Increased straining during bowel movements, by constipation or diarrhea .
It is thus a common condition due to constipation caused by water retention in women experiencing premenstrual syndrome or menstruation .
Hypertension , particularly portal hypertension , can also cause hemorrhoids because of the connections between the portal vein and the vena cava which occur in the rectal wall.
Obesity can be a factor by increasing rectal vein pressure. Sitting for prolonged periods of time can cause hemorrhoids. Poor muscle tone or poor posture can result in too much pressure on the rectal veins.
Pregnancy causes hypertension and increases strain during bowel movements, so hemorrhoids are often associated with pregnancy.
Excessive consumption of alcohol or caffeine can cause hemorrhoids. Both can cause diarrhea. Note that caffeine ingestion increases blood pressure transiently, but is not thought to cause chronic hypertension. Alcohol can also cause alcoholic liver disease leading to portal hypertension.
Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.
Although many people have hemorrhoids, not all experience symptoms. The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding hemorrhoid.
Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid.
In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.
After visual examination of the anus and surrounding area for external or prolapsed hemorrhoids, a doctor would conduct a digital examination. Visual confirmation of hemorrhoids can be done by doing an anoscopy .
Endoscopic image of internal hemorrhoids seen on retroflexion of the flexible sigmoidoscope at the ano-rectal junction.
Hemorrhoidectomy. A true surgical procedure to excise and remove hemorrhoids. Is often now recommended only for severe (grade IV) hemorrhoids.
Stapled hemoroidectomy. Also called the procedure for prolapse and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the blood flow to the hemorrhoids. It is generally less painful than complete removal of hemorrhoids. It's meant for hemorrhoids that fall out or bleed.
Doppler Guided hemorrhoid artery ligation . The only evidence-based surgery for all grades of hemorrhoids. It does not involve cutting tissues or even a stay at the hospital; patients are usually back to work on the same day. It is the best treatment for bleeding piles, as the bleeding stops immediately.
Transanal hemorrhoidal dearterialization (THD) Similar to HAL, but more standardizable and therefore safer, less painful and has a shorter recovery time.
Anal fissure is an unnatural crack or tear in the anus skin. As a fissure, these tiny tears may show as bright red rectal bleeding and cause severe periodic pain after defecation. The tear usually extends from the anal opening and located posteriorly in the midline. This location is probably because of the relatively unsupported nature of the anal wall in that location.
The most common cause for this is spasm of the internal anal sphincter muscle. This spasm causes poor blood flow to the anal mucosa, hence producing an ulcer which does not heal since it is deprived of normal blood supply .
Local application of medications to relax the sphincter muscle, thus allowing the healing to proceed (nitroglycerine ointment, nifedipine ointment, topical diltiazem).
Botulinum toxin injection can also be used to relax the sphincter muscle. Combination of medical therapies may offer up to 98% cure rates, These medical treatments are used as first line therapy in treating chronic anal fissures.
Treatment depends on where the fistula lies, and which parts of the anal sphincter it crosses.
Lay-open of fistula-in-ano
Fibrin glue injection
Fistula plug is an "advanced" version of the fibrin glue method. It involves "plugging" the fistula with a "plug" made of porcine small intestine submucosa
Endorectal advancement flap is a procedure in which the internal opening of the fistula is identified and a flap of mucosal tissue is cut around the opening.
Anal Fistula Plug. This treatment requires placement and fixing of a plug in the anal fistula by a special technique. The plug is made of highly sophisticated absorbent material; it provides a scaffold over which body’s collagen gets deposited and closes the fistula.
Pilonidal means "nest of hairs". Ingrown hairs can be one of many causes of pilonidal sinus.
Pilonidal sinus between the buttocks could be caused by ingrown hairs. Due to increase moisture and pressure around the buttocks area, ingrown hairs find it easier to burrow into the skin. Pressure around the buttocks inhibits the body to reject the hair and thus allow it to continue to burow deeper until infection occurs.
Surgery involves either drainage of the sinus, or complete excision.
Drainage is the preferred method of treatment; however, sinus can return even if it has been drained. The doctor lances the abscess and drains all the pus. The wound is left open and packed by a piece of gauze, which can fall out a few days later or be changed daily. This is a small operation and can cure the problem. 40% of patients have a recurrence of pilonidal disease.
Full-excision surgery is one way of removing the abscess and sinus tracts. The surgeon uses a scalpel to remove the cavity and sinus tracts. The wound can then be left open to heal, which causes new scar tissue to grow at the base of the wound which gradually fills in the cavity (this process is called granulation). Another way is to partially close the wound, which is called marsupialisation. The edges of the wound down to deeper tissues are stitched with absorbable stitches. This procedure ensures that the centre of the wound is healing as quickly as the sides.
The condition of Rectal prolapse, a type of rectal rupture, undergoes progression: beginning with prolapsation during bowel movements, through Valsalva movements ( sneezing and so forth), then through daily activities such as walking until finally it may become chronic and ceases to retract