The question of whether a person can be born with hemorrhoids is a common concern that stems from observing anal symptoms in infants. Hemorrhoids are defined as swollen and inflamed vascular cushions, which are naturally occurring clusters of blood vessels in the anal canal. While these vascular cushions are present at birth, the pathological condition known as hemorrhoids is an acquired disorder, meaning it develops over time. Therefore, a newborn is not born with the disease, but rather with the anatomical structures that can later become diseased.
Understanding Hemorrhoids and Typical Causes
Hemorrhoids are classified based on their location relative to the dentate line in the anal canal, separating them into internal and external types. The underlying cause for the pathological swelling is an increase in pressure within the lower rectum, which forces the blood vessels to stretch and bulge. This pressure buildup is almost always related to bowel habits and lifestyle factors. Common mechanisms that cause this sustained pressure include chronic straining during bowel movements, prolonged sitting, and chronic constipation or diarrhea. Conditions that increase abdominal pressure, such as pregnancy or obesity, also contribute to the development of hemorrhoids in adults. These factors create the high-pressure environment necessary for the vascular cushions to become inflamed and symptomatic.
The Definitive Answer: Congenital Hemorrhoids
The pathological condition of hemorrhoids is not considered a congenital defect because the physiological conditions required for their formation are typically absent in newborns. Infants do not engage in the chronic, strenuous pushing and prolonged sitting that leads to the sustained venous pressure buildup seen in older children and adults. For this reason, true hemorrhoids are exceedingly rare in the pediatric population. When they do occur in children, it is usually in the teenage years, often after years of chronic constipation and straining to pass stool. In the rare instances where true hemorrhoids appear in younger children, they are often linked to severe, underlying medical conditions, such as chronic liver failure, which creates portal hypertension that forces blood into the rectal veins.
Conditions in Newborns Mistaken for Hemorrhoids
Parents often mistake other, more common anorectal conditions for hemorrhoids when they observe blood or a lump near their infant’s anus. Any instance of bleeding or a noticeable lump near an infant’s anus should always be evaluated by a pediatrician to ensure an accurate diagnosis and appropriate treatment.
Anal Fissures
The most frequent cause of bright red rectal bleeding in infants is an anal fissure. An anal fissure is a small, linear tear in the moist skin of the anoderm, usually caused by the passage of a hard or large stool. The tearing causes pain during defecation, and the blood appears as streaks on the stool or the diaper.
Perianal Abscesses and Fistulas
Another condition often misinterpreted as an external hemorrhoid is a perianal abscess or fistula. An abscess is an infected cavity of pus that appears as a painful, red, swollen lump near the anus, and it originates from an infection of the anal glands. If this abscess drains and forms a tract to the skin, it is called a fistula.
Skin Tags and Polyps
Parents might also notice small, fleshy growths that are actually anal skin tags, which are remnants of previous inflammation, or rectal polyps, which are abnormal but typically harmless growths. These lumps are benign and are not swollen blood vessels. Their presence can easily be mistaken for an external hemorrhoid by an untrained eye.