Hemorrhoids are dilated or enlarged veins that form in the anus and lower rectum. Sometimes when the veins enlarge too much, they cause the hemorrhoids to swell, making the anal walls to stretch, thin, and get irritated when passing stool. It is estimated that 3 out of every 4 people in this world will have hemorrhoids at some point in their lives.
Generally, hemorrhoids are categorized as internal (originating in the rectum) or external, (originating in the anus). When hemorrhoids enlarge, they cause symptoms such as burning sensation in the anus, itching, severe pain, mucus discharge, bleeding, or a sensation that the bowel is not empty.
Proctologists note that most internal hemorrhoids are found in the inner lining of the rectum and may require an anoscopy or proctoscopy to confirm their presence. Endoscopists use special equipment to view the inside of a person’s body, specifically the esophagus, stomach, colon and rectum. Sometimes, internal hemorrhoids become substantially enlarged, in which case, they may prolapse and can be felt during a physical examination. Most internal hemorrhoids are painless and are diagnosed when patients note rectal bleeding following a bowel movement.
When internal hemorrhoids prolapse or protrude outside the anus, they can be felt as pads of skin that appear raw and swollen. As these slipped hemorrhoids contain a lot of nerve endings, they can be very painful and discomforting to the patient. Most of the time, these hemorrhoids slip out of the anus during a bowel movement and recede into the rectum sometime later. If it is too large, you may have to gently push it back into the anus.
External hemorrhoids are quite straightforward as they are located underneath the skin surrounding the anus and can be seen and felt easily. External hemorrhoids are at higher risk of forming a hematoma that ultimately will clot. This leads to an extremely painful condition called thrombosis. In this situation, the hemorrhoids look blue or purple and firm, and are cause significant pain. They can sometimes burst on its own and cause bleeding. While it is not a dangerous condition and may resolve on its own in a few weeks, sometimes gastroenterologists suggest removing the clot from the thrombosed hemorrhoid to ease the pain.
Hemorrhoids are not fatal. However, they can be quite painful and affect the quality of your life. To provide the best possible treatment, gastroenterologists have devised a hemorrhoid grading system. Here is what you need to know about them-
Hemorrhoid Grading System
The hemorrhoids are graded according to their position, size and whether it has prolapsed or not. There are four categories-
- Grade 1
These kinds of hemorrhoids are internal and do not prolapse or protrude out of the anus. They may protrude into the anal canal, causing painful bowel movements. For such hemorrhoids, proctologists are likely to recommend home remedies such as having fiber-rich meals or trying an over-the-counter pain medication. Hemorrhoid creams containing hydrocortisone are generally prescribed to reduce the inflammation, swelling, and itching associated with Grade 1 hemorrhoids.
- Grade 2
These are internal hemorrhoids that protrude out of the anus but then recede inside without the need for interference. Patients suffering from Grade 2 hemorrhoids are advised to use pain medications and fiber supplements, similar to Grade 1 treatment to manage the symptoms before deciding on further treatments. If the Grade 2 hemorrhoids are large and are causing significant discomfort, outpatient procedures such as rubber band ligation, injection sclerotherapy, or infrared coagulation can be used to remove hemorrhoids. These procedures are done on internal hemorrhoids and give temporary relief to the patient, with the results usually lasting 6 months to a year. However, they may recur and need further treatment sessions.
- Grade 3
These hemorrhoids slip and protrude through the anus during straining or bowel movements and need to be manually returned to position. As these hemorrhoids are quite bothersome, doctors may recommend patients to surgeons for surgical hemorrhoid treatment with minimally invasive methods ( stapled hemorrhoidopexy, laser hemorroidoplasty, etc.) or hemorrhoidectomy.
- Grade 4
This kind of hemorrhoid remains prolapsed outside of the anus all the time and cannot be pushed back into the anus. It is usually associated with fibrotic changes and formation of excess of scarred skin ( skin tags). Grade 4 hemorrhoids are the ones that are mostly treated with traditional hemorrhoidectomy as patients ask for those unpleasant skin tags to be removed. However, since hemorrhoidectomy is quite painful, other techniques are often used. The stapled hemorrhoidectomy procedure is less painful compared to the former. However, it comes with some risks and downsides. If not done by a seasoned surgeon, the rectum may get stapled to the vagina in female patients or cause damage to the small bowel if done too high in the rectum, leading to severe bleeding and infection. The procedure also leaves permanent staples within the rectum, which may not be an ideal situation for some patients.
Can Grade 2 And 3 Hemorrhoids Go Away on Their Own?
So far, hemorrhoid doctors note that if the patient is willing to change one’s habits, Grade 2 hemorrhoid symptoms can be managed without the need for medical interventions. However, the patient has to increase their free water intake to an extent that their urine is always clear and eat fresh salads with their meals to meet their daily dose of fiber intake. This will promote healthy digestion and reduce the chances of constipation and straining, which are two of the main reasons for the formation of hemorrhoids. For patients with Grade 3 internal hemorrhoids, a fiber-rich diet and adequate hydration will translate as less easy bowel movements, which prevents the hemorrhoids from prolapsing. Over time, Grade 2 and Grade 3 hemorrhoids may shrink and become asymptomatic, as long as the patient follows healthy eating habits and keeps their digestive process clean.
Healthy habits to keep hemorrhoids at bay
Your hemorrhoids doctor will recommend you to follow healthy habits to manage and prevent hemorrhoids. Apart from eating a fiber-rich diet and drinking adequate water, you must also practice the following-
- Consider fiber supplements such as psyllium or methylcellulose to meet your daily dose of 20 to 30 gms. This will help you manage your existing hemorrhoids. However, if you take fiber supplements, be sure to drink at least 8 glasses of water or other fluids to avoid constipation.
- Avoid straining when passing stool as it puts pressure in the veins of the lower rectum.
- Don’t hold in your urge to have an evacuation. If you wait instead of having the bowel emptied, your stool may dry out, making it harder to pass.
- Avoid sitting for long periods. If your job requires you to sit for hours, take breaks to stretch your legs and reduce the pressure build-up in your pelvic region. Sitting for long on the toilet must also be avoided as it increases the pressure in the veins of the anal region.
- Stay active as a rule to prevent constipation and reduce pressure on the veins of your anal region. Exercise will also help you lose weight, which may be a contributing factor to your hemorrhoids.
If you have highly symptomatic hemorrhoids or recurring ones even after undergoing minimally invasive treatments, consult with Dr. Antonio Privitera, renowned collateral surgeon and proctologist in Dubai for a comprehensive checkup. Book your appointment today.