What Are Hemorrhoids?

Hemorrhoids do not cause short ‘attacks’ of pain. Patients with pain during or following bowel movements or itching or burning or a sensation of a cut in the anal area are usually suffering from an anal fissure, not hemorrhoids. Do not accept hemorrhoid treatment if your problem is actually an anal fissure. It is rare for patients with an anal fissure to also require hemorrhoid treatment such as banding.  As a fundamental policy, patients presenting with anal pain should never have their hemorrhoids banded.

Often the result of extreme straining at the gym, or lifting or coughing or squatting, etc, this is a painful blue lump that suddenly appears at the margin of the anus and can be painful for up to a week. It is a subcutaneous clot of blood arising from a ruptured blood vessel.

Hemorrhoids are covered by the bowel surface called mucosa and mucosa does not have many itch receptors. So if the main problem is extreme itch, the cause is almost certainly not hemorrhoids, it is a skin problem. The skin is loaded with itch receptors. The anal canal is lined with skin and this can develop dermatitis as can the skin surrounding the anus. This is an inflammation of the skin that can lead to severe itching and discharge of unpleasant fluid. The treatment is not hemorrhoid banding! The treatment should be designed to deal with the underlying skin condition and its cause.

Whenever a patient presents with rectal bleeding, the key consideration is ‘where is it coming from?’. The vast majority of rectal bleeding comes from the last inch of the bowel, the anal canal, and is almost never serious. However, bleeding from higher up in the bowel may be very serious and so if there is any question about where the bleeding is coming from, a higher examination may be necessary to rule out a higher, more serious source. Higher sources of bleeding may include polyps or inflammatory bowel disease, bowel infection or a tumor.

This is an inflammatory disorder of the rectum (proctum). It presents with bleeding, mucus, urgency to go to the toilet, more frequent bowel movements and sometimes with a lot more gas or even lower abdominal pain. Diagnosis requires a simple short scope (sigmoidoscopy) to look at the rectal lining. Treatment includes special intestinal anti-inflammatory medications.

Abscesses in the anal area can arise from infected anal fissures, or infected anal glands or skin glands. Diagnosing the underlying cause is key to successful treatment. Abscesses are painful and may be accompanied by fever and chills, in which case they are a surgical emergency! They contain pus and that pus needs to be drained unless it is already spontaneously draining. The abscess may heal down to a fistula, a tract to the inside of the anus. Abscesses and fistulas require specialized care at a centre such as the Pezim Clinic.

Fortunately, anal cancer is rare. But it always has to be considered as a possible cause of an anal lump or anal pain or bleeding. Careful examination by an experienced physician may be necessary to rule this out.

Symptoms of bleeding, pain in the pelvis, change in bowel habit may be due to a low-lying rectal cancer. This needs to be diagnosed or excluded as a very early step in patients thought to have hemorrhoids.