That Which We Call A Hemorrhoid By Any Other Name Would Feel As Painful…
Call them hemorrhoids, emorods or piles, spell them haemorrhoids or hemroids … what you are describing is swelling and inflammation of veins in the rectum and anus – in other words, swollen veins in the anal canal.
Hemorrhoids are actually very common among both men and women. About half the population suffers from haemorrhoids, to varying degrees, by the age of 50. While hemorrhoids can be painful (in some cases, excruciating), they’re usually not serious.
Veins that swell inside the rectum are called internal haemorrhoids. When they swell near the opening of the anus they are referred to as external hemorrhoids. You can have both types simultaneously (ugh!). The symptoms and treatment depend on which type you have.
What’s in a name?
The word “hemorrhoid” is an old one. The origin of the word comes from the Greek “haema” (or blood) and “rhoos” (or flowing). It was probably first used as a medical description by Hippocrates in 460 BC. The term “piles”, derived from the Latin “pile” (or ball), was widely used as early as 1370 AD.
The first use of the word “hemorrhoid” in English occurs in 1398, derived from the Old French “emorroides”, from Latin hæmorrhoida, in turn from the Greek αἱμορροΐς (haimorrhois), “liable to discharge blood”, from αἷμα (haima), “blood” and ῥόος (rhoos), “stream, flow, current”, itself from ῥέω (rheo), “to flow, to stream”.
Symptoms of Internal Hemorrhoids
Internal hemorrhoids are veins in the lower rectum and anal canal which have swollen and protruded from the wall lining. You can have internal hemorrhoids for a long time before you become aware of their existence. And some (lucky) people never develop symptoms.
Any of the following symptoms could indicate the presence of internal haemorrhoids – but, of course, you should always confirm the cause of any pain or abnormality with your healthcare practitioner.
• Bleeding during a bowel movement As the hard stool passes through the rectum, the swollen veins will begin to bleed. In most cases, there is no pain experienced because nerve endings are lacking in this area. The amount of blood loss is usually small, but it will be bright red in color.
• Mucus can be on the toilet tissue or on the bowel movement. Mucus can drain steadily from the anus.
• Rectal itching and burning from the drainage caused by the hemorrhoids. The skin around the anus can not handle the irritating fluids as the internal tissue can.
• Leakage of stool from the anus. Stool can escape with the drainage from this swollen area.
• Prolapse An internal hemorrhoid can fall down (prolapse) and protrude outside the anus. Usually, there are two stages associated with prolapsed hemorrhoids. The first stage is when the hemorrhoid will be pushed out of the anus during a bowel movement, but it then retracts back inside (after the bowel movement). The second stage is when the prolapsed hemorrhoid no longer retracts, and it remains outside the anus.
• A feeling of rectal fullness as if you need to have a bowel movement.
Symptoms of External Hemorrhoids
External hemorrhoids are often extremely painful and more serious than internal hemorrhoids. They occur below the pectinate line where the internal tissue changes to external skin.
• A painful swelling or hard lump around the anus which results from a blood clot forming in the veins. These hemorrhoids are said to be thrombosed because the blood in them cannot return to circulation in the body and is strangulated. This can be a serious (though uncommon)condition that leads to gangrene (tissue death).
• Pain can be severe because of the nerve endings around the outside of the anus.
• Skin irritation can cause itching, burning and bleeding.
• Drainage of mucus and stool.
Causes of Hemorrhoids May Include:
• Straining during bowel movement
• Excessive tissue paper cleaning
• Pregnancy & Childbirth
• Sitting on the toilet too long
• Unnatural sitting habits
• Eating a low-fiber diet
• Standing for too long
• Lifting too much weight
• Cirrhosis of the liver
• Bad Diet
• Anal or rectal infections
Yes, Even Famous People Suffer From Hemorrhoids
–Napoleon Bonaparte was said to have had hemorrhoids, and some historians have actually debated whether he lost the Battle of Waterloo because he was unable to sit on his horse during the battle to lead his army.
-In 1978, President Jimmy Carter had to leave a party at the White House because of hemorrhoidal pain. The pain was so severe that he was incapacitated and could no longer perform his duties. He had surgery soon afterward, and returned to the Oval Office.
–George Brett, a third baseman for the Kansas City Royals, missed part of the World Series in 1980 because of hemorrhoids. Minor surgery was performed, so he could return quickly to the game the next day.
Canadian football player Arland Bruce III, at the time with the Argonauts and later the Hamilton Tiger-Cats, had a well publicized bout with hemorrhoids including an interview where he gave details…
”It’s kind of odd that I wound up with this 50-year-old man’s disease,” Bruce said yesterday. “But all I can do is ice it and rest. I’ve had these before in college. It went well (yesterday), but I have two grape-sized hemorrhoids and I’m taking some anti-inflammatories and see how I feel (today).”
In May 2009, the big “hemorrhoids in sports” news was that the Tigers’ Carlos Guillen was battling a bad case of hemorrhoids.
Team manager Jim Leyland said:
”He can hardly move — he’s got hemorrhoids so bad. He’s been playing with hemorrhoids that probably need to be lanced. He probably shouldn’t have been out there.”
Japanese Prime Minister Fumimaro Konoye suffered from a severe case of hemorrhoids. “In April 1939,” according to historian Roger J. Fadness, “the pain he experienced when sitting down was at least partly responsible for his refusal to ride with Minister of Foreign Affairs Yosuke Matsuoka to an important cabinet meeting. This lost opportunity to clear up a misunderstanding with Matsuoka about a U.S. peace proposal may very well have contributed to Japan’s entry into World War II.”
While traveling through France on a train one day, English actor Hugh Grant began to suffer discomfort from his first ever hemorrhoid. Eventually, Grant slipped into the bathroom to investigate. Standing on the toilet, he turned his back to the mirror, pulled his cheeks apart and put his head between his legs to have a look. Unfortunately, in his haste, Hugh had forgotten to lock the door …
You can watch this video to hear Hugh Grant recount his story (warning – colourful language).
History of Surgical Treatment of Hemorrhoids
How Hemorrhoids Have Been Treated Through Various Ages Around The World
• The Egyptians
The earliest record of hemorrhoids comes from Egyptian Papyrus dated at 1700 BC. The document recorded the first treatment for piles, an herbal poultice: “if thou inspecteth a man in his anus, whether standing or sitting, suffering very greatly with seizures in both his legs. Thou shouldst give a recipe, an ointment of great protection; Acacia leaves, ground, titurated and cooked together. Smear a strip of fine linen therewith and place in the anus, that he may recover immediately.”
• The Greeks
Hippocrates wrote some of the earliest medical descriptions of hemorrhoids. The Hippocratic Treatises, written in 460 BC, described hemorrhoids as being caused by “bile or phlegm be determined to the veins of the rectum, it heats the blood in the veins; and being gorged the inside of the gut swells outwardly, and the heads of the veins are raised up, and being at the same time bruised by the faeces passing out, and injured by the blood collected in them, they squirt out blood, most frequently along with the faeces.”
Hippocrates also wrote of a hemorrhoid treatment similar to today’s rubber band ligation procedure. He wrote: “And hemorrhoids in like manner you may treat by transfixing them with a needle and tying them with very thick and woolen thread; for thus the cure will be more certain. When you have secured them, use a septic application, and do not foment until they drop off, and always leave one behind; and when the patient recovers let him be put on a course of Hellebore.”
• The Romans
In a medical treatise De Medicina, a Roman physician named Celcus (25 BC – AD 14) described the ligation and excision surgeries, as well as possible complications. Another description of hemorrhoids was provided by Galen (AD 131 – 201), who also promoted the use of severing the connection of the arteries to veins in order to reduce pain and avoid spreading gangrene.
Maimonides (1134–1240 AD) wrote an entire book devoted to the subject of haemorrhoids and digestion.
• The Far East
Hemorrhoids are not limited to the Western world – it is acknowledged as a disease in India by the Susruta Samhita, an ancient Sanskrit text dated between the fourth and fifth century AD. The description in this text is comparable to the Hippocratic Treatise, but with advancement in surgical procedures and emphasis on wound cleanliness.
• The Master & Barber Surgeons
By the 13th century, there is significant progress in surgical procedures, led by European physicians called the Master Surgeons. Renowned figures such as Lanfrank of Milan, Guy de Chauliac, Henri de Mondeville, and John of Ardene greatly expanded and refined surgical procedures.
However, the progress of science & surgery stalled for about 350 years when barbers began to routinely conduct surgeries! Between 1500 and 1850 AD, in an era later known as the era of “Barber Surgeons”, hemorrhoids were commonly called the “Curse of St. Fiacre”.
The story is that St. Fiacre, who later became the patron saint of gardeners, was told by his church that he could farm on all of the land that he could cultivate in a single day with a very small shovel. In his zeal to obtain the maximum amount of land, St. Fiacre developed a terrible case of hemorrhoids. According to legends, after praying for a miraculous relief, St. Fiacre sat on a stone and found that his problem was cured and an image of a hemorrhoid is imprinted on the stone. Today, hemorrhoid sufferers continue to sit on the stone and pray for relief!
• The Renaissance
During the Renaissance (18th century), surgeries thankfully returned to the realm of the scientists. A celebrated physician, Lorenz Heister (1739), wrote about the crudeness of past procedures to treat haemorrhoids. His famous book, titled “Chirurgie,” is one of the earliest surgical textbooks with detailed illustrations, including descriptions of the excision and ligation of hemorrhoids. Heister sutured and ligated the bleeding hemorrhoids with a needle and thread excising the lower part and described a detailed procedure for ligation. He wrote: “he is then to tie up the bleeding tunercles with a needle and thread, cutting off those parts which are distended beyond the ligature, taking care at the same time to leave a few of the smallest veins open as before observed.”
Acknowledging that hemorrhoids and varicose veins seem to affect only the upright humans, a physician-scientist named Morgnani wrote: “Without doubt, it was not very easy for the blood to pass through a liver of that kind. But why, then, you will say, did it not stagnate equally in the other veins which go to the trunk of the vena portarum? And for this very reason it was that I said you would immediately understand it, or at least in part. Add therefore, to omit other things, the very great length, which is peculiar to this one vein among others, so that it is much more difficult for the blood to be carried upwards, from this vein, than from the others, especially as the situation of the human body requires it, which without doubt is one of the reasons why other animals are not subject to piles. And if you ask why, in those bodies in which there is any impediment to the quick motion of the blood upwards, the veins of the legs in particular are dilated into varices, you will find the same thing to be the cause of them chiefly which we assign for the piles.”
It was an innovative theory as it overturned the hypothesis of Hippocrates concerning the cause of hemorrhoids.
• The Eighteenth / Nineteenth Century
In 1774, Jean Louis Petit wrote a three-volume treatise on surgery, in which he noted that the skin of the anus is very sensitive. He reasoned that excision surgery alone should be avoided due to the pain and the possibly fatal complication of hemorrhage, whereas ligation procedure alone should not be performed because of the pain and the possibility of gangrene.
However, other physicians such as Brodie, disagreed with Petit’s concern on ligation, noting that “the application of ligature to internal piles in general causes by little pain, and only a slight degree of inflammation follows, for the mucous membrane has nothing like the sensibility of the skin, and does not resent an injury in like manner.”
Sir Astley Cooper also supported ligation after complications from hemorrhoid excision surgeries claimed three of his patients’ lives.
During the nineteenth century, another treatment for hemorrhoids called anal stretching or rectal bouginage, became popular. In this treatment, a bougin – a cylindrical medical device used to stretch muscles and tissues, is inserted in the anal canal to enlarge the rectum as well as to “relax” the sphincter muscle and diminish hemorrhoids.
In 1888, Frederick Salmon, the founder of St. Marks Hospital, expanded the surgical procedure of hemorrhoid surgeries into a combination of excision and ligation. In this technique, the perianal skin is incised, the hemorrhoidal plexus and the anal muscles are dissected, and the hemorrhoid is ligated.
• The Twentieth Century
So successful was Salmon’s excision/ligation surgery that it has remained virtually unchanged since its introduction in late nineteenth century. Even today’s Ferguson and Milligan Morgan hemorrhoidectomy – considered the gold standard in hemorrhoid surgery – was a modification on Salmon’s techniques.
In the late twentieth century, three further developments were introduced: the diathermy hemorrhoidectomy by Alexander Williams, rubber band ligation by Baron, and the stapled hemorrhoidectomy or Procedure for Prolapse and Hemorrhoids (PPH) by Longo.