Haemorrhoids

Sixty per cent of the symptoms of hemorrhoids are bleeding from the bowel (fresh bloody stools), 55% are anal itching, 20% are anal discomfort or pain, and 10% are fecal leakage. The most common symptom in patients with hemorrhoids is non-painful bleeding in the feces (internal hemorrhoids). In the case of internal hemorrhoids, the bleeding is often seen as red blood at the "end" of the stool, or when wiping the buttocks. When internal hemorrhoids swell to a certain extent, they will sag down towards the anus, so that you can feel the hemorrhoidal mass near the anus. The degree of swelling and prolapse of internal hemorrhoids is classified according to the degree of swelling and prolapse of internal hemorrhoids, and the treatment required is also  different.

The classification of hemorrhoids is as follows:

• Grade I internal hemorrhoids: the blood vessel clusters and epithelial tissues are bulging without any prolapse.
• Grade 2 internal hemorrhoids: the hemorrhoid begins to prolapse but can be restored to its original position automatically.
• Grade III internal hemorrhoids: the hemorrhoids can be pushed back to the top of the dentate line by the fingers after they have prolapsed. This may cause anal itching.
• Grade IV internal hemorrhoids: the hemorrhoid has prolapsed beyond the anal opening and cannot be pushed back with a finger, and may be accompanied by chronic inflammation and ulceration.

Varicose veins or abnormal congestion near the anus, usually caused by increased intra-abdominal pressure, which obstructs blood circulation to the anus, i.e. venous reflux. 

• People with constipation or diarrhea (increased local pressure in the anus)
• Obese people (increased pressure in the abdomen)
• Insufficient intake of fibre (constipation easily leads to increased pressure in the abdomen).
• Occupations with prolonged standing and sitting, e.g. designers, drivers, chefs, hairdressers, etc. (difficult to return blood to the anorectal vein).
• Patients with portal hypertension (high pressure in the abdominal venous system, affecting the anorectal venous return)

In addition to the above risk factors, pregnant women (increased pressure in the abdomen affects anorectal venous return) and elderly silver-haired people (loose connective tissue and decreased mobility affects anorectal venous return) are also at high risk.

Treatment of hemorrhoids depends on the symptoms and severity of the symptoms in different patients:

If the hemorrhoids are extremely painful, or if there are suspicious symptoms such as severe anal bleeding, discharge of black feces or blood clots, the patient should consult a doctor immediately for an accurate diagnosis and early treatment. In case of pregnant women, it is recommended to consult a doctor instead of buying medication on their own.

The most common symptom of haemorrhoids is bloody stools, but bleeding in the stool is not the same as having haemorrhoids. Bleeding in the stool is also a common symptom of other serious digestive diseases, such as colorectal cancer, peptic ulcers or bleeding. Prolonged bleeding haemorrhoids may cause chronic anaemia, which poses a health risk to the patient. If you have a bleeding bowel movement, it is important to seek immediate medical attention to determine the cause of the bleeding.

To prevent hemorrhoids, the first thing you need to do is to prevent constipation. Eating more high-fibre foods can help improve bowel movements. Secondly, you should develop a regular bowel habit, do regular exercise, and avoid prolonged standing or sitting, all of which can help reduce the risk of hemorrhoids forming and occurring.

1. Non-communicable Disease Watch January 2011 - Haemorrhoids - No Joke - Centre for Health Protection from https://www.chp.gov.hk/files/pdf/ncd_watch_jan_2011_chi.pdf 
2. Common Diseases in Men - Haemorrhoids - Health Protection Centre from https://www.chp.gov.hk/tc/static/80041.html
3. Hemorrhoids - NIDDK from https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids