Hemorrhoids or “piles” is a well- known problem of the anorectal tract. They are composed of tortuous veins that prolapsed from the rectum due to frequent straining or increased intraabdominal pressure. Small hemorrhoids may be asymptomatic. The bigger ones may cause pain, pruritus and bleeding.
Normally, they are a part of the rectal canal and are collectively known as the rectal venous plexus or the hemorrhoidal plexus, plexus meaning a group of veins. Most of the time they are filled with blood and acts as cushions to help the anal sphincters hold the anal walls together and maintain resting continence.
The major causes for hemorrhoids to swell is due to frequent straining during passage of hard stools, weakening of the recto anal wall, and from increased abdominal pressure that happens during labor and childbirth. Hemorrhoids can be internal or external. External hemorrhoids are found on the sides of the anal opening and almost never in the vagina unless there’s a massive internal hemorrhoid from the rectal wall that pushes the vaginal wall.
Internal hemorrhoids may be asymptomatic but passage of blood streaked stools is apparent. Malignancy should be ruled out before considering a possible internal hemorrhoid. The notion about a vaginal hemorrhoid growth is a misconception. Distended structures seen in the vaginal wall is most probably from other pathological condition. Engorgement of the vaginal veins could happen, but is extremely rare. Examples of which that present as hemorrhoid-like structures in the vagina are anogenital warts, vaginal wall cysts, tumors or could also be vaginal prolapse, although prolapse of the vagina is unusual since it’s a very strong and elastic muscular organ built for copulation and child birth.
Unusual growth in the vaginal piles or the taint area should be checked by a health professional to establish the right diagnosis and appropriate treatment. Anogenital warts can appear as a skin tag. They can also be itchy and bleed just like a hemorrhoid in the anus. Warts are caused by the human papillomavirus and are transferred through rubbing in between epithelial surfaces or skin to skin contact. The virus feeds on the capillaries and grows superficially in the skin.
There are many ways to get rid of warts. It can be through topical medicines, surgical excision, cautery or cryotherapy. These warts are the major causes of cervical cancer and should be given immediate treatment. Vaccination against genital warts is now widely available to avoid its occurrence and spread. Safe sex should be practiced and always be wary of other sexually transmitted diseases such as HIV.
Distention of vaginal wall skin can also be from a vaginal cyst, infection or a tumor. It is important to test it and do biopsy to rule out malignancy. Bartholin gland abscess is a common finding along the vaginal wall from the infection of the bartholin glands found in the labia minora. The bartholin glands contribute to the vagina’s mucosal secretions. Once they are infected, the bartholin ducts become clogged and abscess formation occurs. They are treated through antibiotics, pain relievers, and incision and drainage.
Other differential diagnosis could be a condyloma latum, a painless growth in the perineal area that is a manifestation of syphilis. Other gynecological infections such as chancroid, molluscum contangiosum, bowen’s disease and many others may be considered, other than thinking it’s a hemorrhoid. These other pathologies are treated differently and accordingly, therefore early medical consultation is very important.
Vaginal outgrowths could also be just skin tags, a common name for fibroepithelial polyps. Skin tags are commonly found on folded areas of the body like in the armpits, neck, groin and outstretched skin that is totally benign. On the other hand, pelvic organ prolapse such as rectocele is a condition wherein the posterior vaginal wall has prolapsed along the space between the vagina and the rectum. This happens as a result of a difficult vaginal delivery or chronic increase in the intra-abdominal pressure by other means.
By the law of gravity, persistent and massive increase in the intraabdominal pressure can cause organ prolapse in the perineal area. Rectocele can cause difficulty passing out stools and dyspareunia or painful sexual intercourse. A high degree of prolapse should be managed surgically to bring back the structures to its normal position.
Going back to hemorrhoids, rectoanal hemorrhoids are like varicose veins. They are distended veins that did not go back to their original form due to increase in blood pressure along the vessels, losing its elasticity over time and can be painful or even asymptomatic.
Growths that look like them in the vagina are never considered as a hemorrhoid. The vagina has no hemorrhoidal plexus and it is a very dependable and elastic organ. However, the vagina has its own network of veins and they are covered with strong connective tissues and muscles that it becomes rare for these vaginal veins to become tortuous. Hemorrhoids are treated only through surgery once it becomes bothersome. If it doesn’t get uncomfortable, it is advised to leave it as it is because it still helps maintain continence even though it went out of its natural habitat.
Helpful remedies can soothe the pain experienced from distended hemorrhoids such as a high fiber diet and use of suppositories to prevent straining, warm sitz bath targeted to the perianal area to ease out the vessels, and promote a smoother blood flow. Hemorrhoids are treated very differently from those found in the vagina. It is very important to know the etiology of the outgrowths found in the vagina since it could be from numerous causes as discussed.
Prompt management should be done to protect the vagina’s main function as an organ and to protect other people from the spread of an unwanted disease. Ignorance of the fact that hemorrhoids are strictly a part of the rectum and not the vagina is dangerous as it makes the affected woman become complacent on seeking medical help if it doesn’t bother her. Furthermore, check your sexual organ from time to time for any physical changes, foul smelling discharge, greenish or yellowish discharge or any inflammation, and seek medical consult right away. Early prevention and detection is better than trying to cure an advanced disease.
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