Internal hemorrhoids are those that occur above the dentate line. Specifically,
they are varicosities of veins draining the territory of branches of the superior rectal arteries.
HemorrhoidsHemorrhoids are varicosities of the veins around the dentate line of the anal canal. Of all the anorectal disorders, hemorrhoids has the highest rate of occurrence and is commonly believed to be caused by:
- Anatomical reason
- Chronic constipation
- Pregnancy, tumor in the pelvic region, enlarged prostate glands
- Infection, excessive hot and spicy food, alcoholism, inflammation in the rectal region
Hemorrhoids can be classified based on their location into:
- Internal: inflamed and swollen veins above the dentate line at the rectum, and commonly called primary hemorrhoids. Major symptoms are bright red blood covered stools, the gradually growing hemorrhoids will be eventually pushed outside the anus and may stay prolapsed. Internal hemorrhoids can be pathologically classified into three types: varicose vein, inflamed artery and fibrosis.
- Depending on the condition it can be graded into: – Grade I – bleeding upon defecation and no prolapse; – Grade II – prolapsed upon defecation but can be pushed back into the anus; – Grade III – hemorrhoids stay prolapsed.
- External: inflamed and swollen veins below the dentate line at the rectum or skin growth (cutaneous skin tag) at the anus region. Major symptoms are difficulty in cleaning the anus region after bowel movement, pain arising from inflamed veins or blood clots at these veins. External hemorrhoids can be classified into four types: scarring, varicose veins, blood clot, inflammatory.
- Combined: varicose veins both above and below the dentate line, and frequently the internal and external hemorrhoids are connected together. Major symptoms are bright red blood covered stools, prolapsed hemorrhoids, difficulty in cleaning the anus region after bowel movement, itchiness, mucous discharge, in serious cases there may be severe pain caused by the prolapsed and inflamed hemorrhoids.
Why are Hemorrhoid Conditions Common among Females?There is a Chinese saying that nine out of ten men have hemorrhoids but in reality, same is also true of women. The reasons for this are:
- Anatomical: women’s colon is subjected to the pressure exerted by the uterus inside the pelvic cavity and is longer than that of men’s, as a result feces take long time to get to the rectum; such condition can easily lead to constipation and consequently hemorrhoids.
- Pregnancy: the fetus exerts pressure on the colon and rectum, restraining the return of blood from the veins leading to varicosis and consequently hemorrhoids.
- Menstruation and leucorrhea: the discharge irritates the region around the anus, which may result in chronic inflammation, followed by abnormal skin tissue growth, eventually developing into hemorrhoids or anal eczema.
- Childbirth: during the childbirth process, different level of laceration of the pudendum may occur resulting in swelling and inflammation of the anus with accompanying pain, and developing into external hemorrhoids.
- Postnatal condition: following childbirth, women may feel emptiness and weakness in the abdomen, with decreased sensation on the urge for bowel movement. The lack of physical activity is also making it difficult for them to make bowel movement, as a result feces will remain in the colon for longer period leading to dry and harder stools, with the possibility of injuring the anus when straining bowel movement and developing anal fissure.
How Do Senior People Prevent Hemorrhoids and Choose Treatment Methods?Generally senior people have weaker physical conditions and many have cardiovascular and/or neurological disorders, with diminishing functional capacity and lower self-healing capabilities in response to external stimulations. Under these conditions, surgical operation to treat the anorectal diseases will carry higher risk whereas our treatment therapy using external application of our “Ba Zhi San” powder is a completely safe option.
People generally feel that a thorough treatment to take care of the anorectal problems prior to entering old age or before any signs of cardiovascular, neurological diseases appearing will make it easier for senior people to maintain a healthier life. Disease prevention is obviously a better choice and to avoid having hemorrhoids, older people should pay attention to the following:
- Maintain regular routine on diet, sleep, exercise, rest and entertainment, and keep the body in a healthy condition.
- Have a nutritional diet that provides high protein, multi-vitamins, low fat, low cholesterol, low salt, low sugar; have meals at regular times, in constant quantities, neither too hot or too cold and easy to digest.
- Exercise at an appropriate intensity level on a consistent basis, avoid being vigorous and being excessive.
- Prevent disease and when sick, seek medical treatment as early as possible, pay attention to body conditions and have periodic medical checkup so that problems can be dealt with at an early stage.
Wine Drinking and HemorrhoidsThere is a close link between drinking wine and the occurrence or worsening of the anorectal diseases. Wine can stimulate one’s blood circulation and relax the walls of the blood vessels, such that too much blood is supplied to the rectal venous vessels. For people with hemorrhoids, the inflammation will get more severe; to those with anal fissure or fistula, the symptoms will become more serious and painful feeling will intensify.
Drinking wine may occasionally bring about pain relief and better feeling about the body condition; however, the person may find in the next morning that the hemorrhoids will get more swollen and protruding, with excruciating pain.
It was mentioned in ancient Traditional Chinese Medicine literature that one of the causes of hemorrhoids is alcoholism, for the reason that excessive wine will damage the digestive organs, creating “heat” (as defined in T.C.M.) in the body and accumulating wine toxin in the internal organs which will eventually be channeled to the colon, leading to stasis followed by bleeding.
It can therefore be seen that wine has a damaging effect on hemorrhoid patients, who should avoid drinking or reduce wine consumption and frequency.
While discussing on restraining wine intake, we should also consider the adverse effects of wine on our liver and heart. One should always limit the wine consumption in accordance with one’s health conditions.
Constipation and HemorrhoidsConstipation is a common symptom of the hemorrhoids patient. Around 50% of the senior people suffer from constipation. Constipation is not only a cause of anorectal diseases like hemorrhoids and fistula, it may also lead to other diseases or worsening them.
Constipation can have three different meanings:
- infrequent bowel movements (less than three times per week): moisture and toxins will be absorbed by the body; decreased elasticity of the anal venous vessels leading to blood stasis
- difficult bowel movement, not smooth, with feeling of incomplete evacuation
- dry and hard stools: with tendency of straining on bowel movement thereby injuring the anal muscle, leading to inflammation and abscess, increasing the extent of blood stasis
Chronic constipation may cause more serious complications like intestinal obstruction.
What are anal fissures?An anal fissure is a cut or tear occuring in the anus (the opening through which stool passes out of the body) that extends upwards into the anal canal. Fissures are a common condition of the anus and anal canal and are responsible for six to fifteen percent of the visits to a colon and rectal (colorectal) surgeon. They affect men and women equally and both the young and the old. Fissures usually cause pain during bowel movements that often is severe. Anal fissure is the most common cause of rectal bleeding in infancy.
Anal fissures occur in the specialized tissue that lines the anus and anal canal, called anoderm. At a line just inside the anus–referred to as the anal verge or intersphincteric groove–the skin (dermis) of the inner buttocks changes to anoderm. Unlike skin, anoderm has no hairs, sweat glands, or sebaceous (oil) glands and contains a larger number of somatic sensory nerves that sense light touch and pain. (The abundance of nerves explains why anal fissures are so painful.) The hairless, gland-less, extremely sensitive anoderm continues for the entire length of the anal canal until it meets the demarcating line for the rectum, called the dentate line. (The rectum is the distal fifteen cm of the colon that lies just above the anus and just below the sigmoid colon.)
What causes anal fissures?Anal fissures are caused by trauma to the anus and anal canal. The cause of the trauma usually is a bowel movement, and many patients can remember the exact bowel movement during which their pain began. The fissure may be caused by a hard stool or repeated episodes of diarrhea. Occasionally, the insertion of a rectal thermometer, enema tip, endoscope, or ultrasound probe (for examining the prostate gland) can result in sufficient trauma to produce a fissure. During childbirth, trauma to the perineum (the skin between the posterior vagina and the anus) may cause a tear that extends into the anoderm.
The most common location for an anal fissure in both men and women (ninety percent of all fissures) is the midline posteriorly in the anal canal, the part of the anus nearest the spine. Fissures are more common posteriorly because of the configuration of the muscle that surrounds the anus. This muscle complex, referred to as the external and internal anal sphincters, underlies and supports the anal canal. The sphincters are oval-shaped and are best supported at their sides and weakest posteriorly. When tears occur in the anoderm, therefore, they are more likely to be posterior. In women, there also is weak support for the anterior anal canal due to the presence of the vagina anterior to the anus. For this reason, ten percent of fissures in women are anterior, while only one percent are anterior in men. At the lower end of fissures a tag of skin may form, called a sentinal pile.
When fissures occur in locations other than the midline posteriorly or anteriorly, they should raise the suspicion that a problem other than trauma is the cause. Other causes of fissures are anal cancer, Crohn’s disease, leukemia as well as many infectious diseases including tuberculosis, viral infections (cytomegalovirus or herpes), syphilis, gonorrhea, chlamydia , chancroid (Hemophilus ducreyi), and human immunodeficiency virus (HIV). Among patients with Crohn’s disease,four percent will have an anal fissure as the first manifestation of their Crohn’s disease, and half of all patients with Crohn’s disease eventually will develop an anal ulceration that may look like a fissure.
Studies of the anal canal in patients with anal fissures consistently show that the muscles surrounding the anal canal are contracting too strongly (they are in spasm), thereby generating a pressure in the canal that is abnormally high. The two muscles that surround the anal canal are the external anal sphincter and the internal anal sphincter (already discussed). The external anal sphincter is a voluntary (striated) muscle, that is, it can be controlled consciously. Thus, when we need to have a bowel movement we can either tighten the external sphincter and prevent the bowel movement, or we can relax it and allow the bowel movement. On the other hand, the internal anal sphincter is an involuntary (smooth) muscle, that is, a muscle we cannot control. The internal sphincter is constantly contracted and normally prevents small amounts of stool from leaking from the rectum. When a substantial load of stool reaches the rectum, as it does just prior to a bowel movement, the internal anal sphincter relaxes automatically to let the stool pass (that is, unless the external anal sphincter is consciously tightened).
When an anal fissure is present, the internal anal sphincter is in spasm. In addition, after the sphincter finally does relax to allow a bowel movement to pass, instead of going back to its resting level of contraction and pressure, the internal anal sphincter contracts even more vigorously for a few seconds before it goes back to its elevated resting level of contraction. It is thought that the high resting pressure and the “overshoot” contraction of the internal anal sphincter following a bowel movement pull the edges of the fissure apart and prevent the fissure from healing.
The supply of blood to the anus and anal canal also may play a role in the poor healing of anal fissures. Anatomic and microscopic studies of the anal canal on cadavers found that in eighty five percent of individuals that the posterior part of the anal canal (where most fissures occur) has less blood flowing to it than the other parts of the anal canal. Moreover, ultrasound studies that measure the flow of blood showed that the posterior anal canal had less than half of the blood flow of other parts of the canal. This relatively poor flow of blood may be a factor in preventing fissures from healing. It also is possible that the increased pressure in the anal canal due to spasm of the internal anal sphincter may compress the blood vessels of the anal canal and further reduce the flow of blood.
What is Anal Fistula?Anal fistula is an abnormal connection or tunnel between the anal canal, rectum, anus and the perianal skin, most commonly developed from abscesses in the anal glands around the rectum and anus region; in some rare cases, these can be caused by concretion, actinomyces infection, or the ulceration of malignant tumors. Because the anal fistula tunnels run in the region of the anal sphincter muscle and tend to be long, narrow, winding, the pus trapped therein cannot be easily drained; if the outside opening of the tunnel heals, recurrent abscesses may develop and may lead to repeated acute inflammation, with possible induration along the tunnel wall. Major symptoms are recurring painful inflammation around the anus region, discharging pus when turned ulcerous. Types of fistulas include: simple, complicated, high location, low location, blind and internal, blind and external, and horseshoe.
Anal Abscess OverviewA perirectal abscess is a collection of pus in the deep tissues surrounding the anus. By contrast, a perianal abscess is a shallower collection of pus under the skin surrounding the anus; however, both are sometimes described as an anal abscess. Both types of abscesses need immediate medical attention; however, a perirectal abscess usually is the more severe infection. A delay in treatment may cause serious worsening of the condition and unnecessary complications.
Anal Abscess CausesPerirectal and perianal abscesses are thought to develop from the glands surrounding the anus; on occasion, perianal abscesses may develop from infected skin adjacent to the anus. Glands may plug up, usually leading to bacterial infection. When the glands fill with pus, they may burst inward, releasing their infected contents into the spaces around the rectum and anus. This pus causes an abscess, or pus collection, in the spaces surrounding the rectum or anus. The anal abscess may enlarge, causing pain, fever, and difficulty with bowel movements.
What is anal itching?Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Although itching may be a reaction to chemicals in the stool, it often implies that there is inflammation of the anal area. The intensity of anal itching and the amount of inflammation increases from the direct trauma of scratching and the presence of moisture. At its most intense, anal itching causes intolerable discomfort that often is described as burning and soreness.
What causes anal itching?
- Anal itching can be caused by irritating chemicals in the foods we eat, such as are found in spices, hot sauces, and peppers.
- Anal itching also can be caused by the irritation of continuous moisture in the anus caused by frequent liquid stools, diarrhea, or escape of small amounts of stool (incontinence). Moisture increases the possibility of infections of the anus, especially yeast, particularly in patients with diabetes mellitus or HIV.
- Treatment with antibiotics also can lead to a yeast infection and irritation of the anus.
- Psoriasis also can irritate the anus
- Abnormal passageways (fistulas) from the small intestine or colon to the skin surrounding the anus can form as a result of disease (such as Crohn’s disease), and these fistulas bring irritating fluids to the anal area.
Crohn’s DiseaseCrohn’s disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms. It primarily causes abdominal pain, diarrhea (which may be bloody if inflammation is at its worst), vomiting (can be continuous), or weight loss, but may also cause complications outside the gastrointestinal tract such as skin rashes, arthritis, inflammation of the eye, tiredness, and lack of concentration.
Crohn’s disease is caused by interactions between environmental, immunological and bacterial factors in genetically susceptible individuals. This results in a chronic inflammatory disorder, in which the body’s immune system attacks the gastrointestinal tract possibly directed at microbial antigens. Crohn’s disease has traditionally been described as an autoimmune disease, but recent investigators have described it as a disease of immune deficiency.
There is a genetic association with Crohn’s disease, primarily with variations of the NOD2 gene and its protein, which senses bacterial cell walls. Siblings of affected individuals are at higher risk. Males and females are equally affected. Smokers are two times more likely to develop Crohn’s disease than nonsmokers. Crohn’s disease affects between our hundred thousand and six hundred thousand people in North America. Prevalence estimates for Northern Europe have ranged from twenty seven to forty eight per one hundred thousand. Crohn’s disease tends to present initially in the teens and twenties, with another peak incidence in the fifties to seventies, although the disease can occur at any age.
There is no known pharmaceutical or surgical cure for Crohn’s disease. Treatment options are restricted to controlling symptoms, maintaining remission, and preventing relapse. The disease was named after American gastroenterologist Burrill Bernard Crohn, who, in 1932, together with two colleagues, described a series of patients with inflammation of the terminal ileum, the area most commonly affected by the illness.