Varicose Veins and Hemorrhoids -
Cousins or Distant Relations

Varicose veins and hemorrhoids (or haemorrhoids for those using UK English spelling) seem in many ways so similar. Basically enlarged, often engorged veins.

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Both can require treatment. Many times they present in the same people. So how are they related?

Well they tend to be quite different in their structure, underlying problems, presentation and, to a degree, in their management.

Varicose veins and hemorrhoids - with the difference of localised butt pain

Yes varicose veins and hemorrhoids can both be painful. They can bleed. They can itch and cause skin breakdown. You can get local clots, or thromboses, in them.

Often both varicose veins and hemorrhoids can occur in pregnancy. And improve after the delivery.

They can be left alone, treated with surgery or injection.

How do they differ?

Varicose Veins and Hemorrhoids Differentiated

Varicose Veins

As I noted in the area on causes with varicose veins there are some simple drivers from genetics to a number of occupational and lifestyle choices.

Their underlying problem, I also mentioned, is a weakening or poor repair over time in their walls. This creates dilatation of the vessel and subsequent inability of the internal valves to create the one way flow required to get your blood back to your heart.

They are associated over time with slightly deeper seated veins also becoming involved and creating a worsening presentation.

Hemorrhoid Variation

In contrast hemorrhoids arise from a plexus, or network, of veins around the local rectal and perianal area. This is the normal anatomy.

Varicose veins and hemorrhoids differ in their anatomy and drainage.

The two points haemorrhoids arise with specific vascular drainage.

Those inside your lower bowel drain into vessels in your pelvis - part of the deep blood vessel system. Whereas those on the skin outside drain into vessels that link to the long saphenous vein as part of the superficial venous system.

Again, when they become a problem, somewhat similar to varicose veins, these veins can become dilated or stretched. This much is similar. They can enlarge locally. But their problem does not extend to the underlying draining veins in the pelvis or the groin area.

Causes

The major cause contrasting varicose veins and haemorrhoids seems to be related to bowel habit. Constipation definitely seems to be strongly associated with them.

They are correlated with prolonged sitting on the toilet, often more a male tendency than female!

But it could well be the Western toilet position with sitting is less mechanically efficient in defecation than the Asian and Middle Eastern one. Squatting loos, which seem so foreign to us, do make this easier. Just as delivery in this position is more effective.

Associated Problems

If the dilated vessel clots off in a local thrombosis, they will cause quite sudden pain. The vessel will feel hard and tender. Without further management the pain will last some days until the clot is remodelled.

It is possible to release it which will give immediate relief. But it will not definitively clear the problem.

Pain can also arise from a split in the anal skin area - an anal fissure. Medical treatment with creams can settle this. If not the area can be stretched under anaesthetic.

Redundant skin from the enlarged vein area can produce difficulties in full cleansing. This can cause local itching and skin irritation. Using a bidet or similar for cleansing can alleviate and prevent this.

Pain can also arise from the vessels in the bowel area protruding through the anus causing a drawing sensation.

Sudden bright bleeding can occur from one of the vessels breaking.

Management

Many hemorrhoids occurring with pregnancy will improve some time after delivery.

Management of recurring problems usually occurs in a step-wise fashion.

Local applications of haemorrhoid cream with or without suppositories can help to shrink local swelling.

Injection with a sclerosing solution, as is used varicose treatment, can close the area down. Quite often other solutions not used in varicose veins are employed. This is more from historical management practices over years.

Continued problems can be managed with surgical cutting out of the problem vessel or vessels. You will require some time to recover after this!