Hemorrhoids are a common condition affecting the anal canal and the lower rectum, primarily caused by pathological changes in vascular tissue. This condition is highly prevalent in clinical practice, with statistics indicating that approximately 50% of adults worldwide will experience related symptoms at some point in their lives. Hemorrhoids can be classified into internal hemorrhoids, external hemorrhoids, and mixed types, with severity ranging from mild discomfort to severe bleeding or thrombosis. Understanding their causes, symptoms, and treatment options can help patients undertake early lifestyle adjustments and medical interventions.
The formation of hemorrhoids is closely related to human anatomy, as the venous plexus at the distal end of the rectum tends to swell under increased pressure. Modern lifestyle changes, such as prolonged sitting and insufficient dietary fiber intake, have led to a rising incidence of this condition. Although most hemorrhoids are benign, if not properly managed, they may lead to complications such as anemia, infection, or thrombosis. Therefore, accurate understanding of their characteristics is crucial.
This article provides a comprehensive overview of hemorrhoids from the perspectives of etiology, diagnosis, and treatment options. It covers risk factor identification, self-assessment methods for symptoms, and the applicability of different treatment strategies to help readers develop correct disease management concepts.
The development of hemorrhoids is mainly related to increased venous pressure and degeneration of supportive tissue structures. The venous plexus at the lower end of the rectum lacks muscular support, and prolonged high intra-abdominal pressure impedes blood return, leading to dilation. The main risk factors include:
Modern sedentary occupations and Westernized diets have contributed to a younger age of onset. Studies indicate that obesity, due to accumulated abdominal fat, is also a significant risk factor. Additionally, chronic diarrhea or ascites can indirectly induce hemorrhoids.
The venous system at the distal rectum includes the superior and inferior hemorrhoidal plexuses, which normally have valves to control blood flow. When supportive tissues fibrose or lose elasticity, the veins dilate to form hemorrhoidal nodules. Internal hemorrhoids are located above the anal sphincter and are usually painless but prone to bleeding; external hemorrhoids are located around the anus and are prone to inflammation and pain. This anatomical characteristic determines the symptom presentation and treatment strategies for different types of hemorrhoids.
The symptoms of hemorrhoids vary greatly depending on the type and severity, with some patients being asymptomatic and only diagnosed during examinations. Common clinical manifestations include:
About 30% of patients experience recurrent symptoms, and excessive bleeding may lead to iron-deficiency anemia. It is important to note that anal bleeding can also be a sign of serious conditions such as colorectal cancer, so early diagnosis and differentiation are essential when symptoms appear.
According to clinical grading systems, hemorrhoids are classified into four grades: Grade I without prolapse, Grade II with prolapse during defecation that can spontaneously reduce, Grade III requiring manual reduction, and Grade IV with permanent prolapse that cannot be reduced. Pain severity does not directly correlate with the grade; a comprehensive assessment of symptoms is necessary.
Diagnosis typically begins with a detailed medical history, including questions about bleeding characteristics, pain levels, and lifestyle habits. Initial examination involves digital rectal examination and visual inspection, which can confirm the diagnosis in approximately 70% of cases. Further examinations may include:
The diagnostic process should exclude conditions like anal fissures, fistulas, or inflammatory bowel disease. Physicians often evaluate the patient's lifestyle, such as diet and occupation, to develop personalized treatment plans.
Anal bleeding should be distinguished from colorectal cancer, Crohn's disease, and other conditions. Patients over 40 or with a family history are recommended for colonoscopy screening. Anal fissures often cause severe pain during defecation, whereas hemorrhoids usually bleed without pain; this difference aids initial differentiation.
Treatment of hemorrhoids follows the principle of "conservative treatment first," with different approaches based on severity. Mild symptoms can often be improved through lifestyle modifications, while severe cases may require surgical intervention. The main treatment directions include:
The first-line treatments focus on medications and lifestyle adjustments:
Recent studies show that combining high-fiber diets with medication can alleviate symptoms in 60-70% of patients. For prolapsed hemorrhoids, rubber band ligation can induce ischemic atrophy, a non-invasive treatment commonly used for Grade II hemorrhoids.
When symptoms severely affect quality of life or conservative treatments fail, surgery becomes necessary. Main surgical options include:
Modern minimally invasive techniques such as sclerotherapy or radiofrequency coagulation offer additional options for moderate symptoms. Postoperative recovery typically takes 4-6 weeks, with a recurrence rate of approximately 10-20%.
Preventing hemorrhoids begins with lifestyle adjustments. The following measures can reduce the risk:
Regular anal care, such as warm water cleaning, can reduce infection risk. Studies show that maintaining a normal body weight (BMI <25) can reduce the incidence by 30%. Traditional Chinese medicine recommends sitz baths and qigong exercises, which may help prevent occasional symptoms.
A high-fiber diet can soften stool and reduce mucosal damage during defecation. It is recommended to drink at least 2000 ml of water daily and avoid spicy foods that irritate the mucosa. Research indicates that foods like pumpkin seeds and flaxseeds, rich in fiber and unsaturated fatty acids, can improve intestinal motility.
If you experience the following, seek medical attention immediately:
For individuals over 40 or with a family history, it is recommended to undergo anal examination every 3-5 years. Mild symptoms can be managed with lifestyle changes initially, but if they affect daily activities, early professional evaluation is advised.
If black tarry stool, hypotension, or anal tissue necrosis (purple-black and hard like stone) occurs, it should be treated as an emergency. These signs may be accompanied by infection or arterial bleeding, requiring immediate endoscopy or surgical intervention.
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Internal hemorrhoids are located inside the anal canal and typically cause painless bleeding (blood on toilet paper or on the surface of stool, or blood in the toilet bowl), and prolapse of hemorrhoidal tissue (which may require manual reduction in severe cases). External hemorrhoids are located on the outer edge of the anus and often cause pain due to friction or foreign body sensation; thrombosed external hemorrhoids appear as purple, hard nodules with intense pain. If symptoms are unclear, an anal examination with a scope is recommended for accurate diagnosis.
Which daily dietary habits may worsen hemorrhoid symptoms?High-fat and spicy foods can irritate the intestines, leading to constipation or excessive straining, which exacerbates hemorrhoidal congestion. Insufficient fiber intake (such as from whole grains and vegetables) results in hard stool, prolonging defecation time and increasing venous pressure in the anus. It is recommended to consume 25-30 grams of fiber daily along with adequate water intake to soften stool and promote regular bowel movements.
What specific effects does Kegel exercise have on alleviating hemorrhoids?Kegel exercises strengthen the anal sphincter and pelvic floor muscles, promoting local blood circulation and reducing hemorrhoidal congestion. Performing 3 sets of 10 contractions and relaxations daily can lower the risk of prolapse over time. However, these exercises should be combined with improvements in constipation and other underlying factors; they alone cannot fully treat severe hemorrhoids.
What precautions should be taken during recovery after hemorrhoid surgery?During the first two weeks post-surgery, avoid lifting heavy objects, prolonged sitting, or cycling to prevent wound dehiscence or bleeding. Use sitz baths (2-3 times daily, 10-15 minutes each) to promote healing. If there is heavy bleeding, persistent severe pain, or fever, seek medical attention immediately, as it may indicate infection or thrombosis recurrence.
Why does hemorrhoid bleeding sometimes resolve spontaneously but recur repeatedly?Minor internal hemorrhoid bleeding may temporarily stop due to venous constriction, but if underlying factors such as constipation or prolonged standing are not addressed, venous pressure will again cause mucosal rupture and bleeding. Recurrent bleeding indicates incomplete resolution of the lesion; early treatment with rubber band ligation or sclerotherapy is recommended to prevent worsening.
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