Local impairment - Anal intercourse, rectal pathology
Straining for defecation
Insufficient oral fluids intake
Alcohol, fatty or spicy food
As prolonged physical inactivity can promote constipation, it might also be considered as a risk factor of hemorrhoidal disease.
Exact data on hemorrhoidal disease prevalence are rare. The true prevalence is inevitably underestimated due to the under-reporting of these symptoms. It is estimated to be up to 40% of the general population.
Are "hemorrhoids" frequent? (8,9,10)
Hemorrhoids are very common during pregnancy and post-partum.
Up to 85% of pregnant women
This can be explained by the physiological changes occurring during pregnancy as well as the frequent occurrence of constipation.
How should I know if I have hemorrhoidal disease? (1,3)
All symptoms of hemorrhoids are non-specific. Many other conditions may be concomitantly present or cause similar symptoms (anal fissure, malignancy, inflammatory bowel diseases...).
Therefore, a thorough medical examination is necessary for diagnosis. It includes:
If you experience blood in the stool, it is recommended to see a doctor as soon as possible as this sign may be caused not only by hemorrhoids but also by more severe pathologies.
What are the treatment methods for hemorroidal disease?
What are the treatment methods for hemorrhoidal disease? (8,11,12,13)
Usually require no specific treatment unless they become acutely thrombosed or causes patients discomfort.
Can be effectively treated with lifestyle and dietary measures, medication, instrumental measures and/or surgery.
Lifestyle and dietary measures
The objective is to prevent or reduce pathological development or symptoms of hemorrhoidal disease.
Increasing dietary fibers and oral fluids intake consumption;
Avoiding straining and prolonged defecation position;
Avoiding anal intercourse;
Performing regular exercise.
Before starting any treatment, it is essential to consult your doctor or pharmacist for advice.
INSTRUMENTAL AND SURGICAL TREATMENT
The objective is to induce fibrotic scarring of internal hemorrhoids.
Rubber band ligation: Hemorrhoids are tied off with rubber bands leading to their obliteration.
Infrared coagulation: The infrared light converted into heat allows coagulation of hemorrhoids.
Sclerotherapy: Sclerosant drugs are injected at the base of the hemorrhoid leading to an inflammatory response and shrinking of hemorrhoids.
Surgery is generally restricted to the most severe forms of hemorrhoids. A wide range of technic are available.
The objective is to relieve symptoms.
Modifiers of intestinal transit can help regulate the consistency or frequency of stools.
Phlebotonics are drugs that reduce capillary fragility and improve microcirculation in venous insufficiency. They are effective for overall symptom improvement of hemorrhoidal disease. They are recommended for short-term use in cases of acute manifestations of hemorrhoids (hemorrhoidal crisis), in particular bleeding and pain. Phlebotonics can usually be used during pregnancy lactation and post- partum.
Non-steroidal anti-inflammatory drugs (NSAIDS), analgesics, and cortisone derivatives can be used in case of pain caused by thrombosed hemorrhoids. However they should be used carefully for safety reasons.
Localized topical treatments (suppositories, creams or ointments) combining, to varying degrees, applied corticosteroids, anesthetics, lubricants, protectors and phlebotonics can also be indicated.
For pregnant women, only certain medications can be used, with caution. Hip baths can help reduce hemorrhoidal pain.
1. Sneider E.B, et al. Diagnosis and Management of Symptomatic Hemorrhoids. Surg Clin N Am 90 (2010) 17–32.
2. Sandler R.S, et al. Rethinking what we know about hemorrhoids. Clinical Gastroenterology and Hepatology 2019;17:8–15.
3. Sun. Z et al. Review of Hemorrhoid Disease: Presentation and Management. Clin Colon Rectal Surg (2016). 29, 22–29.
4. Geçim E., et al. Haemorrhoidal Disease Management. EMJ Gastroenterol. 2017; 6[Suppl 6]:2-12.
5. Margetis N. Pathophysiology of internal hemorrhoids. Annals of Gastroenterology (2019)32, 1-9.
6. Lohsiriwat V. Hemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol 2012 May 7; 18(17): 2009-2017.
7. Iovino P et al. New onset of constipation during long-term physical inactivity: a proof-of-concept study on the immobility-induced bowel changes. PLoS One. 2013 Aug 20;8(8):e72608.
8. Perera N, et al. Phlebotonics for haemorrhoids. Cochrane Database Syst Rev (2012). CD004322.
9. Riss S, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis (2012) 27:215-220.
10. Vazquez J.C. Constipation, haemorrhoids, and heartburn in pregnancy. BMJ Clin Evid 2008.
11. Ohsiriwat V. Treatment of hemorrhoids: A coloproctologist’s view. World J Gastroenterol. 2015 Aug 21;21(31): 9245–9252.
12. Higuero T, et al. Guidelines for the treatment of hemorrhoids (short report). J Visc Surg (2016). 153, 213–218.
13. Abramowitz L. Management of hemorrhoid disease in the pregnant woman. Clinic and Biologic Gastroenterology (2008) 32, S210-S214.