What Are Hemorrhoids? Types, Causes, and Clinical Insight

Los Angeles Times

a day ago

Hemorrhoids (also called piles) are one of those health issues no one likes to talk about—but they're super common and affect millions of people worldwide. Hemorrhoids are swollen veins or blood vessels in the lower rectum and anus, and this swelling can cause discomfort, itching and even bleeding.
In fact, hemorrhoids are swollen veins like varicose veins in the legs, both caused by increased pressure in the blood vessels. While they're often lumped into one category, hemorrhoids come in different types and stages, each with its own set of symptoms and treatment options.
Understanding what hemorrhoids are and why they happen can help reduce the stigma and encourage early care.
Let's start with the basics: hemorrhoids aren't abnormal in and of themselves. They're actually part of your normal anatomy. These vascular cushions are located just inside the anal canal and help maintain continence—essentially they help seal the anal opening along with the sphincter muscles. These cushions are made up of hemorrhoidal tissue which is present in everyone. This is different from other things like anal fistulas and anal fissures.
Each hemorrhoidal cushion contains:
Trouble starts when these structures become engorged, lose their supportive tissue and slide down. This engorgement causes swollen blood vessels and that's when we call them 'hemorrhoidal disease' [1].
Not all hemorrhoids are the same. They're classified based on their location relative to the dentate (or pectinate) line—a key anatomical landmark in the anal canal. The symptoms of hemorrhoids vary depending on the type, internal and external hemorrhoids have different hemorrhoid symptoms like pain, bleeding, swelling, irritation and prolapse [3]. Recognizing these symptoms is important for diagnosis and treatment.
These are above the dentate line and are covered by rectal mucosa which has no pain receptors. That's why internal hemorrhoids can go unnoticed—until they start bleeding or prolapsing. A common sign is the presence of bright red blood on toilet paper or in the toilet bowl. Rectal bleeding can be a symptom of hemorrhoids but should always be evaluated by a healthcare provider to rule out more serious conditions like colorectal cancer or anal fissures as these can also cause similar symptoms [4].
They're classified into four grades:
These develop below the dentate line, under the skin (anoderm) that's rich in sensory nerves. That means they're more likely to cause pain, itching and swelling. If a blood clot forms inside an external hemorrhoid (a condition called thrombosis), the pain can be intense [6]. A thrombosed external hemorrhoid typically presents as a firm, bluish or purple lump under the overlying skin, and is often associated with severe pain. The overlying skin may become stretched or irritated, and after the thrombosed hemorrhoid resolves, skin tags can develop as soft, painless protrusions [5].
So, what causes hemorrhoids to go from helpful cushions to problematic bulges?
It comes down to a few key mechanisms:
Think of it like this: if you over-inflate a water balloon, it stretches and weakens. Add gravity and pressure from below (like from straining), and it starts to bulge or even rupture.
Contributing factors include:
To prevent hemorrhoids, focus on prevention strategies such as adding fiber to your diet by consuming high fiber foods, whole grains, vegetables and whole grains, and fruits vegetables and whole. Using a fiber supplement or fiber supplements can also be beneficial. Make sure to drink adequate fluid to help soften stools and promote regular bowel movements [9]. Maintaining digestive health is important, as issues like digestive and kidney diseases or kidney diseases can impact overall well-being. These strategies can help prevent hemorrhoids.
Hemorrhoids are a common reason patients visit colon and rectal surgeons. While not life-threatening, they can significantly affect quality of life when symptoms become chronic or severe.
Diagnosis begins with a detailed medical history and physical exam, often including a digital rectal exam to check for blood and abnormalities. Additional procedures like anoscopy or colonoscopy may be used to rule out other causes and ensure accurate diagnosis, guiding appropriate hemorrhoids treatment.
Most hemorrhoid symptoms—such as pain, swelling, itching and bleeding—can be managed with conservative care. Common signs include blood on toilet paper or in the toilet bowl after bowel movements. Home treatments like warm baths, sitz baths and using damp toilet paper help reduce irritation and provide relief.
When symptoms persist or hemorrhoids are large, office treatments such as rubber band ligation, infrared coagulation or sclerotherapy may be recommended, often performed with numbing medicine for comfort.
For severe or persistent cases unresponsive to conservative or office-based treatments, surgical options like hemorrhoidectomy or stapled hemorrhoidopexy may be necessary. These procedures remove problematic hemorrhoid tissue and are reserved for more serious conditions.
Post-procedure, mild pain is common and manageable with home care. Health care providers play a vital role in diagnosis, treatment guidance and postoperative care. Lifestyle modifications, including high-fiber diets and improved toilet habits, remain essential for preventing hemorrhoid flare-ups and maintaining digestive health.
Hemorrhoids are a part of our anatomy but when they become swollen, prolapsed or thrombosed they become a problem. They are classified into two types—internal and external—with varying degrees of severity. At the core of the issue are vascular changes and weakened support structures which is often made worse by straining, poor diet or sitting for too long.
Understanding the anatomy and mechanics of hemorrhoids helps not only in diagnosis but also in choosing the right treatment. And for many, simple lifestyle changes can go a long way in preventing hemorrhoidal disease from taking over their daily life.
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