ANATOMY & PHYSIOLOGY

To understand hemorrhoids, we need to review the anatomy of the digestive system (start backward- from the anus)

The anus is the end-point of the digestive system. It contains sweat and oil glands, hair follicles, as well as many nerve endings, which make it very sensitive to pain and erotic stimulation. The anal opening is an oval opening located about an inch in front of the spine. When closed, the anus is about an inch in circumferencehowever, the external sphincter muscle that circles it can stretch to about five times the size.

Inside the opening is the anal canal. It is approximately two inches deep; with an encircling internal sphincter muscle that controls the passage of stool in the elimination process. On top of the anal canal, there is a ring of tissue fold arranged in zigzag or sawtooth pattern called the dentate line. Underneath this line lies some vestigial glands- in our evolutionary ancestors, these glands secrete odors that attract mates. Now, however, these glands are empty and unused. About an inch above the dentate line is the rectum, or the last holding place for feces in the elimination process. The rectum is approximately six inches long, with folds called the valves of Houston. These valves serve as shelves where the feces rest between bowel movements. When the stool becomes heavy, the valve presses against the rectal walls, which results in the the call of nature signal or urge to defecate.

WHAT ARE HEMORRHOIDS

The term hemorrhoids refer to a condition in which the veins around the anus or lower rectum are swollen and inflamed.

There are two types of hemorrhoids: External hemorrhoids Hemorrhoids located outside of the anus are called external hemorrhoids. Here, swollen veins cause a soft lump around the anal opening. These lumps can turn hard if blood clot develops, and become painful thrombosed hemorrhoids. Since the anus has many nerve endings, external hemorrhoids can be very painful or itchy. Sometimes, the clot may even break out of the hemorrhoid by itself or dissolve back into normal blood circulation. Internal hemorrhoids Internal hemorrhoids are located inside the rectum or anal canal, and are usually not painful. This is because the anal canal does not have many nerve endings. Indeed, most people are not aware that they have internal hemorrhoids until a hard stool rubbing against them cause these hemorrhoids to rupture and bleed. Left untreated, some internal hemorrhoids can prolapsed or be pushed out of the anal opening. Sometimes, the sphincter muscle can close shut in a spasm and trap this prolapsed hemorrhoid outside the anus. This cuts off the blood circulation, and creates a strangulated hemorrhoid. Some prolapsed hemorrhoids can be manually pushed back inside the anus. Advanced cases of prolapsed hemorrhoids, however must be surgically treated. Prolapsed and strangulated hemorrhoids are serious medical condition that requires immediate attention. Also, bleeding of any amount should be checked by a doctor since it may be an indication of more serious conditions, such as colorectal cancer.