Hemorrhoids In Children: Causes, Treatment, And Prevention

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Hemorrhoids, often called piles, are swollen veins in the anus and lower rectum resembling varicose veins. Hemorrhoids in children can occur at any age, though it is less prevalent in children than in adults.

In the pediatric population, constipation is among the most common causes of hemorrhoids, which are not life-threatening but can be extremely painful and bothersome.

Read this post to know about the different causes, symptoms, and complications of hemorrhoids and how they can be treated and prevented in children.

Types Of Hemorrhoids

Hemorrhoids can be of the following types (1).

• Internal hemorrhoids occur when the veins inside the anal canal are swollen
• External hemorrhoids occur when the veins near the anus are swollen

It is possible to have both types of hemorrhoids simultaneously, and the symptoms and treatment options may vary depending on the type.

Causes Of Hemorrhoids

Increased pressure in the rectal and pelvic area can cause swelling and stretching of the veins, leading to hemorrhoids. The following situations may increase the risk of hemorrhoids in children (2).

• Straining during defecation due to constipation, diarrhea, or other digestive problems

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• Chronic liver failure
• Sitting on hard surfaces, such as on wooden stools, for a long time
• Sitting on the toilet for a long time
• Low-fiber diet
• Obesity
• Children who practice weight lifting may have a higher risk of developing hemorrhoids

Straining due to constipation or diarrhea can be a common cause of hemorrhoids in many children. You may seek medical care for persistent bowel movement issues in your child.

Signs And Symptoms Of Hemorrhoids

Common signs and symptoms of external and internal hemorrhoids could include the following (3).

• Painless bleeding while passing stool (in cases of uncomplicated hemorrhoids). Bright red streaks of blood on toilet paper or in the toilet bowl after a bowel movement may indicate bleeding.
• Persistent itching and irritation in the anal area.

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• Rectal or anal pain. Children may complain that it is painful to clean after a bowel movement.
• Mucus and stool on toilet paper without bowel movement may indicate bulging internal hemorrhoids.
• Hard, painful lump and clot under the skin can be seen in external hemorrhoids.

Internal hemorrhoids can be small and located in the wall of the anal canal. Sometimes, large internal veins can sag and bulge out (prolapse) of the anus. This may cause continuous pain in the anal area since the anal muscle may squeeze the vein. The child may complain of increased pain if there is the cessation of blood supply to hemorrhoids.

A study determined the prevalence and severity of hemorrhoidal symptoms associated with different grades of internal hemorrhoids. Internal hemorrhoids are classified based on the norms defined by Goligher and are ranked from grade I to IV depending on their appearance and degree of prolapse. As the graph below depicts, the frequency of pain, bleeding, swelling, and itching increased with the severity of the disease.

Occurrence of hemorrhoidal symptoms according to hemorrhoid grades

Complications Of Hemorrhoids

Complications are rare in children. However, the following complications may arise if the hemorrhoids are left untreated for a long time (4).

• Anemia may occur due to blood loss.
• A thrombosed hemorrhoid is when a blood clot is formed in it. Although it is not a life-threatening condition, this can be extremely painful and require intervention.
• Strangulated hemorrhoid is when the blood supply to the internal hemorrhoid is cut off, causing extreme pain.

Prevention Of Hemorrhoids

The following ways may help to prevent or reduce the symptoms of hemorrhoids in children (4).

• A high-fiber diet may help soften the stool and reduce straining during defecation. Vegetables, fruits, and whole grains are good sources of fiber.

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• Adequate hydration to prevent hardening of the stool. You may ensure that the child is drinking enough water with a high-fiber diet. If not, it may worsen constipation.
• Exercise may help to ease constipation. This can also be beneficial for obese children.
• Avoid sitting on the toilet for a longer duration since this may increase pressure on anal veins.
• Do not sit on hard surfaces for a long time.
• Ask your child to defecate when they feel an urge. Stool may harden if the bowel movement is delayed.
• Tell your child not to strain and hold breath to empty the bowel.

Point to consider

Chronic hemorrhoids with bleeding need medical evaluation as long-term bleeding can lead to anemia (9).

Diagnosis Of Hemorrhoids

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Health history and physical examination may help to diagnose hemorrhoids in children. Usually, the physical examination is enough for the diagnosis, and further tests may not be ordered. Some children with internal hemorrhoids may require proctoscopy or anoscopy to visualize the rectum.

If the initial examination is not precise, doctors may order sigmoidoscopy or colonoscopy to look for other causes of rectal bleeding. All these diagnostic procedures use a flexible tube with a camera and light to visualize the lumen of bowels.

How To Help Children With Hemorrhoids At Home?

Children with mild cases may receive homecare directions from the pediatrician. The following home treatments are often recommended for non-complicated cases (5).

• High-fiber diet and adequate hydration
• Use sitz bath or soak the anal area in warm water for 10 to 15 minutes two or three times daily
• Take oral pain relievers recommended by the pediatrician

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• Use topical hemorrhoid creams and ointments recommended by the pediatrician
• Use pads with numbing agents and suppositories with hydrocortisone after consulting the pediatrician
• Over-the-counter stool softeners may help to relieve constipation

Quick fact

Over-the-counter (OTC) Hydrocortisone creams do not cure hemorrhoids. Instead, they help relieve pain and itching in children (10).

Treatment For Hemorrhoids

Minimally invasive procedures are often done to manage persistently painful and bleeding hemorrhoids (5).

• Rubber band ligation: This involves putting tiny rubber bands at the base of internal hemorrhoids to stop the blood supply. Most hemorrhoids may fall off within a week after this procedure. Although rarely severe, banding may cause bleeding and other complications in some children after two to four days.
• Coagulation techniques: This method uses heat from infrared, bipolar, or laser sources to control internal bleeding hemorrhoids. This may help stop the bleeding from small hemorrhoids and often causes discomfort and side effects in some children.
• Sclerotherapy: This is done by injecting chemical solutions into the hemorrhoid tissue leading to inflammation and shrinkage. Although it may cause less pain and discomfort, effectiveness is less than rubber band ligation procedures.
• External hemorrhoid thrombectomy: This is a surgical procedure to remove the thrombosed (blood clot) external hemorrhoid under local anesthesia to relieve pain. It is most effective to do this procedure within 72 hours of clot formation.

Children with larger and complicated hemorrhoids with unsuccessful minimally invasive procedures may require surgical procedures (5).

• Hemorrhoidectomy: This is the surgical removal of hemorrhoids. Recurrent and severe cases are treated with this procedure.
• Stapled hemorrhoidopexy: This is also called hemorrhoid stapling, and it is a procedure to block the blood supply to the internal hemorrhoids.

These procedures may cause bleeding and urinary tract infections in some children. However, life-threatening complications, such as sepsis (blood infection), are rare due to advancements in surgery.

Infographic: More About Surgical Treatments For Hemorrhoids In Children

Hemorrhoids are rarely severe in a child, requiring surgical intervention. However, when they become enlarged and painful, a doctor may suggest a surgical approach to treat them. In such cases, knowing the criteria and possible adverse effects of surgical procedures, as discussed in this infographic, is essential before considering one for your child.

Illustration: Momjunction Design Team

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Dr. Neema ShresthaMD

Dr. Neema Shrestha is a pediatrician with a special interest in the field of neonatology. She has an overall experience of five years working in the field. Currently working in Kathmandu, Nepal, she completed her MBBS from Kasturba Medical College, Manipal in 2008, Diploma in Child Health from D.Y. Patil University in 2011, MD from Nepal Medical College in 2015...more

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