Causes Of Hemorrhoids (Piles)
Hemorrhoids or piles occur when hemorrhoidal tissues in the anal canal get enlarged. Constipation and straining to pass the stool are major risk factors and so is frequent wiping during diarrhea. Obesity, anal sex and lifting heavy objects can also increase the risk for hemorrhoids. It is common during pregnancy and childbirth and also among long-term spinal cord injury patients.
The word “hemorrhoids” brings to mind unpleasant images of a painful poop chute and bleeding stools. Truth be told, all of us have hemorrhoids; it’s a part of our anatomy. Hemorrhoids are, in fact, tissues within the anal canal and perianal area. These tissues consist of blood vessels, connective tissues, and a small amount of muscle.1 Together with the anal sphincter, a circular muscle, hemorrhoids control bowel movements. When people say they are having hemorrhoids, they are referring to a condition where the hemorrhoids become enlarged. Enlarged hemorrhoids are also called piles.
How do hemorrhoids become enlarged? Depending on the placement of the hemorrhoidal tissues, hemorrhoids are either internal or external. Internal hemorrhoids occur above the anal canal where hemorrhoidal tissues are placed adjacent to the anal canal. External hemorrhoids occur below the anal canal and in the skin around the anus.2
Thrombosed hemorrhoids, whether external or internal, occur when a blood clot forms inside the hemorrhoidal tissue. A thrombosed hemorrhoid can prolapse; both conditions are painful and can cause bleeding.3
Watch out for these symptoms if you suspect hemorrhoids:4
- Rectal bleeding. Spotting blood in the stool or/and on the wipes after wiping.
- Anal pain, during or after bowel movements, anal itching as well as burning
- Bulging (prolapse) of the internal hemorrhoids during bowel movements which may or may not go back on its own.
What Causes Hemorrhoids Or Piles?
Hemorrhoids are more common than you think. It is believed that at least half the population go through hemorrhoids at some point in their lives. There is no one cause. And the susceptibility increases with age. The veins in the hemorrhoidal tissue get distended and loose as you age. It becomes more sensitive from straining leading to clot formation, swelling or erosion of the lining with bleeding.5
There are other causes too; some of them are interlinked. Lack of fiber in the diet or dehydration can result in hard stool or constipation. Constipation makes you spend more time in the toilet and also lead to straining, both of which can put pressure on the hemorrhoidal tissues leading to hemorrhoids or piles.
Here, let’s look at each cause in detail.
1. Too Much Straining From Constipation Or Hard Stool
Spending too much time in the toilet is said to be one of the reasons for hemorrhoids. This is mainly from constipation or hard stools that require much straining to be passed.6 A good number of people experience hemorrhoids in relation to constipation or straining. Straining can also result in the prolapse of the hemorrhoid tissues which can be felt near the anus. High anal pressure from straining can result in anal fissures, too.7
This can be avoided to a great extent by having fibrous food to make the stool soft and easy to pass.
2. Wiping Too Much Or Too Long
Not just constipation, diarrhea too can lead to hemorrhoids. You might wonder how loose stools can result in hemorrhoids. Wiping the anus too hard and/or for too long are very common causes of hemorrhoids. Diarrhea makes your rectal area sore and prompts you to make frequent trips to the loo and wipe your anus frequently that can result in hemorrhoids.
While diarrhea gets treated and your bowel movements get back to normal, go easy on the wiping. You can use extra soft baby wipes to avoid “bloody” wipes which are often the not-so-subtle indicator that you have hemorrhoids.
Obesity is considered one of the major risk factors of hemorrhoids. This is due to the increased intra-abdominal pressure, venous congestion, and chronic inflammation in the abdominal area of the obese patients.8 To avoid piles, you need to ensure your bodyweight is well within the limit.
4. Pregnancy And Straining During Delivery
Many women complain of thrombosed external hemorrhoids and anal fissures after childbirth from straining during childbirth. Constipation during pregnancy can also lead to hemorrhoids9 and so is prolonged standing.10
5. Spinal Cord Injuries
There is evidence of hemorrhoid cases among long-term spinal cord injury patients. Long-term spinal cord injuries can affect the efficient management of bowel. Constipation and diarrhea are frequent occurrences in such patients which can cause hemorrhoids. Another risk factor is the use of suppositories and enemas in the case of constipation.11
6. Other Causes
Though there aren’t many scientific studies available, there are anecdotes that show anal sex as one of the risk factors. Hemorrhoids have been noticed among both heterosexual and homosexual couples engaging in anal sex.
Gym enthusiasts, as well as those involved in manual material handling where lifting heavy objects are involved, should apply caution as this too is considered a risk factor.
Lastly, those with weak pelvic support are often asked to work on strengthening the muscles to reduce the incidents of hemorrhoids or piles.
Be cautious of these risk factors so you can avoid this painful condition in the future.
References [ + ]
|1.||↑||Hemorrhoids: Expanded Version. ASCRS.|
|2, 3.||↑||What Are Hemorrhoids? MUSC.|
|4.||↑||Hemorrhoids. Cleveland Clinic.|
|5.||↑||Haas, Peter A., Thomas A. Fox, and Gabriel P. Haas. “The pathogenesis of hemorrhoids.” Diseases of the colon & rectum 27, no. 7 (1984): 442-450.|
|6.||↑||Johanson, John F., and Amnon Sonnenberg. “The prevalence of hemorrhoids and chronic constipation: an epidemiologic study.” Gastroenterology 98, no. 2 (1990): 380-386.|
|7.||↑||Arabi, Y., J. Alexander-Williams, and M. R. B. Keighley. “Anal pressures in hemorrhoids and anal fissure.” The American Journal of Surgery 134, no. 5 (1977): 608-610.|
|8.||↑||Lee, Jong-Hyun, Hyo-Eun Kim, Ji-Hun Kang, Jin-Young Shin, and Yun-Mi Song. “Factors associated with hemorrhoids in korean adults: korean national health and nutrition examination survey.” Korean journal of family medicine 35, no. 5 (2014): 227-236.|
|9.||↑||Abramowitz, L., and A. Batallan. “Epidemiology of anal lesions (fissure and thrombosed external hemorroid) during pregnancy and post-partum.” Gynecologie, obstetrique & fertilite 31, no. 6 (2003): 546-549.|
|10.||↑||Pregnancy And Hemorrhoids. APA.|
|11.||↑||Menter, Robert, David Weitzenkamp, Dianne Cooper, Jenny Bingley, Susan Charlifue, and Gale Whiteneck. “Bowel management outcomes in individuals with long-term spinal cord injuries.” Spinal cord 35, no. 9 (1997).|