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Internal Hemorrhoids

Hemorrhoids, the condition in which blood vessels around the lower rectal and anal region become inflamed, is caused by several factors such as aging, chronic constipation and pregnancy. Though hemorrhoids do not pose any threat to life, they cause great discomfort to patients.

There are two types of hemorrhoids, internal hemorrhoids where lumps develop on the inside of the anus, and external hemorrhoids when the engorged veins appear on the outside of the rectal region.

Internal hemorrhoids can be classified into the following types:

  • Grade 1: When the hemorrhoid has not prolapsed or come out of the anus.
  • Grade 2: Where the hemorrhoid has come out during bowel movement but returns to its original position afterwards.
  • Grade 3: Where the hemorrhoid has prolapsed during bowel movement, and has to be pushed into its original position manually.

  • Grade 4 Internal Hemorrhoid: When the prolapsed hemorrhoid cannot be pushed back into its original position manually.

Symptoms of Internal Hemorrhoids

Here are some common symptoms of internal hemorrhoids:

  • Rectal Bleeding: The appearance of bright red blood on the toilet paper or a coating of blood on the stools is the most common symptom identified with internal hemorrhoids.

  • Small lumps: Sometimes small lumps can be felt hanging outside the anus. These are known as prolapsed hemorrhoids. Sometimes these can be pushed back manually, or in the worst case even if pushed back, they came out again or cannot be pushed back at all.

  • Itchy or Painful Anus: This is another common symptom, and causes a lot of discomfort when sitting down for long periods.
  • Incomplete Bowel Movements: Patients feel that they still need to empty their bowels, even after they have shortly been to the toilet.

  • Discharge of Mucus: The mucus discharged causes a lot of itching and skin irritation as it dries around the anal opening.

  • Straining: Passing stools can become very painful and may require a lot of straining, which worsens the condition.

Internal Hemorrhoids: Treatment Methods

These methods are used to reduce the size of or eliminate internal hemorrhoids:

  • Rubber Band Ligation: In this procedure, the doctor first uses a proctoscope and inserts it into the anal opening. Then the ligator device is lined up with the affected hemorrhoid tissue and an elastic rubber band is slipped around the base of the hemorrhoid. This cuts off the blood supply to the hemorrhoid, causing it to shrivel up and fall off within a few days.

  • Infra-red Coagulation: In this treatment procedure, a doctor first uses a proctosccope to identify the affected tissues. Then the infrared coagulator device is inserted. The infrared beams destroy the affected tissue by essentially raising the temperature and burning it away. The blood supply to the affected tissue is cut off, causing it to dry up, shrink and finally fall off.

  • Sclerotherapy: In this procedure, a chemical agent is used to harden the affected tissue. The hardening agent, which usually includes phenols and saline solutions, is injected into the base of the hemorrhoidal tissue. This produces a sustained swelling of the affected region over a long period, leading to the scarring of the hemorrhoidal tissue. The scarring causes the affected veins to collapse and finally to shrivel up and harden. The scar also helps to strengthen the wall of the anal canal, thus preventing the hemorrhoid from bulging or reoccurring.

  • Hemorrhoidectomy: Severe internal hemorrhoids are removed surgically by this process. The patient is given a general or spinal anesthesia to numb the pain. The inflamed veins in the affected area are tied off, so that they do not bleed. The doctor makes incisions in the tissue surrounding the hemorrhoid and then removes it. The surgery is carried out using a cautery pencil, a scalpel or a laser.

Lifestyle Changes That Help Prevent the Occurrence of Internal Hemorrhoids

Internal hemorrhoids develop mainly due to unhealthy food habits and lack of exercise. Having a balanced diet that is rich in fiber content, drinking plenty of fluids and moderate exercise usually helps to prevent the occurrence of hemorrhoids. High fiber content and fluids help in making the excreta bulkier and softer, which prevents straining and makes bowel movements easier. Making these lifestyle changes helps reduce the risk of developing hemorrhoids.

Knowledge about the symptoms of this condition can help in the early detection, prevention and early treatment of hemorrhoids.