Overview
Table Of Contents
Hemorrhoids in seniors are one of those medical conditions that almost everyone (especially seniors) experiences at some point in their lives.
They may be painful or painless and in severe cases, they can alter the normal functioning of patients.
The prevalence of this condition is extremely high with over 50% of individuals above the age of 50 witnessing at least one episode of hemorrhoids.
Additionally, hemorrhoids do not have a definitive cure and for most cases, it is a lifelong condition with periods of episodic flareups.
The good news is that they can be prevented by taking some dietary measures along with keeping a healthy lifestyle.
In this article, we will discuss the basic concepts of hemorrhoids in seniors.
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What are hemorrhoids?
In order to understand hemorrhoids, we have to take a detour to briefly discuss the anatomy/embryology of the rectal canal and the anus.
Embryological origin of the rectum and anus
The rectum and the anus are the final segments of the gastrointestinal tract; these two structures are surrounded by several muscle groups and sphincters.
The major difference between the rectum and the anus is the embryological origin. You see, the rectum originates from an embryological layer known as the endoderm while the anal canal comes from another layer called the ectoderm.
I know what you’re thinking, “what does this shenanigan have to do with hemorrhoids?”
The importance of this information lies within the logical explanation of why hemorrhoids happen and the symptoms that may present with.
For instance, structures that originate from the endoderm like the intestines and the colon are often presented clinically as dull pain and feelings of bloating or fullness.
On the other hand, structures from the ectoderm present with sharp localized pain.
This explains why external hemorrhoids cause localized pain in the anal canal while internal hemorrhoids are painless.
Hemorrhoids
The anal canal and the rectum are perfused by multiple blood vessels to ensure their proper irrigation. The arteries and arterioles bring the oxygenated blood from the heart to the cells and the veins take the unoxygenated blood back to the heart.
This circulatory mechanism works for all the cells in our body.
There are two major groups of veins in the rectum and anus, the first group is called the internal hemorrhoid plexus and the second is referred to as the external hemorrhoids plexus.
These two plexuses are the major veins that drain the unoxygenated blood from the rectal and anal cells to the heart.
Whenever a group of veins extends and swells, we will be dealing with hemorrhoids.
What causes hemorrhoids in seniors?
There are many causes of hemorrhoids, which differ depending on their type (e.g. internal, external). However, you should keep in mind that any factor that causes the veins to enlarge and swell can result in hemorrhoids.
Diarrhea
Chronic diarrhea can irritate the mucosal lining, which releases pro-inflammatory substances such as prostaglandin and histamine. In return, the veins lying just under the mucosae will vasodilate (blood vessel expansion) in response to those substances. Et voila! You now have hemorrhoids.
Constipation
Similar to diarrhea, chronic constipation can irritate the rectal and anal canals while increasing the pressure inside these structures.
The dramatic increase in pressure will obstruct the normal flow of the veins and cause them to swell and become painful.
Advanced age
This one of the risk factors of developing hemorrhoids; while it’s true that people from all age groups can develop hemorrhoids, it is way more common in older individuals.
Researchers believe it is the result of weakened muscular tone, blood vessel damage, and the decreased physical activity that comes with aging.
Staying seated for too long
This is especially seen in patients who spend a long period of time seated in the toilet.
Using your phone inside the toilet can be a factor that increases the time spent while seated, and all that pressure and strain inside your rectum and anal canal can be the tipping point to develop hemorrhoids.
Strength training
By increasing the intraluminal pressure inside the rectum, lifting extremely heavy weights can injure the lining walls of the mucosae and the hemorrhoidal veins.
Sexual intercourse
Anal intercourse can either exacerbate existing hemorrhoids or trigger them De novo. This is very straight forward and it is caused by the direct mechanical irritation of the anal canal.
Obesity
While obesity by itself isn’t a risk factor for hemorrhoids, the diet of obese individuals is the most likely culprit in this scenario. Most obese people do not have healthy eating habits and they barely consume any fiber, which is the number one factor that may prevent future episodes of hemorrhoids.
Additionally, spicy food, alcohol, and other beverages can also trigger hemorrhoids.
Genetics
If you analyze a patient who presents with hemorrhoids, you are most likely going to see a pattern that runs in the family. While scientists have not yet pinpointed a single gene that causes hemorrhoids to be common in certain families, it is still a widely accepted theory.
Idiopathic
Let’s imagine this scenario: a patient comes to the doctor’s office with the chief complaint of chronic hemorrhoids, the physician will then try to determine if there are any risk factors that could be addressed in order to reduce the frequency and severity of the patient’s symptoms.
After a careful history and physical examination, the doctor is not able to deduce any risk factors and all the tests come back negative. Note that tests are not routinely done in the management of hemorrhoids.
In conclusion, the case of this patient can be called idiopathic, which means without an apparent cause.
Internal vs. external hemorrhoids
Internal hemorrhoids (IH) are located deeper inside the rectal canal and cannot be visible from the outside.
IH is often triggered by chronic straining of the internal hemorrhoidal veins, which causes them to expand in size. They rarely present with pain and one of the first signs IH present with is rectal bleeding in the stool.
For this reason, IH can be terrifying to patients who experience it for the first time as they see the large amounts of blood coming out of their anal canal.
On the other hand, we have external hemorrhoids (EH), which are located just around the anal canal and under the skin, and can be seen from the outside.
Due to their embryological origin, EH manifests clinically as severe pain and strain of the anal canal. They are the most common types of hemorrhoids.
What are the signs and symptoms of external hemorrhoids?
Symptoms of external hemorrhoids are different from those of IH for the reasons explained above.
Here are some of the symptoms of EH:
- Anal itching
- Tender lumps around the anus
- Pain localized in the anal region and exacerbated when seated
- Mild bleeding from the anal canal
Options for relief of hemorrhoids in seniors
For the majority of cases, simple changes in your habits along with staying more active can alleviate your symptoms without any treatment.
For a group of patients; however, the severity and/or frequency of the symptoms require medical or surgical interventions.
Let’s quickly see what you can do about your hemorrhoids at home:
Local ointments
These are over-the-counter drugs that can be used as a topical treatment for external hemorrhoids; the active ingredient in these drugs is most often hydrocortisone, which is a steroid with anti-inflammatory and analgesic properties.
Ice
Ice may help reduce the swelling and the release of pro-inflammatory compounds around the hemorrhoids. Of course, this option is only viable for external hemorrhoids.
A sitz bath
This is a special seat that you can put over your toilet. It is believed to reduce the severity of the itching and pain.
Analgesics and NSAIDs
Drugs such as acetaminophen and ibuprofen can be used to reduce the symptoms of external and internal hemorrhoids.
These drugs act by blocking the metabolic pathways that lead to the production of pro-inflammatory substances.
Moreover, NSAIDs can reduce the swelling, which is a cornerstone in the pathogenesis of hemorrhoids in seniors.
Important information: Check out Senior.com for all your medical needs. They can supply you with everything from band-aids to electric scooters and all between.
Conclusion
Whether it’s internal or external hemorrhoids, both of these conditions are extremely common in the senior’s general population and can be a cause of severe pain, discomfort, and reduced performance.
In this article, we covered all of the basic concepts of hemorrhoids in seniors and how to treat them.
What would be interesting; however, is to read your stories about homemade recipes you used to treat hemorrhoids that worked, so feel free to share your thoughts in the comment section below.