Veins can swell inside the anal canal to form internal hemorrhoids.

Or they can swell near the opening of the anus to form external hemorrhoids. You can have both types at the same time. The symptoms and treatment depend on which type you have. See a picture of hemorrhoids .

Many people have hemorrhoids at some time. What causes hemorrhoids? Too much pressure on the veins in the pelvic and rectal area causes hemorrhoids. Normally, tissue inside the anus fills with blood to help control bowel movements. If you strain to move stool, the increased pressure causes the veins in this tissue to swell and stretch. This can cause hemorrhoids. Diarrhea or constipation also may lead to straining and can increase pressure on veins in the anal canal. Pregnant women can get hemorrhoids during the last 6 months of pregnancy. This is because of increased pressure on the blood vessels in the pelvic area. Straining to push the baby out during labor can make hemorrhoids worse. Being overweight can also lead to hemorrhoids. What are the symptoms? The most common symptoms of both internal and external hemorrhoids include:

Bleeding during bowel movements. You might see streaks of bright red blood on toilet paper after you strain to have a bowel movement. Itching. Rectal pain. It may be painful to clean the anal area.

Internal hemorrhoids With internal hemorrhoids, you may see bright red streaks of blood on toilet paper or bright red blood in the toilet bowl after you have a normal bowel movement. You may see blood on the surface of the stool. Internal hemorrhoids often are small, swollen veins in the wall of the anal canal. But they can be large, sagging veins that bulge out of the anus all the time. They can be painful if they bulge out and are squeezed by the anal muscles. They may be very painful if the blood supply to the hemorrhoid is cut off. If hemorrhoids bulge out, you also may see mucus on the toilet paper or stool.

External hemorrhoids External hemorrhoids can get irritated and clot under the skin, causing a hard painful lump. This is called a thrombosed, or clotted, hemorrhoid. How are hemorrhoids diagnosed? Your doctor can tell if you have hemorrhoids by asking about your past health and doing a physical exam. You may not need many tests at first, especially if you are younger than 50 and your doctor thinks that your rectal bleeding is caused by hemorrhoids. Your doctor may just examine your rectum with a gloved finger. Or your doctor may use a short, lighted scope to look inside the rectum. Jadi apa sih sebenarnya hemorrhoid itu? Hemorrhoid adalah suatu keadaan yang disebabkan oleh pelebaran pembuluh darah vena di bagian bawah dari saluran cerna, yaitu rektum dan anus (dubur). Keadaan ini terjadi akibat peningkatan tekanan di daerah tersebut. Hemorrhoid sangat umum kita temukan di masyarakat dan meningkat angka kejadiannya pada umur 50 tahun ke atas. Hemorrhoid dapat terjadi pada 2 tempat, yaitu : 1. Hemorrhoid interna : Pelebaran pembuluh darah vena terjadi di bagian yang lebih dalam. Pada daerah ini tidak terdapat banyak saraf nyeri, sehingga biasanya penderita tidak merasa nyeri. Gejala yang lebih sering adalah BAB yang berdarah segar. Walaupun lokasinya yang ada di dalam, hemorrhoid interna dapat membesar dan keluar dari lubang anus dan dapat teraba seperti daging. Hemorrhoid yang keluar ini dapat didorong masuk lagi pada awalnya, namun jika semakin parah akan semakin sulit untuk mendorongnya ke dalam. 2. Hemorrhoid eksterna : Pelebaran pembuluh darah vena terjadi di bagian luar. Biasanya pasien mengeluh rasa gatal dan nyeri. Apa penyebab hemorrhoid? Seperti yang telah disebutkan di atas, penyebab hemorrhoid adalah peningkatan tekanan. Jadi, kondisi yang dapat menyebabkan terjadinya hemorrhoid adalah : 1. Sering dan terlalu kuat mengedan 2. Diare dan konstipasi yang menahun 3. Kehamilan. Rahim yang membesar dapat menekan daerah rektum dan anus sehingga menyebabkan hemorrhoid.

4. Persalinan. Pada saat persalinan, ibu akan berusaha mengejan sekuat tenaga untuk membantu melahirkan bayi, sehingga akan meningkatkan tekanan dan menyebabkan hemorrhoid. 5. Kegemukan dan obesitas 6. Penyakit jantung 7. Penyakit hati 8. Faktor keturunan 9. Faktor usia 10. Faktor gizi. Makanan kurang serat. 11. Tumor atau kanker Bagaimana pencegahan hemorrhoid? Berikut adalah tips mencegah hemorrhoid : 1. Jangan terlalu sering dan terlalu kuat mengedan 2. Banyak makan makanan yang tinggi serat. Perbanyak sayur dan buah. 3. Jangan suka menunda-nunda BAB 4. Cukup minum 5. Olahraga teratur Bagaimana pengobatan hemorrhoid? Yang perlu anda lakukan pertama adalah konsultasi ke dokter. Dokter akan melakukan anamnesis keluhan dan riwayat medis anda, lalu akan melakukan pemeriksaa fisik. Jika dibutuhkan, dokter akan melakukan pemeriksaan dubur atau pemeriksaan anokopi/colonoskopi untuk memastikan diagnosis. Dapat pula dilakukan pemeriksaan lain sesuai kebutuhan dokter. Setelah dilakukan pemeriksaan, selanjutnya adalah pengobatan. Pengobatan hemorrhoid dapat dilakukan dengan 2 cara, yaitu tanpa operasi atau dengan operasi. Pengobatan tanpa operasi ditujukan lebih untuk menghilangkan gejala, yaitu dengan makan tinggi serat, banyak minum, olahraga teratur, dan menggunakan obat-obat yang tersedia di pasaran. Sedangkan, untuk menghilangkan hemorrhoid dilakukan dengan cara operasi. Operasi dapat dilakukan dengan berbagai cara tergantung kebutuhan dan kesepakatan antara dokter dan pasien. Jenis operasi hemorrhoid yang banyak dilakukan saat ini adalah skleroterapi, ligasi, hemorrhoidektomi, dan bedah beku.

Jadi, apa yang perlu saya lakukan jika saya mengalami hemorrhoid? Tidak perlu khawatir, hemorrhoid bukan penyakit yang berbahaya, apalagi memalukan. Hemorrhoid dapat terjadi pada siapa saja dan kapan saja. Seperti yang telah diulas pada artikel ini, cobalah konsultasi ke dokter untuk segera mengatasi kondisi ini. Semoga artikel ini bermanfaat.
What are hemorrhoids?

A precise definition of hemorrhoids does not exist, but they can be described as masses or clumps ("cushions") of tissue within the anal canal that contain blood vessels and the surrounding, supporting tissue made up of muscle and elastic fibers. The anal canal is the last four centimeters through which stool passes as it goes from the rectum to the outside world. The anus is the opening of the anal canal to the outside world. Although most people think hemorrhoids are abnormal, they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems and be considered abnormal or a disease. Prevalence of hemorrhoids Although hemorrhoids occur in everyone, they become large and cause problems in only 4% of the general population. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age. Anatomy of hemorrhoids The arteries supplying blood to the anal canal descend into the canal from the rectum above and form a rich network of arteries that communicate with each other around the anal canal. Because of this rich network of arteries, hemorrhoidal blood vessels have a ready supply of arterial blood. This explains why bleeding from hemorrhoids is bright red (arterial blood) rather than dark red (venous blood), and why bleeding from hemorrhoids occasionally can be severe. The blood vessels that supply the hemorrhoidal vessels pass through the supporting tissue of the hemorrhoidal cushions. The anal veins drain blood away from the anal canal and the hemorrhoids. These veins drain in two directions. The first direction is upwards into the rectum, and the second is downwards beneath the skin surrounding the anus. The dentate line is a line within the anal canal that denotes the transition from anal skin (anoderm) to the lining of the rectum. Formation of hemorrhoids If the hemorrhoid originates at the top (rectal side) of the anal canal, it is referred to as an internal hemorrhoid. If it originates at the lower end of the anal canal near the anus, it is referred to as an external hemorrhoid. Technically, the differentiation between internal and external hemorrhoids is made on the basis of whether the hemorrhoid originates above or below

the dentate line (internal and external, respectively). As discussed previously, hemorrhoidal cushions in the upper anal canal are made up of blood vessels and their supporting tissues. There usually are three major hemorrhoidal cushions oriented right posterior, right anterior, and left lateral. During the formation of enlarged internal hemorrhoids, the vessels of the anal cushions swell and the supporting tissues increase in size. The bulging mass of tissue and blood vessels protrudes into the anal canal where it can cause problems. Unlike with internal hemorrhoids, it is not clear how external hemorrhoids form.

What are hemorrhoids?

Hemorrhoids are swollen and inflamed veins around the anus or in the lower rectum. The rectum is the last part of the large intestine leading to the anus. The anus is the opening at the end of the digestive tract where bowel contents leave the body. External hemorrhoids are located under the skin around the anus. Internal hemorrhoids develop in the lower rectum. Internal hemorrhoids may protrude, or prolapse, through the anus. Most prolapsed hemorrhoids shrink back inside the rectum on their own. Severely prolapsed hemorrhoids may protrude permanently and require treatment.

Hemorrhoids [Top]
What are the symptoms of hemorrhoids?

The most common symptom of internal hemorrhoids is bright red blood on stool, on toilet paper, or in the toilet bowl after a bowel movement. Internal hemorrhoids that are not prolapsed are usually not painful. Prolapsed hemorrhoids often cause pain, discomfort, and anal itching. Blood clots may form in external hemorrhoids. A blood clot in a vein is called a thrombosis. Thrombosed external hemorrhoids cause bleeding, painful swelling, or a hard lump around the anus. When the blood clot dissolves, extra skin is left behind. This skin can become irritated or itch. Excessive straining, rubbing, or cleaning around the anus may make symptoms, such as itching and irritation, worse. Hemorrhoids are not dangerous or life threatening. Symptoms usually go away within a few days, and some people with hemorrhoids never have symptoms. [Top]
How common are hemorrhoids?

About 75 percent of people will have hemorrhoids at some point in their lives.1 Hemorrhoids are most common among adults ages 45 to 65.2 Hemorrhoids are also common in pregnant women.
1

Baker H. Hemorrhoids. In: Longe JL, ed. Gale Encyclopedia of Medicine. 3rd ed. Detroit: Gale; 2006: 17661769.

Chong PS, Bartolo DCC. Hemorrhoids and fissure in ano. Gastroenterology Clinics of North America. 2008;37:627644. [Top]
What causes hemorrhoids?

Swelling in the anal or rectal veins causes hemorrhoids. Several factors may cause this swelling, including

chronic constipation or diarrhea

straining during bowel movements

sitting on the toilet for long periods of time

a lack of fiber in the diet

Another cause of hemorrhoids is the weakening of the connective tissue in the rectum and anus that occurs with age. Pregnancy can cause hemorrhoids by increasing pressure in the abdomen, which may enlarge the veins in the lower rectum and anus. For most women, hemorrhoids caused by pregnancy disappear after childbirth. [Top]
How are hemorrhoids diagnosed?

The doctor will examine the anus and rectum to determine whether a person has hemorrhoids. Hemorrhoid symptoms are similar to the symptoms of other anorectal problems, such as fissures, abscesses, warts, and polyps. The doctor will perform a physical exam to look for visible hemorrhoids. A digital rectal exam with a gloved, lubricated finger and an anoscopea hollow, lighted tubemay be performed to view the rectum. A thorough evaluation and proper diagnosis by a doctor is important any time a person notices bleeding from the rectum or blood in the stool. Bleeding may be a symptom of other digestive diseases, including colorectal cancer. Additional exams may be done to rule out other causes of bleeding, especially in people age 40 or older:

Colonoscopy. A flexible, lighted tube called a colonoscope is inserted through the anus, the rectum, and the upper part of the large intestine, called the colon. The colonoscope transmits images of the inside of the rectum and the entire colon.

Sigmoidoscopy. This procedure is similar to colonoscopy, but it uses a shorter tube called a sigmoidoscope and transmits images of the rectum and the sigmoid colon, the lower portion of the colon that empties into the rectum.

Barium enema x ray. A contrast material called barium is inserted into the colon to make the colon more visible in x-ray pictures.

[Top]
How are hemorrhoids treated?

At-home Treatments Simple diet and lifestyle changes often reduce the swelling of hemorrhoids and relieve hemorrhoid symptoms. Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining. Fiber is a substance found in plants. The human body cannot digest fiber, but fiber helps improve digestion and prevent constipation. Good sources of dietary fiber are fruits, vegetables, and whole grains. On average, Americans eat about 15 grams of fiber each day.3 The American Dietetic Association recommends 25 grams of fiber per day for women and 38 grams of fiber per day for men.3 Doctors may also suggest taking a bulk stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel). Other changes that may help relieve hemorrhoid symptoms include

drinking six to eight 8-ounce glasses of water or other nonalcoholic fluids each day

sitting in a tub of warm water for 10 minutes several times a day

exercising to prevent constipation

not straining during bowel movements

Over-the-counter creams and suppositories may temporarily relieve the pain and itching of hemorrhoids. These treatments should only be used for a short time because long-term use can damage the skin. Medical Treatment If at-home treatments do not relieve symptoms, medical treatments may be needed. Outpatient treatments can be performed in a doctors office or a hospital. Outpatient treatments for internal hemorrhoids include the following:

Rubber band ligation. The doctor places a special rubber band around the base of the hemorrhoid. The band cuts off circulation, causing the hemorrhoid to shrink. This procedure should be performed only by a doctor.

Sclerotherapy. The doctor injects a chemical solution into the blood vessel to shrink the hemorrhoid.

Infrared coagulation. The doctor uses heat to shrink the hemorrhoid tissue.

The Facts on Hemorrhoids

Hemorrhoids, also called "piles," are swollen tissues that contain veins. They are located in the wall of the rectum and anus and may cause minor bleeding or develop small blood clots. Hemorrhoids occur when the tissues enlarge, weaken, and come free of their supporting structure. This results in a sac-like bulge that extends into the anal area. Hemorrhoids are unique to humans - no other animal develops them. They are very common - up to 86% of people will report they have had hemorrhoids at some time in their life, though people often use this as a catch-all label for any ano-rectal problem including itching. They can occur at any age but are more common as people get older. Among younger people, they are most common in women who are pregnant. Although they can be embarrassing to talk about, anyone can get hemorrhoids, even healthy young people in good shape. They can be painful and annoying but aren't usually serious. Hemorrhoids differ depending on their location and the amount of pain, discomfort, or aggravation they cause. Internal hemorrhoids are located up inside the rectum. They rarely cause any pain, as this tissue doesn't have any sensory nerves. These hemorrhoids are graded for severity according to how far and how often they protrude into the anal passage or protrude out of the anus (prolapse):

Grade I is small without protrusion. Painless, minor bleeding occurs from time to time after a bowel movement.

A grade II hemorrhoid may protrude during a bowel movement but returns spontaneously to its place afterwards. In grade III, the hemorrhoid must be replaced manually. A grade IV hemorrhoid has prolapsed - it protrudes constantly and will fall out again if pushed back into the rectum. There may or may not be bleeding. Prolapsed hemorrhoids can be painful if they are strangled by the anus or if a clot develops.

External hemorrhoids develop under the skin just inside the opening of the anus. The hemorrhoids may swell and the area around it may become firm and sore, turning blue or purple in colour when they get thrombosed. A thrombosed hemorrhoid is one that has formed a clot inside. This clot is not dangerous and will not spread through the body, but does cause pain and should be drained. External hemorrhoids may itch and can be very painful, especially during a bowel movement. They can also prolapse.

Causes of Hemorrhoids
Hemorrhoids are caused by repeated or constant pressure on the rectal or anal veins. The most common cause of pressure usually results from straining or prolonged sitting during a bowel movement. Other factors that increase the risk for getting hemorrhoids include constipation, diarrhea, lifting heavy objects, poor posture, prolonged sitting, pregnancy, eating a diet low in fibre, anal intercourse, and being overweight. Liver damage and some food allergies can also add stress to the rectal veins.

Symptoms and Complications of Hemorrhoids

External hemorrhoids most often itch, burn, or bleed, and they can be painful, inflamed, and swollen. They're the most common cause of bleeding during bowel movements. A small, painless emission of very bright red blood just after a bowel movement is a sign of an internal hemorrhoid, where the blood will not be mixed in with the stool. In small amounts, it's not a serious issue. If this is the first occurrence, see your doctor to confirm that hemorrhoids are the source. Visit your doctor if bleeding continues, as a constant loss of blood may lead to anemia (lack of oxygen reaching the tissues due to blood or iron shortage). Watch for pain that lasts longer than a week, blood loss along with weakness or dizziness, or infection - these are all situations that should be brought to your doctor's attention. Your doctor should also be consulted about bleeding not brought on by a bowel movement, blood that's dark in colour, or bleeding that is recurrent. This can signal more serious problems higher in the colon, unrelated to hemorrhoids. Also, children under 12 should be referred to a doctor if symptoms of hemorrhoids are present.

Treating and Preventing Hemorrhoids

A high-fibre diet with large amounts of water is the answer for grade I internal hemorrhoids and painless external hemorrhoids. This will soften the stool, decreasing constipation and straining. It will also allow the inflamed veins to decrease in size. There are also a number of ointments and suppositories available without prescription that can help reduce pain and inflammation around the anus. These include topical hemorrhoidal preparations that contain local anesthetics for their soothing properties. Your pharmacist can help you choose a topical application that is appropriate for your circumstances. Prescription medications can include antiinflammatory cortisone creams. Other useful measures include stool softeners or bulking agents, or a sitz bath, used 3 or 4 times daily for 15 minutes at a time. A sitz bath is a container filled with warm water that fits over a toilet bowl. Ice packs alternated with warm packs on the affected area can help dissolve a blood clot in an external hemorrhoid. More severe hemorrhoids may require a doctor's intervention. A hemorrhoidectomy is a type of surgery done under anesthesia and involves complete removal of internal hemorrhoids. It's reserved for severe cases. External hemorrhoids can be removed or drained with local anaesthetic and a scalpel by a doctor if they have thrombosed (developed a clot) within the previous 72 hours. Sometimes, a hardening agent is injected into internal hemorrhoids to make them smaller and firmer. Grade II and III internal hemorrhoids may be tied off with a rubber band via rubber band ligation. This stops the blood flow and the hemorrhoids eventually die and drop off. Electricity, lasers, heat, cold, or infrared light are also used to destroy hemorrhoids. These procedures can involve some discomfort. Here are a few tips on preventing hemorrhoids:

Don't delay bowel movements, because the stool can harden. Avoid straining to have a bowel movement, and don't stay sitting on the toilet for long periods. Drink at least 8 glasses of water a day. Eat foods that are high in fibre and bulk, such as whole grain foods, fresh vegetables, and fruit - especially prunes and bran. Get plenty of exercise and don't sit for prolonged periods of time. Try to go for walks. Lose excess weight.