Hemorrhoids (AmE), haemorrhoids (BrE), emerods, or piles are varicosities or swelling and inflammation of veins in the rectum and anus. Hemorrhoids are common. In the USA, the prevalence is about 4.4%. It is estimated that approximately one half of all Americans have had this condition by the age of 50, and that 50% to 85% of the world's population will be affected by hemorrhoids at some time in their life. [citation needed] However, only a small number seek medical treatment. Annually, only about 500,000 people in the U.S. are medically treated for hemorrhoids, with 10 to 20% of them requiring surgeries.

Causes

The causes of hemorrhoids include genetic predisposition (weak rectal vein walls and/or valves), straining during bowel movements, and too much pressure on the rectal veins due to poor muscle tone or poor posture. Similarly, sitting for prolonged periods of time can cause hemorrhoids. Hypertension, particularly in the portal vein, can also cause hemorrhoids because of the connections between the portal vein and the vena cava which occur in the rectal wall - known as portocaval anastomoses.

Additional factors that can influence the course of hemorrhoids (mostly by increasing rectal vein pressure), especially for those with a genetic predisposition, are obesity and a sedentary lifestyle.

Increased straining during bowel movements, (e.g. constipation, diarrhea) may lead to hemorrhoids.

Pregnancy causes hypertension and increases strain during bowel movements, and thus hemorrhoids are often associated with pregnancy.

Excessive consumption of alcohol or caffeine can both cause hemorrhoids. Both can cause diarrhea. Alcohol can also cause alcoholic liver disease leading to portal hypertension. Caffeine on the other hand can cause general hypertension.

Types of hemorrhoids

• External hemorrhoids are those that occur outside of the anal verge (the distal end of the anal canal). They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom from external hemorrhoids, is more commonly due to skin irritation.
  
  • External hemorrhoids are prone to thrombosis: if the vein ruptures and a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.
• Internal hemorrhoids are those that occur inside the rectum. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may bleed when irritated.
• Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids:
  
  • Prolapsed hemorrhoids are internal hemorrhoids that are so distended that they are pushed outside the anus.
  • If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid.

• Grading of Internal Hemorrhoids
  
  • Grade I: The hemorrhoids do not prolapse.
  • Grade II: The hemorrhoids prolapse upon defecation but spontaneously reduce.
  • Grade IIB(Changela's Sign): The hemorrhoids prolapse upon defecation, but take longer than 3 seconds to reduce spontaneously. The increased reduction time is due to comorbid thrombosis of one of more of the hemorrhoids. Their gross appearance is generally described as "grossly distended", often shortened to simply "gross" while charting.
  • Grade III: The hemorrhoids prolapse upon defecation, but must be manually reduced.
  • Grade IV: The hemorrhoids are prolapsed and cannot be manually reduced.

Prevention

Prevention of hemorrhoids includes drinking more fluids, eating more dietary fiber (such as fiber supplements, fruits and vegetables, and cereals high in fiber), exercising, practicing better posture, and reducing bowel movement strain and time. Hemorrhoid sufferers should avoid using laxatives and should strictly limit time straining during bowel movement. Wearing tight clothing and underwear will also contribute to irritation and poor muscle tone in the region and promote hemorrhoid development. Some sufferers report a more comfortable experience without underwear or wearing only very lightweight panties, etc.

Fluids emitted by the intestinal tract may contain irritants that may increase the fissures associated with hemorrhoids. Washing the anus with cool water and soap may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluid.

Kegel exercises for the pelvic floor may also prove helpful.

Many people do not get a sufficient supply of dietary fiber (20 to 25 grams daily) and small changes in a person's daily diet can help tremendously in both prevention and treatment of hemorrhoids.

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