Hemorrhoids (often referred to as piles) are a common, yet unpleasant disease of blood vessels located in the rectal area. Hemorrhoids usually do not seriously endanger the health but cause many troubles and worsen the overall life quality of the patient. In addition, bleeding caused by hemorrhoids can not be easily distinguished from bleeding from colorectal cancer.


Hemorrhoids are divided to external and internal according to their location. The internal hemorrhoids are much more important as these are the hemorrhoids causing the majority of symptoms including blood in stool.




Internal hemorrhoids


Internal hemorrhoids are related to dilation of venous sinuses in the walls of the rectum. Such dilation of veins occurs in chronic frequent increases of intra-abdominal pressure (caused for example by pregnancy, chronic stronger cough, constipation, etc.) and in long sitting on a hard surface without enough physical exercise. Genetics has surely also some influence as well as presence of any tissue disorder. The dilated veins covered with mucous membrane gradually grow and bulge into the rectal canal causing troubles.


The hemorrhoids have a close anatomical relationship to local arteries. This causes a relatively frequent bleeding with subsequent blood in stool occurrence. The blood has usually bright red color and we may find in on the surface of the feces and on the toilet paper. Especially in older males, however, this finding should not be underestimated as similar symptoms can also cause an intestinal polyp or even colorectal carcinoma. In addition, hemorrhoids can cause pain during defecation and occurrence of mucus in stool. Large hemorrhoids may even prolapse into the anus. Sometimes it is possible to manually return them back into the rectum, but the most advanced stay prolapsed.


Internal hemorrhoids may be found by digital rectal examination, during rectoscopy or total colonoscopy. The doctor can evaluate their size, number and bleeding complications. Total colonoscopy is advisable in males above 50 years of age who complain about blood in stool as this examination shows not only rectum but the whole large intestine to rule out any other sources of bleeding.


Lifestyle changes should be in the first place. It is important not to sit on hard surfaces, have enough physical exercise and eat more fiber. Fiber is a great prevention of constipation, which is accompanied with increased intra-abdominal pressure. Adequate hygiene of the anal area is necessary, especially after any defecation (washing the anus with tepid water). A doctor can prescribe local medications in form of ointments and suppositories that have anti-inflammatory, analgesic and venotonic effect. Large internal hemorrhoids are often treated surgically. In some cases there are cut and removed but more often they are practically painlessly removed by the rubber band ligation (Barron ligature). The hemorrhoid is sucked into a special tube device. This device than deploys a rubber band that strangles the hemorrhoid neck. The strangulation stops blood supply, the tissue dies and the hemorrhoid falls off.

External hemorrhoids

The issue of external hemorrhoids shall be mentioned only briefly. These hemorrhoids are formed by dilation of subcutaneous veins running beneath the skin around the anus. These piles are visible as small skin nodules. They never bleed but they may be complicated by local thrombosis. External hemorrhoid with a blood clot looks like a purplish bump that is significantly painful. It is usually treated by a surgeon, who (in anesthesia) cuts the hemorrhoid and releases its content.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources