This article explains the causes and symptoms of hemorrhoids.

​Types, mechanisms, and symptoms of hemorrhoids

Among anal diseases, hemorrhoids (piles), anal fistulas (anal holes), and anal fissures account for approximately 60%, 10%, and 15% of cases, respectively. These three conditions together make up about 85% of all anal diseases.

Hemorrhoids (piles)

Hemorrhoids are the most common anal disease. Because it is difficult to establish consistent standards for diagnosis and survey methods, there is no survey data on how many people in Japan develop hemorrhoids. In the United States, research reports estimate that 4.4% of the population develops hemorrhoids based on a national hospital database and large-scale surveys, and in London, a survey report indicated that 55% of patients examined by proctologists showed signs of hemorrhoids.

There is no difference in the likelihood of developing hemorrhoids between men and women, and it has been reported that the most common age group for both sexes is 45 to 65 years old.
Hemorrhoids are classified into internal and external hemorrhoids depending on their location. Internal hemorrhoids develop inside the body from the dentate line of the rectum, while external hemorrhoids develop outside the body from the dentate line. Furthermore, internal hemorrhoids are classified into grades I to IV depending on the degree of prolapse from the anus. (Gorigar classification)

The main symptoms include bleeding or mucus from the anus, pain, swelling, and itching. Depending on factors such as the size of the hemorrhoids and whether they are internal or external, one or more symptoms may appear.

Bleeding mainly occurs during bowel movements, but can also occur during exercise or walking. The blood is often bright red. The amount of bleeding varies from a gush to just a small amount on the toilet paper or stool, but the bleeding only occurs during bowel movements and stops immediately afterward; it is rare for bleeding to continue after bowel movements.

Anal fistula (anal fistula)

An anal fistula develops when bacteria enter through the anal crypts, located at the junction of the anus and intestines, and cause a bacterial infection of the anal glands. When the inflammation spreads and pus accumulates, it is called a perianal abscess, and when the condition progresses and the passage for the pus becomes a tube or lump, it is called an anal fistula.
Data from Europe and the United States shows that the incidence rate is between 5.6 and 20.8 cases per 100,000 people. Men are about 3 to 5 times more likely to develop the disease than women, and it is most common in both men and women in their 30s and 40s.
Symptoms include sudden, painful swelling, redness, and fever around the anus in the case of a perianal abscess, and persistent discharge of pus, as well as swelling and pain around the anus in the case of an anal fistula.

Anal fissure (tear-shaped hemorrhoid)

Anal fissure is a general term for a condition in which the skin around the anus is torn. Anal fissures are 1.5 times more common in women than in men, and in both sexes, they most frequently occur in people in their 20s and 30s.
An anal fissure is characterized by pain during bowel movements, but in mild, shallow fissures, severe itching may also occur. Repeated anal fissures can cause the wound to deepen (ulcer), to the point where the anal muscles are visible. Ulcers tend to accumulate stool and other debris, leading to constant, severe pain due to repeated inflammation.

Furthermore, to prevent constipation and diarrhea, which can cause hemorrhoids, it is important to avoid prolonged sitting, exposure to cold and fatigue, and stress. Also, be sure to drink plenty of fluids and fiber, and when you feel the urge to defecate, do not hold it in. When you have a bowel movement, try not to strain too much and keep it short.