Hemorrhoids or piles are the swollen veins surrounding the anus. These veins can be under the skin around the anus or inside the rectum, which is the section of the large intestine leading to the anus. Irrespective of the location, they can make having a bowel movement uncomfortable. In fact, they are a common condition that affects men as well as women. However, there are a few factors that can make women more susceptible. Hormonal changes, pregnancy, and childbirth are some of the common causes of hemorrhoids in women.

What are hemorrhoids?

Also known as piles, these are swollen and inflamed veins located in the rectum and anus. "They can cause discomfort, pain, and bleeding, especially during bowel movements," says gastroenterologist Dr Sukrit Singh Sethi. About 4.4 percent of people in the world are affected by this condition, according to 2021 research published in PLOS One.

Here are the types of hemorrhoids:

• Internal hemorrhoids form inside the rectum and are usually painless, but they can cause bleeding during bowel movements. They may sometimes prolapse, becoming visible or painful.
• External hemorrhoids develop under the skin around the anus, causing swelling, pain, itching, and discomfort. In some cases, these may form clots (thrombosis), leading to severe pain and inflammation.
• Prolapsed hemorrhoids are internal hemorrhoids that have enlarged and extended beyond the anal opening. Depending on their severity, they may retract on their own or need to be pushed back manually.
• Thrombosed hemorrhoids are external hemorrhoids that have developed blood clots, leading to extreme pain, swelling, and inflammation.

The symptoms of hemorrhoids. Image courtesy: Shutterstock

What are the symptoms of hemorrhoids in women?

Women with hemorrhoids may experience a variety of symptoms, including -

• Bright red blood that may appear on toilet paper or in the toilet bowl after a bowel movement. This is often associated with internal hemorrhoids.
• External hemorrhoids can cause significant pain and discomfort, especially while sitting.
• Hemorrhoids may cause persistent itching in the anal area.
• External hemorrhoids may cause noticeable swelling around the anus.
• Prolapsed or thrombosed hemorrhoids may create small lumps around the anal area.
• Piles may cause mucus to leak, leading to skin irritation and discomfort.

What are the causes of hemorrhoids in women?

There are several factors that can lead to the development of hemorrhoids in women -

1. Pregnancy

Pregnancy predisposes women to develop piles or hemorrhoids. Around 25 to 35 percent of pregnant women are affected by hemorrhoids, as per a 2008 study published in the Canadian Family Physician journal. During pregnancy, the growing uterus exerts pressure on the pelvic veins, reducing blood flow from the lower part of the body. This increased pressure on the rectal veins can lead to piles, especially during the third trimester.

2. Childbirth

The intense strain during labour can cause the veins in the rectal area to swell, leading to hemorrhoids. During a 2021 study published in PLOS One, researchers found that 68.7 percent of participants who gave birth to a child had hemorrhoids. "Many women experience hemorrhoids post-childbirth due to the pushing involved during vaginal delivery," says Dr Sethi.

3. Constipation

Men or women, chronic constipation and straining during bowel movements are often the leading causes of hemorrhoids. During a 2021 study published in Frontiers, researchers found that for at least 25 percent of the time, constipation was associated with the prevalence of hemorrhoids. Straining increases pressure on the veins in the rectum, causing them to swell and become irritated.

4. Obesity

Being on the heavier side can invite a lot of health problems, including piles. Obesity is one of the risk factors for hemorrhage, as per research published in the American Journal of Gastroenterology in 2021. Excess body weight, particularly in the abdominal area, can increase pressure on the pelvic veins, contributing to the development of hemorrhoids.

5. Sedentary lifestyle

"Sitting for prolonged periods, especially on the toilet, can hinder blood circulation, increasing the likelihood of hemorrhoids," says the expert. In general, a sedentary lifestyle, which means engaging in less physical activity, can contribute to constipation, which in turn increases the risk for piles.

6. Low-fiber diet

A diet low in fiber often leads to constipation, forcing people to strain during bowel movements. This straining is a major risk factor for hemorrhoids. During a 2019 study published in La Tunisie médicale, internal hemorrhoids were more frequently seen in people who followed a low-fiber diet and had less water.

Low fiber diet can cause piles. Image courtesy: Shutterstock

7. Hormonal changes

Hormonal fluctuations can happen during different stages in a woman's life. These fluctuations can take place not only during pregnancy, but also while menstruating and can cause changes in the digestive system. "Sometimes, they can lead to constipation, which can contribute to the development of hemorrhoids," says the expert.

8. Ageing

As women age, wrinkles are not the only changes you will see. The tissues supporting the veins in the rectum and anus can also weaken, making them more prone to developing hemorrhoids or piles. Hemorrhoids are more prevalent in women as well as older people, as per research published in Scientific Reports in 2022.

How are Hemorrhoids diagnosed?

Diagnosis of this condition usually involves a physical examination by a doctor who may use various methods to assess the condition -

• For external hemorrhoids, a visual examination of the anal area may suffice.
• In the case of a digital rectal exam, the doctor inserts a lubricated finger into the rectum to feel for any abnormal growths or swelling.
• Anoscopy involves using a small, lighted tube to examine the lower rectum and anus.

How to treat hemorrhoids?

There are several effective treatments available for hemorrhoids, ranging from home remedies to medical procedures -

• Increasing fibre intake through fruits, vegetables, and whole grains can help soften stools and reduce the need to strain during bowel movements. Drinking plenty of water along with having more fiber-rich foods is also essential.
• Over-the-counter creams, ointments, or pads containing hydrocortisone or witch hazel can help reduce inflammation and relieve pain and itching.
• Soaking the affected area in warm water for 10 to 15 minutes several times a day can soothe pain and reduce swelling.
• Applying an ice pack to the anal area for a few minutes can help reduce swelling and provide temporary pain relief.
• Rubber band ligation is a non-surgical procedure where a rubber band is placed around the base of the hemorrhoid, cutting off its blood supply. The hemorrhoid eventually shrinks and falls off.
• Sclerotherapy is a procedure in which a chemical solution is injected into the hemorrhoid, causing it to shrink.
• Infrared coagulation uses infrared light to cut off the blood supply to the hemorrhoid, causing it to shrink.
• Stapled hemorrhoidopexy is a surgical procedure in which a stapling device is used to remove excess tissue and reposition the hemorrhoid back inside the anus.

Mild hemorrhoids, especially those caused by temporary factors like pregnancy or constipation, may resolve within a few days with proper self-care. "However, more severe cases, such as prolapsed or thrombosed hemorrhoids, may take longer to heal and may require medical intervention," says the expert.

Hemorrhoids are a common, but manageable condition that affects many women, particularly during pregnancy and childbirth. Make lifestyle changes like increasing fiber intake, and maintaining a healthy weight, and apply creams to deal with it.

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