Hemorrhoids are cushions inside and around the anus. They often resolve on their own within a few days. But blood after a bowel movement is a symptom that is checked separately, not automatically blamed on hemorrhoids.
What hemorrhoids are
Hemorrhoidal cushions are a normal part of human anatomy. There are three of them in the anal canal. They create 15–20 percent of the pressure needed to keep the anus closed at rest and protect the sphincter muscles during a bowel movement. They become a disease when they change abnormally. The name itself comes from the Greek words for "blood" and "flow."
The mechanism is this: arterial blood flow to the cavernous bodies increases and venous outflow becomes difficult. The tissue grows and forms cushions. Hemorrhoids are classified as congenital and acquired. By location, they can be external (subcutaneous) and internal (submucosal): the first is under the skin around the anus, the second is above the dentate line. The size varies: from a pea to a grape, the color is pink or purple.
Internal hemorrhoids have four grades: swollen cushions that may bleed; cushions prolapse and reduce on their own; they must be reduced manually; the cushions cannot be reduced.
It is estimated that at least 50 percent of the US population has symptomatic hemorrhoids at least once in their life. People aged 45–65 are affected most often, men and women equally. Only a small proportion of patients eventually need surgery, and even after the procedure the cushions can return.
Why they occur
The exact cause is unknown. It is a combination of factors. Among them are irregular bowel movements, constipation or diarrhea, straining, lack of physical activity, a diet low in dietary fiber, increased intra-abdominal pressure, heredity, and age.
Prolonged sitting, excess weight, heavy lifting, chronic cough, inflammatory processes and tumors in the intestines and liver, and stress are mentioned separately. Pregnancy also has an effect: the fetus presses on the abdominal cavity, and hormonal changes enlarge the vessels. After childbirth the symptoms usually disappear, and pregnant women rarely need surgery.
Some factors do not depend on you: age, heredity, pregnancy. Others are related to lifestyle. When people talk about prevention, they mean exactly these — the nature of bowel movements and straining, the length of time spent sitting, weight, physical activity, and dietary fiber in the diet.
Symptoms
The two most common symptoms are bleeding and prolapse of the cushions. The blood is usually bright red and appears during a bowel movement.
- bright red blood after a bowel movement;
- itching in the anus;
- a feeling that you still need to go after using the toilet;
- mucus on underwear or on toilet paper;
- cushions and pain around the anus.
Hemorrhoids run a chronic or acute course, but these are phases of the same process. Chronic — blood during a bowel movement, prolapse of the cushions, dull continuous pain, itching. Acute — anorectal thrombosis, thrombophlebitis of the hemorrhoidal veins.
Why blood should not be blamed on hemorrhoids
Blood at the end of a bowel movement is not a signature under a diagnosis. One combination that should not be postponed is painless bleeding from the anus. It does not hurt, so it is easy to put off. Another reason not to postpone is a change around the anus that is unusual for you.
How it is diagnosed
The doctor checks whether the symptoms are caused by something else.
Ask the doctor about: what exactly they are examining, whether an instrumental examination is needed, how long to wait for results, and which signs mean you should come back sooner. These are the questions that remove uncertainty.
When to see a doctor
Routinely — if symptoms worsen or do not go away, if hemorrhoids return again, if you notice something around the anus that is unusual for you.
Separately — if your temperature is high, you feel chilled or feverish and unwell, or pus is draining from the cushions. Do not put this off for months.
Call 103 or 112 immediately if you have hemorrhoids and the bleeding does not stop, a lot of blood or large clots are passed, or the pain has become severe.
This is reference text: it describes what to expect but does not replace a conversation with a doctor.
Sources
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer