Hemorrhoids in infants and children: symptoms, causes and treatments

Hemorrhoids in infants and children symptoms causes and treatments

Hemorrhoids or hemorrhoids cause a lot of discomfort to adults and are an increasingly frequent problem in children. However, unlike what happens with the elderly, there are very few studies and reports on what happens in the pediatric age group.

The hemorrhoidal veins are shock absorbers that have been part of the anus and rectum since birth. Its function is not fully known. They are thought to be important in continence and defecation.

These structures are composed of connective tissue and venous plexuses. Sometimes, due to various factors that we will examine later, they become inflamed and dilated, giving rise to varicose veins or hemorrhoidal disease.

Is it normal for children and babies to suffer from hemorrhoids?

Hemorrhoids are considered an adult condition, with a peak of appearance between 45 and 65 years. However, hemorrhoidal disease can appear at any age, so even children can be affected.

Any factor that produces an increase in the pressure of the hemorrhoidal veins can lead to symptomatic diseases, the most common of which is straining during defecation in case of constipation.

That’s why hemorrhoids problems in children They usually start from the age of 2. age in which they learn to go to the bathroom and to control their sphincters. In any case, newborns can have this condition, albeit less frequently.

AS, Kleiner et al. We report the case of a child who presented with visible inflammation of the hemorrhoids due to prolonged abdominal and pelvic pressure during delivery, having been born breech.

Risk factors for hemorrhoids in children

A study they conducted Yildiz et al. determined that the following are risk factors for hemorrhoidal disease in children:

  • Constipation and chronic constipation.
  • Family history of hemorrhoidal disease.
  • Use of a European-style toilet, since he defecates sitting and not squatting.
  • To be male.

Other factors related to hemorrhoids in children are a low-fiber diet, poor hydration and a sedentary lifestyle.

Serious diseases and hemorrhoids in children

An important detail in the presence of hemorrhoids in children is that they can be a sign of something more serious, especially in the little ones.

The existence of a disease should be investigated and ruled out. which causes an increase in intra-abdominal pressure, such as portal hypertension, which is the increase in pressure in the venous system responsible for much of the blood supply to the liver.

On the other hand, in both children and adults, anal discomfort and symptoms are often attributed to hemorrhoids and can delay the diagnosis of other coexisting conditions, including cancer. Consequently, it is recommended that you consult your doctor for a careful examination.

Symptoms of hemorrhoids in children

Frequently described symptoms in children are pain during defecation, a visible and palpable swelling or mass in the anal region, rectal pain, and difficulty sitting up.

It must be taken into account hemorrhoids do not cause severe or stabbing pain, unless they are incarcerated or thrombosed. Or that there is another associated inflammatory condition, such as a fissure or abscess.

Another common symptom of hemorrhoids in children is the presence of anal mucus along with abdominal pain and itching in the area.

Rectal bleeding is reported in 10% of patients. This contrasts with adults, with around 60% reporting it. It is a hemorrhage that is not characterized as being profuse or associated with anemia.


The diagnosis of hemorrhoidal disease is essentially clinical.. It is based on the presence of the symptoms explained above and on a physical examination, which includes a thorough inspection of the anal and pelvic regions.

Additionally, an abdominal ultrasound may be helpful in revealing the underlying causes of symptomatic hemorrhoids.

Classification of hemorrhoids

The anal canal is divided in two by the dentate or pectineal line. Above the line, towards the rectum, the inner part is covered with reddish rectal mucosa, the nerves of which belong to the autonomic nervous system. Therefore, this part is almost numb.

Below the line, towards the outside, the lining is given by the anoderm (skin of the anus, free of hair and sweat glands). The nerves in this area are very sensitive to painful stimuli.

So, based on their anatomical location, hemorrhoids are classified as follows:

  • External: when below the dentate line, covered by anoderm.
  • Internal: located above the line. These, in turn, are graded according to their outward prolapse, from first degree (with mild inflammation) to fourth degree (totally prolapsed and not reduced).

This classification is used to guide treatment.. However, it is incomplete, as it does not take into account other factors that will influence the decision-making process, such as the size and number of the hemorrhoids or the discomfort and pain it causes.

Treatment of hemorrhoids in children

There are few studies on the treatment of hemorrhoids in children. Much of the information is transferred from what is done in adults.

The approach has two pillars:

  • Determine and treat the causebe it constipation, diarrhea or even a serious illness.
  • Provide conservative (non-surgical) management.with hygienic-dietary measures.

Conservative management includes plenty of fluid intake, dietary changes high in fiber (fruits, vegetables, grains, legumes), and sitz baths. It is recommended not to use toilet paper, but to wash gently after bowel movements.

The child should be prevented resist the urge to go to the bathroomsitting on the toilet for a long time (more than 5 minutes) and making great efforts when defecation.

In patients in whom conservative management fails or there are complications, Various minimally invasive techniques can be used which cause the haemorrhoidal tissue to die, by bandaging, a sclerosing substance (sclerotherapy) or photocoagulation.

Of all of them, Watanabe et al. published a study of sclerotherapy in children with hemorrhoids with an 86% success rate.

Surgical treatment of hemorrhoids in children

In severe or symptomatic cases hemorrhoidectomy or surgical removal of the hemorrhoids may be indicated. Grossmann et al. reported a successful experience in newborns, using a special electrothermal tool to cut tissue during the procedure.

Possible complications of hemorrhoid surgery are bleeding, infection and fistula formation. But they did not appear in the aforementioned investigation.

Management of thrombosed hemorrhoids

In the meantime, when the hemorrhoids become thrombosed (clots), this causes severe pain. In this case, local measures may be applied to relieve the discomfort or the thrombus may be removed within the first 48 to 72 hours of the onset of the condition.

Thrombectomy (removal of the thrombus) is not indicated after 72 hours because the discomfort will disappear without intervention in 7-10 days.

Hemorrhoids in children disturb and affect the quality of life

A child or infant with hemorrhoids will see their quality of life diminish, therefore you need to get proper treatment. You can start a consultation with a pediatrician and then be referred to a digestive tract specialist to evaluate the most appropriate approaches.

If surgery is required, it is best to have exhausted other previous conservative instances. As parents, it is essential that all concerns are resolved in the office.

The post Hemorrhoids in Babies and Children: Symptoms, Causes and Treatments first appeared in research-school.



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