What is it like to have hemorrhoids? Please keep this Chrysanthemum Guide!

I've heard that many people experience burning pain in the anus when they have hemorrhoids. This sounds scary, but it's hard to fully experience this kind of pain without having experienced it once.

Hemorrhoids are a common perianal disease that won't kill you, but it's enough to make a tough guy kneel down and beg for mercy. What's more, this pain can come from different sources.

Hemorrhoids are divided into internal hemorrhoids, external hemorrhoids and mixed hemorrhoids according to their location[1] and are often accompanied by anal fissures.

The dentate line is a circular, serrated line where the rectum meets the anal canal. The tissues above the dentate line are innervated by the visceral nerves and are less sensitive to pain and irritation.

1. Internal hemorrhoids: Internal hemorrhoids are located above the dentate line. They are soft masses formed by the dilation of the submucosal vascular plexus and varicose veins at the end of the rectum. When the patient has dry stools, it is easy to rub the internal hemorrhoid mucosa and cause bleeding, which is usually painless.

2. External hemorrhoids: External hemorrhoids are located below the dentate line and are covered by squamous epithelium. They are mainly manifested by itching, moisture and discomfort, and can form dermatophytes. External hemorrhoids are painful only when combined with thrombosed external hemorrhoids. Thrombosed external hemorrhoids are manifested by sudden onset of anal pain and swelling, and the formation of a purple-red mass at the anus, which requires surgical incision if necessary.

3. Mixed hemorrhoids: Internal hemorrhoids are formed by the fusion of external hemorrhoids through venous anastomosis. The symptoms of internal and external hemorrhoids appear at the same time. More serious mixed hemorrhoids may prolapse in a ring shape, which is called annular hemorrhoids. When the prolapsed hemorrhoids are incarcerated by the anal sphincter, they are called incarcerated hemorrhoids.

4. Anal fissure: It is an ulcer-like longitudinal tear in the midline of the anal canal, distal to the dentate line. The clinical features of anal fissure are pain during defecation, which often persists after defecation. Rectal bleeding is common, occurring during or after defecation, and is usually limited to a small amount of bright red blood on toilet paper. Anal fissures often coexist with hemorrhoids.

Hemorrhoids are a secret that is difficult to describe. They make one restless and restless. Only those who have it know the answer.

Faced with such a variety of hemorrhoids, how should we deal with them?

1. What should I do if hemorrhoids prolapse?

If the hemorrhoids are found to be prolapsed outside the anus, local massage around the anus can be performed to promote relaxation of the anal sphincter, thereby reducing the prolapsed hemorrhoids. If the hemorrhoids are prolapsed outside the anus for a long time, they are prone to thrombosis or even necrosis due to long incarceration time, and surgical treatment should be performed in time, such as mixed hemorrhoid external hemorrhoid ligation.

2. How to relieve hemorrhoid pain

The pain of thrombosed external hemorrhoids is often severe, so it is not recommended to treat it yourself. It is recommended to see a doctor as soon as possible.

Milder hemorrhoid pain is usually treated with two methods: physical therapy and drug therapy.

(1) Physical therapy:

You can try to use ice cubes for cold compress near the anus, mainly to enhance the contraction of micro-vessels around the anus, reduce the permeability of blood vessels, slow down the conduction speed of peripheral nerves, and thus relieve pain. In addition, you can also use warm water to sit in a bath, massage the anus locally, relax the anal sphincter, and relieve pain.

(2) Drug treatment:

It is recommended that under the guidance of a doctor, topical hemorrhoid cream[3], oral nonsteroidal anti-inflammatory analgesics, intravenous vasoactive drugs[2], etc., can be used to reduce swelling, promote blood circulation, and relieve pain. In order to reduce repeated stimulation of the anus by defecation, it is necessary to soften the stool or even use laxative treatment, which also has a therapeutic effect on combined anal fissures.

If the pain is severe or the effect is not good, it is still recommended to see the anorectal department as soon as possible.

3. How to treat bleeding hemorrhoids

Early hemorrhoid bleeding can often stop on its own and improve after stopping straining to defecate. However, if hemorrhoids gradually worsen, they can also cause heavy bleeding. Therefore, it is important to seek medical attention and treatment as soon as possible. If bleeding does not stop after defecation, you can tighten your anus and press the anus with a cotton ball if necessary. Seek medical attention in a timely manner and seek professional treatment.

I believe that at this point, people who have not yet suffered from hemorrhoids are already trembling and starting to pray that they will not get hemorrhoids. If they want to stay away from this pain, they must also understand why we get hemorrhoids.

The most commonly discussed in clinical practice are the anal cushion depression theory and the varicose vein theory, but there are many other inducing factors in daily life.

Humans are upright animals, and the anorectum is located in the lower part of the human body. There is an anal cushion (composed of veins, smooth muscles and connective tissue) inside the anal canal, which can be pressed down during defecation and retract into the anal canal after defecation. When the elastic retraction of the anal cushion weakens, it becomes congested, moves down and proliferates, and hemorrhoids are formed over time.

From another perspective, anatomically, the anorectal venous plexus has no venous valves and is located at the lowest level of the abdominal and pelvic cavity, making it easy for venous reflux to become obstructed. The venous plexus is the main structure that forms the anal cushions. When the anorectal venous reflux is obstructed, blood congestion and venous dilation may occur, forming hemorrhoids.

In daily life, people's eating habits, occupations, diseases, etc. can also induce hemorrhoids.

Drinking alcohol frequently or even excessively, or eating too much spicy food, such as onions, garlic, wine, peppers, etc., can irritate the anorectal canal, causing congestion in the rectum and forming hemorrhoids. In addition, if the diet is too refined and lacks fiber, constipation is also likely to occur, which in turn induces hemorrhoids.

Some occupations require standing for long periods of time, such as doormen and receptionists; some occupations require sitting for long periods of time, such as white-collar workers and drivers; some occupations require frequent lifting of heavy objects, such as construction workers and porters. These occupational characteristics may affect venous return, leading to excessive filling, congestion, and dilation of the hemorrhoidal veins, and then causing hemorrhoids.

Bad habits such as squatting in the toilet for a long time, playing with mobile phones or reading newspapers while using the toilet, or exerting too much force during bowel movements may induce hemorrhoids.

After understanding the cause, we must fundamentally eliminate the pain of hemorrhoids and protect the health of the chrysanthemum.

1. Pay attention to adjusting your diet

Drink more water, eat more fresh fruits, vegetables and whole grains to ensure that there is enough water in the intestines and dietary fiber to stimulate the intestinal wall and cause defecation reflex, thereby reducing adverse stimulation to the intestines and abdominal distension [4]. Drink less alcohol; eat less spicy food, such as chili peppers; and reduce high-fat food.

2. Exercise

When hemorrhoids attack, try to avoid sitting or standing for a long time. Do regular exercise on weekdays to maintain regular gastrointestinal motility and promote defecation.

3. Lifestyle

Prevent constipation and adjust abnormal bowel habits, such as straining during bowel movements, sitting for long periods of time, or squatting, and try to shorten bowel movement time; try to avoid holding your breath for long periods of time when lifting heavy objects; pay attention to the cleanliness of the anal area, avoid frequent friction, and try not to use soap and other products that are irritating or have allergic risks; use warm water sitz baths when necessary, 2 to 3 times a day, and there is no need to add soap, shower gel and other substances to the water; pregnant women should sleep on their side to reduce hemorrhoids by reducing pelvic blood vessel pressure.

From this analysis, we can also find that simply eating less spicy food cannot prevent the occurrence of hemorrhoids. In addition, studies have shown that there is no correlation between eating chili peppers and hemorrhoid bleeding symptoms. There is no significant difference in the incidence of hemorrhoids between the Sichuan and Chongqing regions and the coastal areas where people eat less spicy food.

Therefore, in order to protect the health of our chrysanthemums, we still need to protect them in many aspects to avoid "burning the chrysanthemums".

References:

[1] Types and treatments of hemorrhoids. Zhang Ling. PLA Health. 03.2009

[2] Li Mengli, Song Hongqi. Research progress in clinical treatment of hemorrhoids[J]. Chinese Journal of Folk Therapy, 2020, 28(3): 88-89.

[3] Tan Zhiping. Comparison of the efficacy of hemorrhoid anti-inflammatory ointment and Mayinglong hemorrhoid ointment in the treatment of hemorrhoidal swelling and pain[J]. Journal of Guangdong Medical University, 2020, 38(4): 466-468.

[4] What is hemorrhoids? .Chen Gaopin. Wenhui Health Guide. (C) 1994-2020

[5] ACG clinical guidelines: management of benign anorectal diseases. The American Journal of Gastroenterology 116(10):p 1987-2008, October 2021. | DOI: 10.14309/ajg.0000000000001507

The article is produced by Science Popularization China-Starry Sky Project (Creation and Cultivation). Please indicate the source when reprinting.

Author: Xu Lang Popular Science Creator

Reviewer: Lai Yamin, deputy chief physician, Department of Gastroenterology, Peking Union Medical College Hospital