“Hemroids” is a common misspelling of the term “hemorrhoids”. The term hemorrhoids is composed of two parts, hemo- meaning blood and rhoids meaning flow. So, hemorrhoids mean veins that are likely to bleed. Hemorrhoids are also called piles.
Hemroids are enlarged painful anorectal veins. The anorectal veins are composed of 2 sets of veins; internal veins and external veins. So, hemroids are classified into two types.
- Internal hemroids are due to swelling of internal veins and they can not be seen or felt unless severe.
- External hemroids are due to swelling of external veins and they can be seen and felt around the anus.
How much common are hemorrhoids ?
Hemorrhoids are a very common disease affecting more than 50% of the people by the age of 50 years. Also, 75% of the population will get hemroids at some time in their lives. Although hemroids are common in any person, they occur more commonly with pregnancy, in old people, in obese persons, with liver cirrhosis, with constipation, and with persons who strain during bowel movements.
What are the causes of hemroids?
Two main factors are responsible -together- for the development of hemroids.
A) Genetically predetermined weakness of the anorectal veins.
B) Acquired increase of the pressure inside the anorectal veins. Causes of increased pressure include the following.
- Straining to pass stools as in constipation and diarrhea.
- Pregnancy during the last 6 months, due to increased pressure on the pelvic veins by the pregnant uterus. Straining to pass the baby during delivery makes the hemroids worse.
- Liver diseases causing portal hypertension.
What are the types of hemroids?
Development of Hemroids
As mentioned above, the anorectal veins are grouped into 2 sets of veins; internal hemorrhoidal veins and external hemorrhoidal veins. Therefore hemorrhoids are classified into 2 types according to which group of veins is affected; internal hemorrhoids and external hemorrhoids.
Internal hemroids: they occur due to increased pressure in the internal hemorrhoidal veins, leading to their swelling. Internal hemroids usually has only one sign; rectal bleeding with bowel movements which is bright red in color. Pain is usually absent or minimal, unless thrombosis or infection occurs.
External hemroids: they occur due to increased pressure in the external hemorrhoidal veins, leading to their swelling. Rectal bleeding from straining or rubbing and itching from irritation by mucus are the main symptoms. Rectal pain is also common and becomes severe if thrombosis occurs. Also, symptoms of external hemroids include feeling of a hard mass outside the anus, especially if thrombosis occurs.
Differential diagnosis of hemroids.
Hemroids are the most common cause of rectal pain and/or rectal bleeding, however, other causes of rectal bleeding include anal fissure, anal fistula, pruritis ani and perianal abscess. Also, above the age of 50 years the most important cause is anorectal cancer, especially if there is a positive family history of anorectal cancer. So, these cases should be seen by a healthcare provider to exclude these serious causes.
Diagnosis of hemroids.
History is taken including present history of the current symptoms, and history of a possible cause such as constipation or diarrhea.
Clinical examination to observe the anus for signs of hemorrhoids and PR examination to confirm the diagnosis and to clinically exclude other causes of rectal bleeding.
Investigations are done in cases not cofirmed to be due to hemorrhoids by clinical examination, especially to exclude more serious causes. Investigations include anoscopy, proctoscopy or colonoscopy.
