The anus is the exit sphincter of the digestive tract. It is made up of two circular muscles (the anal sphincters), one autonomous and the other voluntary, which controls bowel movements.
Inside and through the muscles is a network of veins, the hemorrhoidal plexus.
These veins can dilate if there is an increase in abdominal pressure or if feces accumulate in the rectum (constipation). If this increase in pressure is temporary, the veins will return to their original shape once the cause has been resolved. However, if the increase in pressure is repeated and frequent, or prolonged, venaprobuy net the veins end up dilating and deforming, projecting into the anal canal, giving rise to hemorrhoids.
While their size is small they can go unnoticed, without significant symptoms. However, as they increase in size their presence and effects are increasingly noticeable.
The main symptoms they can produce are:
Bleeding: in the form of red blood, usually in small amounts staining the stool or toilet paper.
Pain: especially during anal dilatation for the passing of the stool. This pain can be sharp and intense during defecation or sordid, deep and continuous.
Venous prolapse: the dilated veins “come out” through the anus, being visible. It is not essential for the hemorrhoids to be visible for the rest of the symptoms to occur.
Continuous, very violent pruritus (itching).
Rectal tenderness: the permanent sensation of needing to defecate.
The symptoms associated with hemorrhoids make the evacuation of feces (bowel movement) particularly uncomfortable, so we try to avoid them. This favors constipation, which is the main factor causing hemorrhoids, thus closing a vicious circle that increasingly complicates the picture. Hence the importance of trying to avoid constipation during pregnancy in order to reduce the appearance of hemorrhoids or limit their severity.
In pregnancy, especially in the final months, the continuous pressure of the dilated uterus on the rectum and anus contributes to increasing the pressure and, consequently, the development of hemorrhoids.
In childbirth, expulsion efforts (pushing) represent episodes of a very important increase in abdominal pressure that make the hemorrhoids dilate very significantly and are very evident.
In cases with mild symptoms:
Increase of fiber in the diet (legumes, cereals, nuts, fruits, and vegetables), always associated with an increase in the number of liquids, to obtain a soft stool that does not irritate the anal mucosa.
In some cases, fiber supplements may be indicated.
In initial phases of treatment, the use of a laxative may be associated (taking care not to produce diarrhea that may worsen the symptoms).
Avoid caffeinated beverages, alcohol, and spicy foods.
Spending long periods of time in the toilet to defecate also favors the congestion of hemorrhoids and their subsequent bleeding, which should be avoided.
Warm water sitz baths lasting a few minutes can also be beneficial.
The use of anti-haemorrhoidal creams or ointments may be initially indicated, although it must be taken into account that many of them have compounds (corticoids, topical anesthetics,…) that can cause side effects, so they should only be used for a few days and always under the supervision of a doctor.
There are also medicines that can improve the microcirculation of the area and reduce inflammation, and they can be useful.