What causes hemorrhoids
Hemorrhoids are enlarged or varicose veins in the anal canal. They occur in most adults. They are caused by increased pressure in the veins of the rectal outlet, or the end of the rectum. This could be due to increased pressure in the abdomen, which occurs during pregnancy or in a patient with ascites which is the fluid that accumulates in the abdomen with liver disease. Standing or sitting for extended periods of time can also be a contributing factor. (see Lifestyle before treating hemorrhoids)
What causes hemorrhoids to flare up
Hemorrhoids are caused by the disruption of the mucosal suspensory ligament (Treitz’s muscle) and relaxation of the pelvic floor muscle. The anal cushion protrudes out of the anal canal by constant straining, resulting in the disintegration of the ligament. Furthermore, the relaxation of the pelvic floor muscle aggravates hemorrhoids. When the sliding anal lining theory is considered as the pathogenesis of hemorrhoids, the causative factors can be easily surmised, and this can be helpful in the prevention of hemorrhoids. What causes hemorrhoids to act up:
- Defecation with Prolonged Straining
Everyone’s anal cushion descends on defecation. When the posture for defecation is held for a long time, the mucosal suspensory ligament relaxes and does not return to its original site even after the bowel movement. So defecation should be completed in a short period, within 3 min, if possible. For easier defecation, it is better to use the gastrocolic reflex after breakfast, rather than before breakfast.(see Hemorrhoid causes from bowel and dietary)
- Constipation with a Low-Fiber Diet
With illness or a low-fiber diet, hemorrhoids will develop as a result of prolonged straining. Hemorrhoids occur more frequently among Westerners than Africans and more in the higher socioeconomic classes because they consume more meat and less fiber. During defecation, reading a newspaper or books which prolong excretion time is also not recommended. (see How to cure constipation)
Diarrhea also is apt to descendent of anal cushion resulting in prolapse, because the frequency of bowel movement increases.
With high anal tension, more straining is needed on defecation, and hemorrhoids are more likely to occur. With a lax anus, the anal cushion is also more liable to prolapse. Failure of the mucosal suspensory ligament to return after relaxation causes hemorrhoids to prolapse easily. These can be hereditary factors contributing to the development of hemorrhoids.
During pregnancy with abdominal distension and backward posture of the buttocks, abdominal pressure increases, and hemorrhoids can prolapse easily. Furthermore, the enlarged uterus tends to compress the vena cava, which disturbs venous circulation
to cause the engorgement and aggravate hemorrhoids.
- Sports and Leisure Activities
Causing Hemorrhoids Adequate physical activity is helpful in preventing hemorrhoids as it enhances physical strength and improves blood circulation. But the following activities can aggravate hemorrhoidal prolapse: golf, cycling, horse riding, climbing, weight lifting, being the catcher in baseball, wrestling, fishing, card playing, driving, sitting for an extended period, and alcohol drinking.
Hemorrhoids are frequent for those who sit over an extended period while working, such as drivers, or those who work in a squatting position.
- Psychological Problems and Spinal Paralysis
The frequency of hemorrhoids is also high in those with mental problems or spinal paralysis
- Age: Most patients who develop hemorrhoids are between the ages of 30 and 50. In patients who present at an unusually early age, extra care should be exercised in excluding other diagnostic possibilities such as inflammatory bowel disease, juvenile polyps, polyposis syndromes, etc. On the other hand, in older patients, the diagnosis of carcinoma should always be borne in mind.
- Gender: Hemorrhoids occur in both sexes. However, pregnancy and childbirth are the prime causes of hemorrhoids in young females. The hormonal milieu of gestation, venous congestion, and increased pelvic pressure in late pregnancy and delivery all contribute to the development of hemorrhoids. Once the pregnancy is over, the hemorrhoids tend to improve over the next few months.
- Medical history: Some patients with leukemia or bleeding diathesis will have complications from hemorrhoids. Others may be on anticoagulants, nonsteroidal anti-inflammatory drugs, or Plavix. These patients will also have a tendency to bleed. If surgery is being contemplated, these drugs will have to be stopped before surgery. Patients who smoke should be counseled to stop before surgery.
- Family history: Family history should include questions directed towards excluding familial colorectal neoplastic syndromes. In certain individuals, there may be a genetic predisposition towards a development of hemorrhoids. The vein walls or venous valves may be weak. These patients will have a positive family history of hemorrhoid problems
What causes hemorrhoids to itch
Patients with internal hemorrhoids sometimes complain of itching sensation around the anus. With mucosal prolapse, some perianal discharge increases which stimulate perianal skin with the itching sensation. There are various other possible causes of pruritus ani, including mycosis, allergic dermatitis, contact dermatitis, psoriasis, benign tumor, malignancy, mydriasis, and diabetes. (see Symptoms of hemorrhoids)
What causes hemorrhoids to bleed
Bleeding is one of the most common symptoms of hemorrhoids. Although most bleeding is due to anal diseases such as hemorrhoids or fissures, it is sometimes caused by colorectal cancer, ulcerative colitis, polyps, or other diseases, so colon or upper gastrointestinal tract examination is mandatory before the treatment. (see Prevent bleeding hemorrhoids)
How to treat hemorrhoids
Symptomatic hemorrhoids can be treated by simple methods, including avoidance of chronic constipation and strain at stool and use of bulk-forming agents and stool softeners, sitz baths, and anal emollients.(see How to treat piles by medical therapy)
Treatments to eliminate hemorrhoids such as banding, cryosurgery, or injection are discussed. The type of treatment is usually dictated by the kind of hemorrhoid encountered. Treatment options reviewed include injection therapy, infrared coagulation, banding, cryosurgery, laser therapy, and hemorrhoidectomy (surgical removal of the hemorrhoids)
Home remedies for hemorrhoids
This treatment can include an increase in dietary fiber and an increase in water intake, regular exercise, and a decrease in dietary fats. (see Home remedies for hemorrhoids)