Hemorrhoids in children-what is it
Although childhood hemorrhoids generally do not have serious health problems, nor is it a common childhood disease, childhood hemorrhoids can often be both the symptom and the cause of a more serious health problem.
Hemorrhoids, as we all know, are swollen veins that originate around the hemorrhoid pad that helps the anal canal function. When a large vein running through the area is under sufficient pressure, the vein wall swells and encroaches on some tissue.
Internal or external hemorrhoids in children?
Whether in children or adults, if a hemorrhoid occurs in the anal canal, above the dentate line, then it is an internal hemorrhoid.
However, if the swollen vein starts from a point below the dentate line, it is an external hemorrhoid.
The actual opening of the anal canal is called the anal rim, and the dentate line enters the body about two centimeters from the anal rim.
The dentate line is important because it marks the start of a major and sensitive area of nerves that help control the anal sphincter. Internal hemorrhoids do not hurt people very much, because they are not in this nerve area, if any, unless they prolapse to the outside.
However, due to the positional relationship, external hemorrhoids generally hurt people like the devil, and children are more likely to suffer from pain than adults.
Causes of hemorrhoids in children
There are many potential causes of hemorrhoids in children, from constipation to Crohn’s disease (Crohn’s disease is a serious disease of the lower digestive tract) to simply sitting on the toilet for too long.
Although there are many relatively normal causes, hemorrhoids are very rare in childhood, so it is particularly important to check for more serious problems.
Although adults can know very clearly that their hemorrhoids and constipation are the result of unhealthy diet, lack of exercise, and sedentary sitting, children will not be bothered by these problems under normal circumstances.
Children, in fact, are very active, which makes us adults wonder where they get all this energy. An inactive lifestyle is the most common cause of hemorrhoids, but it is a less important factor for children, so other problems are highlighted.
A more serious cause of hemorrhoids in children is called portal hypertension, which means that there is backward pressure in the portal vein that carries blood from the digestive tract to the liver. Diseases that affect the liver often show its first signs through portal hypertension.
Crohn's disease, a chronic inflammatory bowel disorder, is also a possible cause of hemorrhoids in children. These problems should be checked, especially if the baby cannot clearly or accurately express what was hurt.
The most common cause of hemorrhoids in children is constipation, and one of the main causes of constipation is dehydration.
Those children who are dehydrated are children at risk. Although dehydration is not good for anyone, due to pediatric anatomy, dehydration works very quickly on children. Children often do not have the body reserves like adults to resist dehydration, heatstroke, hypothermia, etc.
Constipation in children can be diagnosed by dry, hard, clay-like stools, nausea, vomiting, and weight loss. Some liquid on the child's underwear indicates that the child has stool stored in the rectum and the child does not want to defecate because of pain.
Children are not good at expressing the exact cause of internal pain, but if they see the toilet, they will seem to use all their strength, especially the legs and buttocks, their toes sway up and down, blush, and cry. Babies may feel pain and start crying when they feel the bowel movement.
Constipation in children is usually caused by the same reasons as anyone else, low-fiber diet, lack of water, and lack of exercise.
For children, there is a special reason that they will ignore the urge to defecate until it is too late, because they are distracted or do not want to withdraw from playing, or because they are afraid to repeat a painful experience.
Under no circumstances should children be ashamed to go to the toilet, because any humiliation or scolding will only make the problem worse and may damage the previous successful toilet training.
Another common cause of children’s dehydration and hemorrhoids is diarrhea, which is a relatively common childhood disease.
The large intestine is where water is reabsorbed into the body. Diarrhea occurs when the contents of the intestine pass through the large intestine too quickly. Since various enzymes and fluids will be replenished by the body to digest food, if the water cannot be reabsorbed normally, even if the child drinks the same amount of water, he will undoubtedly lose water and eventually cause constipation.
In addition, sitting for a long time, which usually involves diarrhea, can cause hemorrhoids. Regardless of whether your child has hemorrhoids or not, don't let them stay in the toilet when they are not having a bowel movement. Give them electrolytes to drink. A local doctor or pharmacist can help you choose the best brand in your area.
Pinworms have anal itching similar to childhood hemorrhoids
Another potential cause of anal itching in children is pinworm. Before deciding what treatment to proceed, you will want to take your child to see a doctor to make sure it is not the problem with these small parasites.
When he or she has pinworms, trying to treat your child with hemorrhoids itching is useless and potentially destructive. The treatment of hemorrhoids has no effect on pinworms, and the powerful infectivity of these parasites allows your child to come into contact with them from anywhere.
As an adult, it’s difficult to get pinworms, just because adults don’t play with mud and dirt as often as children, which means that if your child brings some home, they can be easily passed on to you Other people in the family.
I suspect my child has hemorrhoids, when to see a doctor
In the following situations, you should take your child to see a doctor. If the onset of constipation lasts for more than three weeks, your child cannot participate in their normal activities, there is a small crack in the skin around the anus, and the stool cannot be discharged with normal force. Or if your child's anus starts to leak continuously. Obviously, if a lump appears on or near the anus, you should see a doctor as soon as possible.
Special difficulties caused by hemorrhoids in children
When children do have hemorrhoids, they need to be observed carefully, especially if they have pain or itching.
Children often do not have the ability to control themselves to avoid constant scratching, which may cause the hemorrhoids to tear and bleed.
Scratching can cause hemorrhoids to break open, which can lead to severe infection and painful inflammation. In addition, the related pain can make the child very irritable, unwilling to go to the toilet, unwilling to leave the toilet, and eventually connect many bad things to the toilet training itself.
If constipation is a factor, leakage or leakage caused by constipation can also bring potential for infection, especially if the child refuses to have a bowel movement and tries to ignore the problem.
All in all, this is a very unpleasant situation for all relevant people, especially children.
Treatment of hemorrhoids in children-measures for immediate relief of hemorrhoids in children
It may be helpful to wipe your child with wet tissues, and your pediatrician or pharmacist may be able to recommend a moisturizer that is softer than ordinary water.
Dry toilet paper should be avoided because trying to use it to grasp, rub or scrub may cause excessive force.
Keep your little one clean and dry, and let the child bathe in hugs and love, let him or her know that this is not the end of the world, and your love is unchanged.
Once the pediatrician determines that your child does have hemorrhoids, there are a few things you can do to give your little one immediate relief.
There are currently no hemorrhoid creams or ointments made specifically for children in pharmacies, but ibuprofen can indeed be used in children and infants and may help relieve pain and inflammation.
The reason the pediatrician must calculate the dosage is because the weight of the baby is so low, and the metabolism of the baby is very different from that of the older children.
Between these two factors, a certain degree of integration is required to calculate the correct dose of the drug for the baby.
In addition to medication, taking a bath in warm water three times a day for 20 minutes at a time will often bring great relief.
Oatmeal can be found in many pharmacies and can also be added to the sitz bath for extra soothing power.
If the child has a severe itching, regular cornstarch can be sprinkled on the area, as well as on the child's diaper or underwear.
Some children find that sitting on an ice pack wrapped in a towel for a few minutes can also help relieve pain.
Please check to make sure that your child is not sensitive or allergic to your current laundry soap and softener. If in doubt, buy one or two bottles of hypoallergenic laundry detergent and softener, as this can reduce some irritation, as it should be.
Treatment of hemorrhoids in children
Once immediate relief is achieved, hemorrhoids are relatively easy to deal with.
For anyone of any age, the best treatment for hemorrhoids is to get more fiber from foods such as whole grains, fresh fruits and vegetables.
Getting enough liquid from water, juice, or milk sources is very important to avoid constipation.
Since it is very important for your child to get enough fiber, do not try to treat children with constipation with enema or laxative without the supervision of a doctor. Laxatives can make your child dehydrated quickly and dangerously.
If your child drinks soda, tea or coffee, these things need to be removed. The caffeine found in it is a diuretic, which means "increase urination." Or, in other words, caffeinated beverages are actually taking water out of the body.
In addition, the sugar in soda does not help, because it accelerates the child's metabolism, and then digestion, and regularity is the most needed thing.
Exercise can be very beneficial-for a child, it means physical play.
Treatment of infant hemorrhoids
If your child is still an infant and has not eaten food yet, then there is no difference whether it is breastfeeding or feeding unfortified iron formula. Both iron-fortified or soy-based formulas can cause constipation in babies.
At present, there are quite a few formula milk powders specially manufactured for stomach sensitivity or as anti-constipation, which is beneficial.
Although mother's milk is the best, it is not everyone's choice, but you should try and get as close as possible.
Increasing exercise and activities is also beneficial, so it is a good idea to go to the sun to play, and even give mom and dad a moment of breathing.
Babies who have not yet walked like to move their arms and legs like playing a bicycle game. This is when an adult holds the baby's feet in his hands and alternately moves his legs and knees up and down as if the baby is stepping on a pedal. When doing these things, singing silly songs and making silly faces, of course, strictly speaking is optional, but highly recommended.
Hemorrhoids in children-concluding remarks
When attention is paid and treated in time, childhood hemorrhoids will relieve themselves.
Due to the unique biology of human children, surgery is usually not an option, because their small bodies are not yet able to handle the severe physical shocks that accompany any surgical operations. However, there are still opportunities for childhood hemorrhoid thrombosis (which means blood clots get stuck inside) or prolapse (which means internal hemorrhoids run out of the body). Fortunately, the chance is quite small. These two conditions almost require surgical treatment, but the chance of these occurring in children is almost non-existent.
Most children's hemorrhoids disappear on their own after proper diet and of course, with gentle care.
Child Hemorrhoids – what they are
While child hemorrhoids are generally not a severe health problem, they are not a common childhood disorder and child hemorrhoids can frequently be both a symptom and a cause of more severe health issues in children.
Hemorrhoids, as we know them, are swollen veins that emerge from and around the hemorrhoidal cushions that help the anal canal to function. When one of the large veins that runs through this area is put under enough strain, the vein wall swells and takes some of the tissue with it.
Internal or external child hemorrhoids?
Whether child or adult, if the hemorrhoid should occur on the inside of the anal canal, above the dentate line, then it is an internal hemorrhoid.
If, however, the swelling vein should start from a point below the dentate line, it is an external hemorrhoid.
The actual opening of the anal canal is called the anal verge, and the dentate line is approximately two centimeters further inside the body from the anal verge.
The reason that this dentate line is important is because it marks the beginning of a large and sensitive band of nerves that help to control the anal sphincter. Because they are nowhere near this band of nerves,internal hemorrhoids don’t hurt much, if at all, unless they have prolapsed to the outside.
However, due to location, external hemorrhoids usually hurt like the dickens, and children are even more vulnerable to pain than adults.
Causes of child hemorrhoids
There are many potential causes of child hemorrhoids, ranging from constipation to Crohn’s disease, which is a severe disorder of the lower intestinal tract, to simply sitting on the toilet for too long.
While there are quite a few causes that are relatively normal, hemorrhoids in child are still very rare, so it is doubly important to check for more serious problems.
While an adult may know very well that their hemorrhoids and constipation are the result of a bad diet, lack of exercise, and long periods of sitting, children normally do not suffer from these problems.
Children, in fact, are masters at making us adults wonder where the heck they get all of that energy from. An inactive lifestyle, the most common cause of hemorrhoids, is much less of a factor, and so other problems come to the forefront.
One of the more serious causes of child hemorrhoids is called portal hypertension, which means that there is backwards pressure in the portal vein that carries blood from the digestive tract to the liver. Diseases that affect the liver often show their first sign through portal vein hypertension .
Crohn’s disease, a chronic inflammatory bowel disorder, is also a possible cause of childhood hemorrhoids. These issues should be checked for, especially in infants who are unable to express clearly or accurately what hurts.
The most common cause of hemorrhoids in children is constipation, and one of the primary causes of constipation is dehydration.
Children who are dehydrated are children in danger. While dehydration is not good for anyone, due to pediatric anatomy, it works particularly quickly on children, who do not have the sorts of bodily reserves that adults use to cushion themselves against things like dehydration, heatstroke , hypothermia, and so on.
Constipation in children can be diagnosed by hard, dry, clay-like stools, nausea, vomiting, weight-loss liquid in child’s underwear indicating backed-up stool in the child’s rectum, and the child not wishing to defecate due to pain.
Children are not particularly good at expressing exact causes of internal pain, but look for all over clenching, particularly of the legs and buttocks, rocking up and down on their toes, turning red, and wailing like banshees if a toilet comes into view. Infants may start to cry at the first feeling of having an excretion, anticipating the pain.
Constipation in children is often caused the same as it is in anyone else, by low-fiber diets, insufficient water, and a lack of exercise.
A cause particular to kids is their ability to ignore the urge to defecate until too late because they are distracted or don’t want to quit playing, or because they are afraid of repeating a painful experience.
Under no circumstances whatsoever should the child be shamed into going to the toilet, as any shame or scolding will only make the bad associations worse and potentially damage previously successful toilet training.
Another frequent cause of childhood dehydration and hemorrhoids is diarrhea, which is relatively common to childhood ailments.
Diarrhea occurs when material moves too quickly through the large intestine for water to be reabsorbed into the body. Because various enzymes and liquids are added by the body to digest food, if the moisture is not properly reabsorbed, the child can be literally be losing water even if drinking fairly consistently, triggering a bout of constipation on the back end.
In addition, the long times of sitting on the toilet that are usually involved in bouts of diarrhea contribute their own strain leading to hemorrhoids. Whether or not your child has hemorrhoids or not, don't leave them on the toilet when they're not actually going, and give them pediatric electrolytes to drink. Your local doctor or pharmacist can help you pick the best brand in your local area.
Pinworms can mimic the anal itching of child hemorrhoids
Another potential cause of childhood anal itching is pinworms. You’ll want to take your child to the doctor to verify that these miserable little parasites are not the problem before deciding what course of treatment to take.
Trying to treat your child for hemorrhoidal itching when he or she has pinworms is both useless and potentially damaging. Hemorrhoidal treatment won’t do a thing for pinworms, and these parasites are so contagious that your child could literally have picked them up anywhere.
Pinworms are more difficult to get as adults, but only because adults don’t play in mud and dirt as often as kids, which means that they can easily pass to the rest of your family if your child should have brought some home.
When to see a doctor about suspect child hemorrhoids
You should also take your child to the doctor if episodes of constipation last for more than three weeks, your child is unable to participate in their normal activities, small tears start appearing in the skin around the anus, normal pushing is not enough to expel stool , or if your child's anus starts consistently leaking. Obviously, if lumps appear near or in the anus, a doctor should be soon be very fast.
Particular Difficulties that Child Hemorrhoids pose
When a child does have hemorrhoids, they need to be watched carefully, especially if they are painful or itchy.
Children do not often have the self-control to keep from incessant scratching, which can cause the hemorrhoids to be torn open and bleed.
Scratching open hemorrhoids then leads to rampant infection and painful inflammation. In addition, the pain involved can make the child very cranky, unwilling to use the toilet, unwilling to get off the toilet, and eventually associate an untold number of bad things with toilet training itself.
If constipation is a factor, the seepage or leakage that constipation can bring also carries the potential of infection with it, especially if the child refuses to defecate and tries to ignore the problem.
All in all, it’s a very unpleasant situation for all concerned, not least of all the child.
Treatment for Child hemorrhoids – For the immediate relief of hemorrhoids in a child.
It may be helpful to get moistened wipes for your child to wipe with, and your pediatrician or pharmacist may be able to recommend more soothing moisteners than plain water.
Dry toilet paper should be avoided, as the temptation to scratch, rub or scrub with it may become overpowering.
Keep your tiny one clean, dry, and shower on the hugs and affection so that he or she knows this is not the end of the world and your love is constant.
Once a pediatrician has determined that your child does, indeed, have hemorrhoids, there are a number of things you can do to get your little one some immediate relief.
There are no hemorrhoidal creams or ointments currently made for children that are available over the counter, but ibuprofen does come in child and infant doses and may help with both pain and inflammation.
Of course, never give an infant under two years of age anything not recommended by a doctor, but your child’s pediatrician can calculate a proper dosage of ibuprofen for your infant based on age and weight if you call and ask.
The reason that a pediatrician has to calculate the dosage is because infant weights are so low and infant metabolisms work differently from that of even older children.
Between these two factors, it takes a degree in calculus to compute the right dosage of any medication for any infant.
Leaving medication aside, warm sitz-baths, given for twenty minutes at a time three times a day often bring great relief.
Oatmeal powder, which can be found at most drug stores, can be added to the sitz bath for extra soothing power.
If the child’s itching is bad, plain cornstarch can be dusted over the area and into the child’s diaper or underwear.
Some children find that sitting on a towel-wrapped ice pack for a few minutes can help with the pain, as well.
Do check and make sure that your child does not have a sensitivity or allergy to the current laundry soap or softeners that you use. If in doubt, purchase a small bottle or two of hypoallergenic laundry detergent and softener, as any irritation that can be banished , should be.
The cure of child hemorrhoids
Once immediate relief has been obtained, hemorrhoids are relatively easy to deal with.
The best treatment for hemorrhoids in anyone, of any age, is to get more fiber from such foods as whole-grains, and fresh fruits and vegetables.
Sufficient liquid from sources of water, fruit juice, or milk is very important to avoiding constipation.
While it is important for your child to get enough fiber, never try to cure childhood constipation with enemas or laxatives without a doctor’s supervision. Laxatives can quickly and dangerously dehydrate your child.
If your child drinks soda, tea, or coffee, those things will have to go. The caffeine found in them is a drug called a diuretic, which means “to increase urination.” Or, in other words, drinks with caffeine in them are actually pulling water out of the body.
In addition, the sugar found in soda doesn’t help, either, as it speeds the child’s metabolism, and therefore digestion, when regularity is what is most desired.
Exercise may be very beneficial – for a child this means physical playing.
The cure of infant hemorrhoids
If your child is still an infant and not yet eating food,then either breastfeeding or feeding a formula that is not iron-fortified can make all the difference. Iron-fortified or soy formulas can both lead to constipation in infants.
There are quite a few formulas on the market today specifically made for sensitive stomachs or as anti-constipation that can be beneficial.
While mom’s milk is best, that isn’t an option for everyone, but do try and get as close as you can.
Increased exercise and movement is also beneficial, so going and playing in the sunshine is a good idea, and might even give mom and dad a moment to breathe.
Infants that are not yet walking love to have their arms and legs played with in games like Bicycle, which is where an adult takes the baby's feet in their hands and moves the legs and knees alternating up and down as if the baby were pushing pedals. Chanting silly songs and making goofy faces while doing this is, of course, strictly optional but highly recommended.
Hemorrhoids in child – Ending remarks
When paid attention to and treated promptly, childhood hemorrhoids should clear up on their own.
Due to the unique biology of human children, surgery is not usually an option, as their small bodies do not deal well with the serious bodily shock that accompanies any surgical procedure. However, the incidence of childhood hemorrhoids thrombosing, which means getting a blood clot stuck inside, or prolapsing, which refers to an internal hemorrhoid trying to come outside the body, is thankfully rather small. These two conditions almost demand surgery, but the incidence of these happening to children is close to nothing.
The vast majority of child hemorrhoids go away on their own with the proper diet, and of course, tender loving care.
Department of Pediatric Surgery, the First Affiliated Hospital of Sun Yat-sen University
Dr. Sun Junjie
Department of Pediatric Surgery, the First Affiliated Hospital of Sun Yat-Sen University
Dr. SUN Junjie