important for the selection of effective treatment to consult a specialist in a timely manner.

The first thing that should make you wary is the increase and loss of nodes. Other manifestations may be:

• bleeding from the anus during or after stool. Usually people can see blood either on the toilet paper or even the entire toilet bowl splattered with blood. Usually bleeding is not accompanied by pain and therefore is very unexpected for a person.
• discomfort in the anus: itching, burning, pain, discomfort during bowel movements;
• severe soreness, swelling of tissues in the perianal region, which increases after heavy physical exertion, at the end of the working day, after prolonged standing or walking.

Slightly enlarged internal hemorrhoids can rarely be detected by the patient on their own. However, the doctor during the examination can find them by palpation of the anal canal. Sometimes the use of special equipment – an anoscope – is required. With it, you can detect and see even deeply located small plexuses.

Strongly enlarged and prolapsing knots are felt by a person as something superfluous, which interfere with sitting, hygiene of the perianal area, sometimes even painful. But a strong increase in internal hemorrhoids does not occur immediately, but for a long time – several months and even years. Usually, all this time, people try to heal themselves, using suppositories, ointments and other medicines, and sometimes traditional medicine on the advice of friends, acquaintances and a pharmacist in a pharmacy. And they don’t go to the doctor, feeling ashamed to show their intimate places, fear of a painful examination, afraid of the doctor’s rude attitude, that he will ask uncomfortable questions, will shame the person for not turning earlier and starting the disease. The list of reasons and reasons to postpone a visit to the doctor if hemorrhoids are suspected is endless.

What awaits you at the doctor’s appointment

In fact, everything is not as scary as it seems. And many people, after visiting a coloproctologist, exclaim: “And what was I afraid of before?”

A consultation with a coloproctologist for hemorrhoids usually lasts 15 to 30 minutes. And only 2 or 3 minutes of this time is taken by the “most terrible” – the actual examination of the perianal region and the study of the anal canal. The rest of the time is a conversation with a doctor, finding out the possible causes of the disease, determining treatment tactics, discussing recommendations on lifestyle, nutrition, prevention of deterioration, and answering questions.

The first thing doctor will do is to find out from you the whole history of the disease, when you first had problems with hemorrhoids, how the disease manifested itself, what treatments you used and what was their effectiveness, when was the last deterioration, how did it proceed . The doctor will definitely ask about the diet, the features of emptying the rectum, whether there are constipations, how much time you spend in the toilet, if you feel an increase in hemorrhoids – at what time of the day it happens, if there are painful sensations – against the background of what they occur, and many others features of your condition. Be ready to answer all the doctor’s questions so that he can get a complete picture of the disease, how it affects your life and choose the appropriate treatment.

Second, the doctor will invite you for an examination. This may be an examination on a couch in a position on the left side with the knees brought to the stomach. It is not necessary to completely undress for this. Or examination on a gynecological chair. For such an examination, you must completely undress from the waist down. The second option is more preferable, since the doctor can completely examine the entire perineal area, and this is important to exclude concomitant dermatological, venereal and other diseases that can complicate the course of hemorrhoids, or even cause symptoms similar to hemorrhoids. After examining the “eyes”, the doctor will conduct a digital examination of the rectum, during which he gently probes the anal canal and the lower part of the rectum from the inside. It is usually slightly uncomfortable and does not cause severe pain. If the patient has pain in the anal canal, the doctor either does not conduct a digital examination at all, or pre-performs anesthesia so that the procedure is painless for the patient. Sometimes, for a more accurate study of the state of internal hemorrhoids and the anal canal, a special procedure is required – anoscopy. To do this, the doctor will carefully insert a special instrument inside the anal canal – an anoscope, a short tube, through which he will examine the anal canal in detail with his eyes or with the help of a special video camera.

Third, discussing with the patient what the doctor found during the examination, how it relates to the patient’s complaints and symptoms, what treatment options are possible and best suited, what are their advantages and disadvantages, possible negative consequences, whether any – Changes in lifestyle, diet, physical activity and so on. The doctor will describe the important points of the conversation with the patient, the results of the examination, the diagnosis and the proposed treatment.

Causes of internal hemorrhoids

• hereditary predisposition,
• sedentary, sedentary lifestyle;
• strenuous exercise, including sports, e.g. barbell exercises,
• eating disorders: abuse of spices, fatty foods, alcohol;
• overweight and obesity;
• pregnancy and childbirth,
• frequent constipation and the need to strain during the emptying of the rectum.

Stages of internal hemorrhoids

There are several different classifications of hemorrhoids that help doctors select the most appropriate treatment. However, the classification of the English coloproctologist Goliher is the most popular.

According to this classification, there are 4 stages of internal hemorrhoids.

First stage. Internal hemorrhoids are slightly enlarged, located inside the anal canal, do not fall out of it. Sometimes there may be bleeding from them, more often during or immediately after a stool. There is a slight discomfort in the anus, itching, burning.

Second stage. More intense symptoms appear. The node increases in size, its retaining ligaments are stretched, it is already more difficult for the node to constantly be inside the anal canal. When straining, it can go out, but usually, after a stool, after some time, it is set back on its own. There may be bleeding from this hemorrhoid, although internal hemorrhoids may prolapse without bleeding. After a long sitting or physical activity, there may be a feeling of heaviness in the anal canal, even pain, which can persist for a long time.

Third stage. An internal hemorrhoid is so enlarged that it falls out of the anal canal almost every time the rectum is emptied. At the same time, he no longer adjusts back on his own, a person has to refuel him back with his hand. Due to the fact that the node is outside the anal canal for a long time, it comes into contact with the perianal skin, irritates it, itching, constant discomfort may occur. In some cases, there are violations in the work of the sphincter. Due to frequent itching, inflammation appears, scratching is dangerous, because a bacterial infection can join. Bleeding from a constantly prolapsing internal hemorrhoid is more likely.

Fourth stage. Enlarged internal hemorrhoids are constantly outside the anal canal. It is no longer possible to set them even by hand. Often this is accompanied by a simultaneous increase in the external hemorrhoid, this condition is called combined hemorrhoids. The most difficult stage, at this stage it is not always possible to quickly cope with the disease. Often such complexes of hemorrhoids swell, become inflamed, which further complicates the choice of effective treatment.

What happens if you do not treat

Some people do not pay attention to the discomfort that has appeared for a long time or are embarrassed to go to the doctor. The first thing to remember is that once enlarged, internal hemorrhoids will no longer shrink to their original level. They can only increase further or remain as they are. Therefore, it is not necessary to count on the fact that “I will wait, then it will pass by itself”. Over time, it can only get worse: hemorrhoids of the second stage will move into the third, and hemorrhoids of the third stage into the fourth. And if in the initial stages it is possible to cope with the symptoms of internal hemorrhoids with medication, then in the later stages the most effective treatment is only surgical.
Inflammation that develops gradually can lead to edema, thrombosis of internal hemorrhoids, their infringement, persistent pain and severe complications, such as hypertonicity of the anal sphincter, the formation of anal fissures, and even the formation of an abscess – paraproctitis. At this stage, treatment will be difficult, and rehabilitation will be long.

Methods of treatment

Treatment directly depends on the stage of the process.

Conservative treatment

Can be used for all stages. However, its effectiveness depends on the stage. With initial hemorrhoids, conservative treatment may be sufficient, and on the contrary, its effect will be almost zero at stage 4.

Conservative measures include:

• Stool normalization

Often the increase in knots is due to the daily strong straining in the toilet, and this in turn is due to hard stools. People call it “constipation”. Therefore, it is very important to effectively treat hemorrhoids and prevent further deterioration of the situation to have a soft and at the same time formed stool. To do this, it is necessary to include vegetables, fruits and other sources of dietary fiber (vegetable fiber) in the daily diet. Often, special nutritional supplements and medications that a doctor can prescribe during a consultation help to cope well with constipation. It is necessary to drink enough liquid daily, the norm for a relatively healthy adult is up to one and a half to two liters per day.

• Strain relief

Emptying the rectum should take no more than 2-3 minutes and should not be accompanied by straining or discomfort. The first thing that contributes to this is an adequate diet (see above). It also helps to change the habits associated with being in the toilet room – refusal to read, changing posture when emptying. For some people, it is convenient to use a special footrest that is installed next to the toilet and helps to take a squatting position. In this position, excessive straining is usually not required. In addition to the process of emptying the rectum, heavy lifting, prolonged sitting in an uncomfortable position should be avoided. All this contributes to an increase in intra-abdominal pressure, a violation of the outflow of blood from the hemorrhoidal plexuses, an increase and prolapse of hemorrhoids.

• Vessel wall strengthening agents

Preparations from the group of flavonoids (substances derived from citrus fruits) effectively fight varicose veins in the legs, and also strengthen the wall of the hemorrhoidal vascular plexus. This, in turn, allows you to significantly reduce the manifestations of an exacerbation of internal hemorrhoids that have already occurred, as well as to prevent such situations in the future. In pharmacies, you can find a large number of drugs from this group, which differ from each other in terms of indications, mechanism of action, and effectiveness. The doctor should prescribe therapy based on the clinical situation of each patient.

• Creams, ointments and suppositories to stop bleeding

Despite the fact that on the pharmacy shelves you can find a large number of drugs “for hemorrhoids”, among them only a few drugs have a hemostatic effect. They are only needed to stop bleeding from internal hemorrhoids after this bleeding has already happened. They have no other effects. Prevention of bleeding with the help of these means is useless. Therefore, having bought the first medicine “for hemorrhoids” that came across in a pharmacy, you can easily miss, and the treatment will be ineffective. It is important that the treatment of hemorrhoids is prescribed only by a doctor and only after an examination and the necessary examination. Bleeding from the anal canal is a very disturbing symptom. In this case, the doctor must prescribe a colonoscopy to rule out other sources of bleeding.

• Creams, ointments and suppositories for pain relief

If hemorrhoids are accompanied by pain, local anesthetics or glucocorticosteroids, substances that effectively reduce inflammation, can help. Pain in hemorrhoids can be caused by various reasons. If hemorrhoids are combined with an anal fissure, local anesthetics may be an effective treatment. If hemorrhoids are accompanied by inflammation of the hemorrhoids, then simple anesthesia will not help, you need to fight the inflammation. That is why it is so important that the doctor establishes the cause of the pain and the method of its treatment.

• Fall control

Such drugs, unfortunately, have not yet been invented. Internal hemorrhoids fall out of the lumen of the anal canal due to the fact that the thin fibers of the ligaments holding them are stretched. And with the help of tablets, ointments and creams, it is impossible to return the stretched ligaments to their original form. You can either adapt to the condition that is, or act on it surgically. Therefore, it is so important to “not start” the disease, not to bring hemorrhoids to stage 3-4 and consult a doctor in time.

Surgical treatment

There are many ways to deal with the disease surgically. And it doesn’t always mean “cut off”. The so-called minimally invasive methods of treating internal hemorrhoids can reduce the size of internal hemorrhoids and prevent bleeding from them.

Minimally invasive hemorrhoid treatment:

• outpatient
• under local anesthesia
• without cuts
• no pain

Remember! Minimally invasive outpatient treatment of internal hemorrhoids is most effective at the very beginning of the disease, in the early stages. Don’t put off visiting your colonoproctologist. One of the following types of minimally invasive surgical treatment may be right for you.

• Latex ring ligation
• Sclerotherapy
• Desarterization
• Mucopexy
• Laser vaporization

If it is no longer possible to effectively deal with hemorrhoids using minimally invasive techniques, the doctor will suggest a hemorrhoidectomy operation – the removal of one or more nodes.

In terms of treatment effectiveness, hemorrhoidectomy is the most reliable option. This means that more than 95% of patients after surgery forget what hemorrhoids are. For comparison, after minimally invasive treatment, certain manifestations of hemorrhoids can be observed in 30-50% of patients.

Types of operations

Open hemorrhoidectomy

As a method of treating hemorrhoids, this operation, described about 100 years ago, remains the most effective treatment for enlarged, bleeding and prolapsing internal hemorrhoids. After removal of hemorrhoidal tissue, wounds remain inside the anal canal, which will gradually heal on their own.

Removal can be performed with different surgical instruments:

• Ordinary scalpel
• Surgical scissors
• Monopolar coagulator
• Surgitronome (monopolar coagulator version)
• LigaSure Advanced Bipolar Tissue Coagulation Device
• Ultrasonic dissection and coagulation instrument – “harmonic scalpel”

What instrument the surgeon uses during the operation and how carefully and carefully he treats the tissues depends on the time of the operation, the area of ​​the wound surface, the condition of the wounds and the speed of their healing, the intensity of the pain syndrome after the operation. Scientific evidence confirms that the judicious use of high-tech tools for removing hemorrhoids leads to faster recovery, less pain.

Closed hemorrhoidectomy

With this method of performing the operation, the surgeon closes the wound with special threads that remain in the anal canal after the removal of hemorrhoids. The tissue removal itself can be performed using the same methods and tools as during an open hemorrhoidectomy.

In the first days after closed hemorrhoidectomy, the pain syndrome may be less due to the fact that there are no open wounds inside the anal canal. However, often in 2-3 days after the operation, the sutures on the wounds either partially or completely diverge. And wound healing continues in the same way as after an open hemorrhoidectomy. In addition, suturing wounds in the anal canal can lead to its narrowing and the formation of stenosis, which significantly impairs the quality of life and can even lead to disability and repeated plastic surgery.

What will happen after the operation

There are a lot of options for what happens to the patient after the operation. And it depends on the following factors:

• Type of anesthesia during the operation.

If there was local anesthesia, the patient can go home a few hours after the intervention. If there was spinal anesthesia, you will need at least an overnight stay in the hospital.
KKMC has developed and introduced a technique for performing local anesthesia with pudendal nerve blockade, which ensures the absence of pain sensitivity not only during surgery, but also within 1-3 days after surgery.

• Volume and complexity of the operation

Minimally invasive interventions do not require long-term follow-up. But after the removal of 3 hemorrhoids at stage 4 hemorrhoids, the risks of postoperative complications are much higher. Patients may need to be observed in the hospital for several days.

• Type of instruments used by the surgeon during the operation

High-tech instruments (LigaSure, harmonic scalpel, laser) cause less damage to surrounding tissues and faster recovery

• Pain management after surgery

KKMC has developed and successfully applied a complex program of pain relief in the postoperative period, including the combined use of oral agents (painkillers) and topical drugs (creams, suppositories) with analgesic effect. It has been scientifically proven that such a scheme of anesthesia allows you to achieve either a complete absence of pain, or a very low intensity of pain in the postoperative period.

To make an appointment for the treatment of internal hemorrhoids in Moscow, contact the Clinic of Coloproctology and Minimally Invasive Surgery (KKMS). Our center specializes in the treatment of proctological diseases and is equipped with everything necessary for rapid professional diagnosis and treatment. We carry out all types of surgical operations.

Hemorrhoids what is it? And how our proctologist can help you.. Medical Center “Familia”. Gelendzhik and Novorossiysk.

03/26/2021

Hemorrhoids of the 1st degree are detected only during a special examination (anoscopy), they can protrude into the lumen of the rectum, but do not fall below the dentate line.
Hemorrhoids of the II degree – the prolapse of nodes from the anal canal to the outside during defecation or straining, while they are reduced independently.
Hemorrhoids of the III degree – loss of nodes from the anal canal to the outside during defecation or straining, while manual reduction of the nodes is required.
Hemorrhoids IV degree – not amenable to reduction.

Hemorrhoids are a very common surgical disease and the most common reason for visiting a coloproctologist. The prevalence of the disease is 130-145 people per 1000 adults. Hemorrhoids are equally common in both men and women.
Most often, people of working age suffer. This is due to the modern sedentary lifestyle – office work, long sitting in traffic jams in the car, and then not on the couch at home – all this leads to stagnation of blood circulation to the pelvic organs, especially in the rectum.

The main factors contributing to the development of hemorrhoids:

• Heredity
• Constipation
• Unstable chair
• Sedentary lifestyle
• Heavy physical activity with increased intra-abdominal pressure
• Pregnancy and childbirth
• Type of food (spicy, spices, alcohol)
• old age
• Tumors of the pelvic organs

Symptoms of hemorrhoids.
About 40 percent of people with hemorrhoids have no symptoms.
Symptomatic patients usually seek treatment for bleeding, pain associated with thrombosed hemorrhoids, perianal itching, or fecal leakage.

Hemorrhoidal bleeding is almost always painless and usually associated with defecation, although it may be spontaneous. The blood is usually bright red and covers the stool at the end of a bowel movement or may drain into the toilet. Sometimes bleeding can be profuse and increase with straining. In rare cases, chronic blood loss can cause iron deficiency anemia with accompanying symptoms of weakness, headache, irritability, and varying degrees of fatigue and exercise intolerance.
Slight fecal incontinence, mucus discharge, feeling of fullness in the perianal region due to prolapse of internal hemorrhoids.
Irritation or itching of the skin of the perianal region is a common symptom of hemorrhoidal disease.
These symptoms are the result of a combination of factors. Internal hemorrhoids are covered with mucous, which leads to the deposition of mucus on the perianal skin, which can cause itching.
Prolapsed internal hemorrhoids can lead to leakage of rectal contents.
Acute perianal pain and a palpable perianal “bump” are symptoms of hemorrhoid thrombosis. Thrombosis is more common in external hemorrhoids than in internal hemorrhoids.

DIAGNOSIS
Symptomatic hemorrhoids should be suspected in patients with bright red blood in the rectum, anal itching, and/or acute onset of perianal pain. The diagnosis is made by ruling out other causes of similar symptoms and visualizing the hemorrhoids.
Visual examination – begin with a thorough examination of the edge of the anus and the perianal region for the presence of external hemorrhoids, prolapsed internal hemorrhoids, anal fissures, fissures, fistulas, abscesses, neoplasms and warts.
A digital rectal examination is performed in the supine position or on the left side at rest and with straining. Internal hemorrhoids are usually not palpable on digital examination in the absence of thrombosis. Thrombosed hemorrhoids are very sensitive to palpation, and a thrombus can be palpated inside the hemorrhoids.
Anoscopy – In patients with bright red blood in the rectum or in patients with suspected thrombosed hemorrhoids in whom no hemorrhoids were found on digital rectal examination, we perform anoscopy to evaluate the anal canal and distal rectum.
Internal hemorrhoids look like bulging purple-blue veins. Prolapsed internal hemorrhoids look like dark pink, shiny, and sometimes painful formations on the edge of the anus. External hemorrhoids during thrombosis are very painful and have a purple hue. Anoscopy has the advantage of being a quick, relatively painless, and inexpensive procedure that can be performed on the untrained patient to diagnose hemorrhoids and rule out distal anorectal disorders.
Laboratory Evaluation – Laboratory tests are ineffective and are not usually recommended, but if they are performed and anemia or iron deficiency is detected, an endoscopy should be performed.
Endoscopy – In patients under 40 years of age with minimal rectal bright red blood and no anemia, iron deficiency, abdominal pain, diarrhea, systemic symptoms, or risk factors for colorectal cancer or inflammatory bowel disease, we do not perform any additional endoscopic examinations. if hemorrhoids are found on physical examination or anoscopy. In patients older than 40 years, we perform sigmoidoscopy or colonoscopy, depending on the presence of concomitant symptoms and risk factors for colorectal cancer.

Treatment of hemorrhoids.
Most patients with low-grade (I or II) internal hemorrhoids should start with conservative management. It includes dietary modifications and topical medications.
What types of hemorrhoids are treated surgically:
Symptomatic mild (I or II) internal hemorrhoids resistant to six to eight weeks of conservative treatment.
Symptomatic high-grade internal hemorrhoids (III or IV).
Thrombosed hemorrhoids, except for subacute (older than three days) thrombosed external hemorrhoids, which can be treated expectantly with resolution of symptoms expected within 7 to 10 days.