Did you know… our anus has “cushion” tissue that helps the anus expand during defecation and helps the anal opening close tightly. If the cushion tissue hangs lower than normal, bulges without shrinking after defecation, and causes bleeding, you should consider that you might have hemorrhoids. We can classify hemorrhoid symptoms into 4 grades: Grade 1 has bleeding during defecation but no protruding lumps; Grade 2 has lumps that protrude but retract on their own; Grade 3 has lumps that protrude and need to be pushed back manually; and Grade 4 has hemorrhoids that remain outside and cannot be pushed back in. If symptoms are at this level, you must see a doctor urgently before the tissue becomes necrotic due to lack of blood supply.
Common Hemorrhoid Symptoms to Watch For
- Bleeding after defecation
- Lumps protruding during defecation
- Wet and itchy anus around the anal opening
- Inflammation of hemorrhoids and pain around the anus
- Palpable lumps around the anus
Factors Causing Hemorrhoids
Most factors causing hemorrhoids come from our behavior, such as not eating fiber-rich foods, leading to constipation and straining during defecation, which pushes the cushion tissue downward. Also, straining to completely empty the bowels or sitting on the toilet for a long time reading newspapers can contribute to the cushion tissue slipping down. It may also be caused by physical conditions such as pregnancy, where hormonal changes and an enlarged uterus make defecation difficult; liver cirrhosis, which blocks blood flow causing veins around the anus to bulge; or aging, where muscles weaken causing the cushion tissue to slip and protrude from the anus.
Hemorrhoid Treatment
Hemorrhoid treatment depends on the symptoms or grade and also the doctor’s assessment. Some people may only need to adjust their behavior to reduce risk factors, while others may require surgical treatment for hemorrhoids.
In the early stages when symptoms are not severe, at grade 1 or 2, treatment may only involve normalizing bowel movements to prevent constipation, eating high-fiber vegetables and fruits, drinking 8 glasses of water daily, and adjusting defecation habits including sitting and straining. If bowel movements are difficult, mild laxatives such as MOM (Milk of Magnesia) may be used, or medications to stop bleeding may be given.
In severe stages, at grade 3 or 4, surgery is the best treatment. Currently, there are 4 surgical methods:
- Using rubber band ligation at multiple sites simultaneously. This is a minor surgery with the least pain, quick recovery, but has a chance of recurrence.
- Hemorrhoid stapling. Less painful, no hospital stay required, with only 2-3 days of recovery, but also has a chance of recurrence.
- Conventional hemorrhoidectomy. The outcome depends on the surgeon’s expertise, with the lowest chance of recurrence. It is like cosmetic surgery around the anus.
- Surgery using an automatic stapling device that staples all hemorrhoid heads back in place without external wounds around the anus. This surgery is effective, less painful than conventional surgery, requires less recovery time, and the first bowel movement after surgery does not cause increased pain.
However, hemorrhoids are often found both internally, externally, and at the anal margin combined. Successful treatment requires the skill and expertise of the doctor, as well as cooperation and clear communication of symptoms from the patient. Patients often feel embarrassed, fear pain, and avoid examination. It is important to understand that hemorrhoid examinations are done in a private setting with draping, and the doctor will provide proper guidance and care. About 80-90% of hemorrhoid patients do not require surgery. Therefore, early consultation with a colorectal and anal specialist will help ensure faster and better treatment outcomes for the patient.
Dr. Theerasanti Tantitemit
Colorectal and Anal Surgery Specialist
Colorectal and Anal Disease Center, Phyathai 2 Hospital
