Hemorrhoids in Children

What Are Hemorrhoids in Children?

Hemorrhoids (Piles) are bulging and enlargement of blood vessels near the rectum and anus. It can form internally or externally. Internal hemorrhoids occur within the anus at the beginning of the rectum. The hemorrhoids appear as small, swollen veins within the anal wall. They may also appear bulged due to pressure. External hemorrhoids are bulges in the anal opening and hang outside the anus. When the hemorrhoids become inflamed or irritated, they may itch or bleed. Both these hemorrhoids can develop simultaneously in children.

Although hemorrhoids can appear at any age, children are less likely than adults to get them. Hemorrhoids are not life-threatening but cause discomfort to children.

What Causes Hemorrhoids in Children?

Hemorrhoids are caused by the straining and bulging of veins brought on by increased pressure in the pelvic and rectal region. Constipation is a common cause of hemorrhoids in children. Other causes are:

• Prolonged periods of sitting on hard wooden stools or toilets for more than 10 minutes can cause blood stagnation in the pelvic area.

• When the child has constipation or digestive issues, straining while passing bowels increases pressure on the anus and aggravates piles.

• Chronic liver failure.

• Consuming less water and consuming fewer amounts of fiber.

• Parents with a history of piles.

• Inflamed colon due to other medical conditions.

• Tumor formation in the colon can cause blood stagnation, resulting in hemorrhoids.

• An infected large intestine can aggravate hemorrhoids.

• Immobile, obese, and inactive children have a higher risk of developing piles.

• Children who practice weightlifting.

What Are the Signs and Symptoms of Hemorrhoids in Children?

Common symptoms are:

• Hemorrhoids secrete mucus, which combines with stool during bowel movements and causes chronic itch.

• Children can experience pain and discomfort while moving caused by prolonged sitting or bowel movements. Children can complain of severe pain if the blood supply to hemorrhoids decreases.

• Children may fear going to the bathroom to avoid pain from hemorrhoids.

• The small swollen area near the anus.

• Bleeding in stool or near rectum while wiping. Bright red blood is released when blood vessels around the anus rupture.

How Are Hemorrhoids Diagnosed in Children?

Complete physical and laboratory assessment is required to arrive at diagnosis. The children have suggested the following tests:

1. Physical Examination: The healthcare provider examines the child’s anal and rectum area to identify swollen blood vessels or hemorrhoid lumps.

2. Digital Rectum Examination: A lubricated and gloved finger is inserted into the child’s rectum to look for abnormalities.

3. Anoscopy: A hollow tube containing light at one end is inserted into the anus to visualize the inner region of the anus.

4. Sigmoidoscopy: A device called a sigmoidoscope (short, flexible, with a lightened tube) is inserted into the intestine through the rectum. It helps diagnose the cause of diarrhea, constipation, abdominal pain, abnormal growth, and bleeding.

5. Colonoscopy: A colonoscope (long, flexible, lighted tube) is inserted through the rectum into the colon. The device helps the health provider to visualize the colon lining, remove tissue for further examination, and treat minor problems.

How Are Hemorrhoids in Children Treated?

Hemorrhoid treatment in children depends on the child’s age, health, medical history, disease severity, and tolerance to treatment. The following treatment is observed:

• Dietary Changes: Treating the underlying cause, such as constipation, can reduce hemorrhoids. A diet rich in carbohydrates, low fiber, and dehydration can cause constipation. Children need to consume high amounts of fiber and drink lots of fluids.

• Medications: Children's ointments, creams, or suppositories that lessen swelling and discomfort.

• Warm Bath: It can provide relief from discomfort associated with hemorrhoids.

• Avoid Alcohol Wipes: Alcohol-based wipes can increase irritation in sensitive skin. Hence, fragrance-free and gentle wipes are better alternatives.

• Sitz Bath: The child is made to sit in a plain, warm water tub several times to relieve pain and discomfort.

• Ice Packs: They help reduce swelling and alleviate discomfort in children.

• Stool Softeners: They lessen pressure on hemorrhoids caused by straining. Commercially available bulk stool softeners and fiber supplements are Psyllium and Methylcellulose.

• Surgery: Severe cases of hemorrhoids in children are treated with surgery.

If the symptoms persist or worsen, seeking medical help is essential.

What Are the Surgical Options to Treat Hemorrhoids in Children?

Hemorrhoids inside the rectum can be bound with rubber bands. Hemorrhoids' blood supply is decreased; after a few days, it progressively withers away. Severe banding rarely may cause bleeding or other complications after two or four days. For some children, sclerotherapy is recommended. A chemical solution is injected around the blood vessel to shrink the tumor. If the hemorrhoids persist, devices like electrical, laser coagulation, or infrared photocoagulation burn the hemorrhoids. A permanent solution for hemorrhoid removal is hemorrhoidectomy.

What Are the Complications That Develop in Children With Hemorrhoids?

Complications of hemorrhoids are rarer in children. Rarely, longstanding hemorrhoids can develop complications if not treated. Severe and chronic blood cause anemia in children. Sometimes, the hemorrhoids can become thrombosed because of blood clot formation. Thrombosed hemorrhoids are an excruciating condition that requires medical treatment. Blood supply to hemorrhoids may be cut off, causing excruciating pain in children.

How to Prevent Hemorrhoids in Children?

Parents must ensure that the child is eating lots of fiber and drinking lots of fluids. Foods like fruits, vegetables, whole grain bread, and bran have high fiber content. This food item stimulates intestine contraction and prevents feces accumulation. Taking small amounts of food regularly and avoiding spicy, fried, salty, and smoked food can prevent constipation. Children must be encouraged to drink milk as it normalizes intestinal flora and prevents constipation. Avoid tea, juice, or aerated beverages.

Children must not strain the anal area while passing bowel and should keep the anus clean. Overweight children have a higher risk for hemorrhoids and must have adequate weight management. A sedentary lifestyle in children is a common cause of hemorrhoids in children. Therefore, they must be encouraged to walk, exercise, or indulge in sports activities. Ensure the child does not sit on hard wooden stools or toilet seats for prolonged periods.

Conclusion

Hemorrhoids in children can develop because of constipation, low-fiber diet, or sitting for prolonged periods. They develop symptoms like passing blood in the bowels, itching in the anal area, and rectal pain. Hemorrhoids can be overcome with creams, ointments, sitz baths, or surgery. However, prevention of hemorrhoids is better than treating them.