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Hemorrhoids (Piles) In Children


Image by Yiming Wang {https://qsota.com/}

Hemorrhoids are an uncomfortable medical condition that most of us think is more likely to affect the elderly. However, that doesn’t mean we should rule it out at an earlier age, and that includes in children who can also suffer from hemorrhoids and who might find the experience particularly traumatizing and upsetting.

What are Hemorrhoids?

Hemorrhoids, also known as piles, are swollen and inflamed veins in the anus and lower rectum. Hemorrhoids can be found inside and outside of the body.

Types of Hemorrhoids

There are two types of hemorrhoids: internal and external.

Internal hemorrhoids can be found inside the anus and the beginning of the rectum.  They are often small, swollen veins in the wall of the anus, but they can bulge out.

External hemorrhoids can feel like bulges at the anal opening and may hang outside of the anus.  When irritated, they can itch or bleed.  Sometimes blood forms clots (thrombosis) develops inside the hemorrhoid sac causing severe pain, swelling, and inflammation.

Causes of Hemorrhoids in Children

There are many things that can cause hemorrhoids in children. Such as:

  • Straining when passing stool usually due to constipation and digestive problems.
  • Diarrhea and infections.

Symptoms of Hemorrhoids

Common symptoms include bleeding from the rectum, anal itching, general discomfort, and an external anal protrusion.

One of the most common symptoms of hemorrhoids in children is bleeding from the rectum. This is often caused by a rupture of the blood vessels in or around the anal canal, and the blood is often bright red typically during bowel movements.  Rectal bleeding at other times may indicate a more serious problem and should be examined by a medical professional like a pediatric gastroenterologist as soon as possible.

Anal itching is another common symptom. Hemorrhoids often secrete mucus that moistens the anus and surrounding tissue.  This mucus, combined with stool from the bowel movements, often create a chronic itch that children typically have a hard time ignoring.

General discomfort is a classic symptom. Typically, the pain and discomfort come from sitting for long periods, or during bowel movements.  Children often shy away from going to the bathroom to avoid the pain.

Also, for children, for instance, sitting on hard surfaces and feeling discomfort in the anal area can be associated with the onset of piles, and this is something that can be a problem for children who spend long periods sitting on wooden stools in their classroom. It is also a problem for children who spend a long time on the toilet or on the potty.

A large lump or mass that occurs near the opening of the anal canal is another symptom. External hemorrhoids must be treated as well as internal hemorrhoid.

Diagnosis of Hemorrhoids

The doctor can either see any hemorrhoids or do an internal anal and rectum exam. Because internal hemorrhoids are often too soft to feel, an anoscope, proctoscope or sigmoidoscope may be used that allows the doctor to see into the anus and rectum.  If a more extensive exam of the entire colon is needed, a colonoscopy may be recommended if the signs and symptoms suggest a digestive system disease.

Treatment of Hemorrhoids

You should visit a doctor for proper assessment, treatment and follow up. However, as a parent, you should first understand the nature of the problem before attempting to treat. Most hemorrhoids, both internal and external, can be managed at home with care not to worsen the problem.

The treatments you can give to the child are:

  • hemorrhoid creams with lidocaine can be used to help reduce pain
  • wearing cotton underwear
  • avoid toilet tissue with perfumes or colours
  • sitz baths
  • use stool softeners to prevent straining
  • extra Hydration can help reduce constipation
  • monitor toilet habits to ensure they aren’t spending too much time in there
  • the child should avoid sitting on hard surfaces for long periods of time
  • you should also ensure that when the child/children are at home with you, that they aren’t only engaging in sedentary activities – encourage them to go outside and play
  • improve their diet by giving them lots of fruit and fibre and ensuring they drink a lot of water
  • Make sure that hygiene doesn’t suffer.

Prevention of Hemorrhoids

Constipation and straining during bowel movements raise your risk for hemorrhoids. The following steps can help to prevent hemorrhoids from occurring and reduce symptoms of existing hemorrhoids:

  • eat high-fibre foods such as fruits, vegetables, and whole grains
  • drink plenty of water
  • avoid straining when on the toilet
  • go to the toilet as soon as you feel the urge
  • get plenty of exercises
  • avoid sitting for long periods
  • use stool softeners to prevent straining.
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Dr. Ugonna Nwosu (Senior Registrar Paediatrics)

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