What is Hemorrhoids?

Hemorrhoids, popularly known as hemorrhoids, is the outward sagging of the anus veins due to enlargement.

Is Hemorrhoids Seen in Children?

In the past, hemorrhoids were very rare in children. As a Pediatric Surgery specialist, we have recently started to encounter it frequently.

Are there cases where hemorrhoids are confused in children?

Yes, there are, especially the soft tissue thickening around the anus, which we call skin tag due to constipation, is often confused with hemorrhoids. Polyps can also be confused with mucosal prolapse. You should also be careful about periaanal fissure and fistula, ulcerative colitis, and signs of Chron's disease.

What Causes Hemorrhoids in Children?

Constipation is reported to be the leading cause, but the fact that hemorrhoids do not occur in every constipated child suggests other factors.

The main causes of constipation are one-way, fiber-poor diet, drinking less water, sitting for long periods, sedentary lifestyle and improper toilet training. Other triggers for constipation are straining more or delaying defecation due to excessive diligence. Thus, the increase in pressure in the anus causes hemorrhoids.

Obesity (obesity) is another reason for the formation of this disease. Other causes include irritable bowel syndrome, inflammatory bowel disease and portal hypertension.

One of the main factors in the occurrence of hemorrhoids is the anatomical structure of the veins in the region and the weak anatomical support provided to the veins by the soft tissues and muscles around them.

Is Hemorrhoids a Genetic or Aialelic Disease?

Although some gene defects are held responsible, it is not a definite genetic disease. It is a disease with familial predisposition. For example, if the mother and/or father have hemorrhoids, the likelihood of having hemorrhoids in their children is slightly higher than the frequency in the normal population.

Is There a Classification of Hemorrhoids?

Hemorrhoids can be classified according to their appearance and location. The dentate line (the line separating the rectum (the last part of the large intestine) and the anus) can be classified as internal, external and mixed according to its location.

 

• Internal Hemorrhoids;
  • Dentate line - nipples located on the toothed line (the line separating the rectum and anus)
  • Covered with mucosa

• Grading: Based on Prolapse Below the Toothed Line

  • Stage I No swelling after defecation

  • Stage II Appears during defecation and disappears spontaneously

  • Stage III It comes out during defecation and needs to be pushed by hand

  • Stage IV: Always out

• External Hemorrhoids

  • They are located below the toothed line

  • Overlying skin (Squamous Epithelium and Somatic Nerves)

• Mixed Hemorrhoids

  • Welds both above and below the threaded line

What are the signs and symptoms of hemorrhoids in children?

Approximately 40% of people with hemorrhoids may not have any symptoms. Itching around the anus, pain when defecating and bleeding in the later stages are the main symptoms.

The itching is caused by the hemorrhoid tissue secreting a mucus that moistens the anus and surrounding tissue.

Pain and discomfort during defecation are other symptoms that cause the child to have a difficult and troublesome process. One of the main causes of pain is thrombus formation in the dilated veins and circulatory disorders in the surrounding tissues.

There is also a protrusion in the anus. This protrusion may be palpable as a swelling during perineal cleaning.

Although bleeding from the anus in children is rarer than in adults, it is not very rare. Bleeding is bright red in color.

Bleeding may rarely cause anemia (iron deficiency anemia due to bleeding) and may cause complaints such as weakness, headache and fatigue.

Internal hemorrhoids are usually asymptomatic. However, some complaints may be seen as a result of hemorrhoidal veins hanging from the anus. In this case, in addition to bleeding, itching and pain among the symptoms of internal hemorrhoids, discharge, wetness, fullness and discomfort in the anus may also occur.

How is Hemorrhoids Diagnosed in Children?

The diagnosis is usually made by history and physical examination. The patient should be examined in a comfortable environment in a suitable position. Hemorrhoid examination is performed by eye and finger. If finger examination cannot be performed due to pain, it can also be performed with anesthesia. If there is bleeding and its source cannot be clearly identified, endoscopy (colonoscopy-rectosigmoidoscopy) may be necessary. Sometimes a whole abdominal ultrasonography may be required to see if there is any other underlying disease.

What are the Treatment Methods for Hemorrhoids?

Although the treatment method used in hemorrhoid disease may vary depending on the complaints, age of the patient, location and degree of hemorrhoids, diet and lifestyle changes are generally recommended for all patients.

It is ensured that the patient does not sit continuously (such as occupation, computer, studying), and an active lifestyle is recommended as much as possible (see our Obesity article).

The patient's nutrition and constipation, if any, are treated (see article on constipation). It is recommended to consume 20-30 grams of fiber daily and to drink 1.5-2 liters of water, a diet rich in fiber-rich foods and poor in protein.

It is important to prevent constipation and reduce the pressure on the anal canal to improve complaints. In addition, people with itching in the anus are prescribed painkiller creams and sitz baths are recommended. External hemorrhoids usually do not cause bleeding unless they are thrombosed (clotted). In patients with bleeding, creams can be used for treatment.

If clinical signs and complaints of hemorrhoids cannot be prevented with all these, surgical methods are used. Surgical options also include differences. The method is determined by considering the location of the hemorrhoid, the age of the patient and the surgical experience of the practicing physician and by explaining the advantages and disadvantages of the methods to the parents and the patient.

Main Methods of Hemorrhoid Surgical Treatment;

• Hemorrhoid Treatment with Laser
• Hemorrhoid Rubber Band Ligation Method
• Hemorrhoidal Artery Ligation Method
• Classical Hemorrhoid Surgery
• Doppler Guided Laser (HeLP) Method in Hemorrhoid Treatment

Hemorrhoid surgery is generally not preferred in Hemorrhoid Stages I and II, but surgery is considered in Stage III and IV hemorrhoids where the clinic is severe.

Open hemorrhoidectomy (Miligan/Morgan) and closed hemorrhoidectomy (Ferguson) are performed with similar methods. In open surgery, the enlarged tissue is removed with a scalpel and this area is left open, while in closed surgery, this area is closed with healthy tissues. These operations are performed under general anesthesia.

In addition to these traditional methods, the longo method, which uses a stapler to remove hemorrhoids, is one of the operations. In this method, it is aimed to cut the hemorrhoid nozzle hanging from the anus in an area where the nerve endings are not dense and to restore this area to its normal state. This method is one of the ideal methods for stage II, III and IV patients.

Laser hemorrhoid surgery is preferred to deflate hemorrhoid pockets in stage I and II patients and to cut enlarged and sagging breasts in stage III and IV patients. Patients usually return to their daily lives after 1 day of rest.

What should be considered after hemorrhoid surgery?

After hemorrhoid (hemorrhoid) surgery, constipation or foods that will force defecation should be avoided. After hemorrhoid surgery, the patient can regulate his/her diet and focus on the consumption of cereal foods, fruits, vegetables and nuts.

Professions that require constant sitting (such as long-distance drivers, desk jobs) should be avoided and physically active life should be preferred.

What is good for hemorrhoid pain?

What can be done for the treatment and pain of hemorrhoids may vary depending on the level of hemorrhoids. In the early stage of the disease, plenty of fluid intake, diet, painkillers, steroid suppositories and creams are effective. In addition to the hot water bath called ‘sitting bath’, consuming fiber foods in patients with constipation reduces hemorrhoid complaints.

What Should Patients with Hemorrhoids Pay Attention to?

1. Diet should be changed to reduce the effect of hemorrhoid-induced complaints. Olive oil dishes and fiber-rich foods should be consumed. Fiber-rich foods; Whole grains, fruits (especially apples, pears), vegetables, legumes, walnuts, almonds. Red meat consumption should be limited as much as possible. In addition, carbohydrate-heavy foods such as pastries, rice and pasta should also be reduced. They should take care to drink 2-3 liters of water a day.
2. Do not stay in the toilet for a long time. They should not hold their toilets due to excessive meticulousness and should adopt regular toilet habits. If possible, use a saturated toilet and take a suitable position. It should not be forgotten that wrong toilet habits will trigger hemorrhoids.
3. External hemorrhoids are usually seen in office workers and long-distance drivers who sit for long periods of time. It is important to avoid sitting for long periods of time if possible to prevent hemorrhoids from becoming a health problem.
4. People with chronic constipation should regularize their lifestyle and diet before the disease occurs.
5. Hot peppers and some spices irritate the area with hemorrhoids. Therefore, excessively hot and spicy diets should be avoided.
6. Lifting heavy loads can cause hemorrhoids by increasing the pressure in the body. Therefore, when doing sports, choose exercises suitable for your body weight.
7. Control weight; Excess weight increases the risk of hemorrhoids, especially by increasing pressure in the abdominal area. It is important to reach and maintain a healthy weight.

What Complications Can Occur If Hemorrhoids Are Not Treated?

Main Complications:

1. Anemia: Blood loss due to bleeding can rarely cause anemia. This can lead to weakness, pale skin, fatigue, and dizziness.
2. Thrombosed hemorrhoid; When blood flow to the hemorrhoid is cut off, it is called a thrombosed hemorrhoid. Thrombosed hemorrhoids can cause severe pain. Emergency surgery may be required.
3. Blood clot: Sometimes, a blood clot may form in hemorrhoids. This is called a thrombosed hemorrhoid. Although not dangerous, it can be extremely painful and may require drainage in some cases.

What to Do About Hemorrhoid Itching?

Constant scratching can cause further damage to the area and worsen the problem. Instead, measures should be taken to reduce the itching. These include:

• Filling a bathtub with warm water and sitting in it
• Applying a cold compress to the anal area
• Using over-the-counter creams or ointments approved by a doctor

*** The information provided here is intended to inform visitors, particularly families, about the content of the website. No information should be considered as advice by visitors and should not lead to any decisions or actions. Families should have their child examined by a pediatric surgeon, consult with them, and make decisions based on their individual expertise.