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What is the incidence and epidemiology of hemorrhoidal disease?



Perhaps you have already heard about hemorrhoids, and how they are related to constipation. The human body is an exquisite work of art that is capable of so many adjustments once it is subjected to abnormalities; and part of the function of the hemorrhoidal complexes is to enable the body to cope up with abnormal conditions (such as hypertension). Let's take a quick look at how these coping up structures suddenly become disease conditions, and how these are associated with constipation.

What is the incidence and epidemiology of hemorrhoidal disease? Every year, it is roughly estimated that greater than one million individuals among the Western populace suffer from hemorrhoidal disease that has already progressed to become symptomatic. The prevalence of hemorrhoidal disease is not selective with regards to a specific age or sex (it can occur also in young individuals), but it is already a given fact that as age increases, the human body slowly deteriorates, so hemorrhoids become increasingly symptomatic as well. It is also found out to be lesser in prevalence in underdeveloped countries, and a diet which is noticeably low in fiber and high in fat is very much associated with constipation, straining, and hemorrhoid development.

Anatomically, hemorrhoidal cushions are typically found along the anal canal, functioning as structures that help prevent damage to the sphincter muscle. Normally, the anal canal is crossed by three main hemorrhoidal complexes which, when engorged with so much blood and subjected to too much straining, will cause its prolapse into the canal. As time passes by (or as age increases), there is gradual weakening of the support system of these complexes, and therefore, these are afterwards exposed to the outside of the anal canal where it is more prone to damage.

Usually categorized to whether it is internal or external, hemorrhoids are actually classified based on the progression of the disease, as to whether these had changed location – from being in the normal internal location towards the prolapsed external condition. But what are the specific presentations of this disease, and the usual complaints that bring patients to the clinics?

Since these are commonly asymptomatic, there are two main reasons why people with hemorrhoids decide to see a doctor: either due to bleeding, or due to protrusion. Pain is usually not the chief complaint, since concurrent pain, if there is any, is commonly described as “dull” and not that prominent. The pain is due to the hemorrhoidal tissue being engorged with blood; severe pain would indicate blockage or thrombosis. Bleeding is noticed usually upon seeing bright red blood in the toilet or after wiping the rectum with tissue. Occasionally, there is significant bleeding, which can cause anemia, and in cases such as this the presence of any abnormal lesions or neoplasm has to be ruled out.

In hemorrhoidal disease, the diagnosis is usually made based on physical examination, giving it a greater weight compared to patient history. But then, a history of cancer in the patient would require the attending physician to rule out colon cancer. The physical examination is usually done through inspection, and then followed by a careful yet thorough digital examination. The patient is typically asked to strain, or asked to do several maneuvers, after which the physician checks whether a tissue prolapses.

Hemorrhoids need to be given medical attention so that it will not progress into an uncontrollable and untreatable state. If left untreated, a bleeding hemorrhoidal complex can cause significant blood loss, and eventually, anemia. The treatment for hemorrhoids comes along with a lot of considerations, and usually if there is bleeding, the main concern is to prevent further blood loss, rather than excision of the prolapsed tissue. Banding, sclerotherapy, and other measures such as excisional hemorrhoidectomy or stapled hemorrhoidectomy are among the treatment options. Among these, only physicians know which is best for a specific condition. So if you happen to think that you might have hemorrhoids, or if you missed out on an executive check-up, try to pay your physician a visit right now. It pays to be aware of how your body is doing, after all these years!

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