A hemorrhoid, when subjected to undue pressure or trauma, may undergo a break in its surface. This event typically manifests as bleeding, often observed as bright red blood during or after a bowel movement. The quantity of blood can vary significantly from a small streak to a more substantial flow. Pain, while not always present, may accompany this occurrence, particularly if the surrounding tissue is irritated or inflamed.
Understanding the potential consequences of this occurrence is vital for appropriate management and prevention. While generally not life-threatening, bleeding can be alarming and contribute to anxiety. Chronic or recurrent blood loss may, in some instances, lead to anemia. Furthermore, a compromised tissue barrier increases the susceptibility to infection in the affected area. Historically, such incidents have been a source of discomfort and concern, prompting the development of various treatment modalities.
The subsequent sections will delve into the causes, potential complications, diagnostic approaches, and management strategies associated with this condition. The information presented aims to provide a clear and concise overview to facilitate informed decision-making regarding healthcare.
1. Bright Red Blood
The presence of bright red blood is a salient indicator following hemorrhoidal tissue compromise. Its appearance signifies an active, localized hemorrhage, serving as a key diagnostic clue. Understanding the characteristics and implications of this bleeding is essential for proper assessment.
-
Source Localization
The bright red color indicates that the blood originates from the lower gastrointestinal tract, specifically the anus and rectum, where hemorrhoids are located. The color results from oxygenated hemoglobin, confirming the proximity of the bleeding site to the anal opening. This helps to differentiate it from darker blood, which might suggest bleeding higher in the digestive system.
-
Bleeding Patterns
The blood may be observed in different patterns. It can appear on the toilet paper after wiping, drip into the toilet bowl, or coat the stool. The quantity can range from minor streaks to a more significant volume. The temporal relationship to bowel movements, such as occurring during or immediately after, is characteristic. Recurrent bleeding, even in small amounts, should be evaluated.
-
Severity Assessment
While alarming, the presence of bright red blood following a hemorrhoidal rupture is typically not life-threatening. However, the frequency and volume of blood loss are critical factors in determining the severity of the situation. Prolonged or heavy bleeding can potentially lead to anemia, necessitating further investigation and intervention. Individuals on anticoagulant medications may experience more profuse bleeding.
-
Diagnostic Significance
Visual confirmation of bright red blood serves as an initial indication, prompting further examination to confirm the diagnosis and rule out other potential causes of rectal bleeding, such as anal fissures, inflammatory bowel disease, or, in rare cases, colorectal cancer. A digital rectal exam and/or anoscopy are commonly employed to visualize the hemorrhoids and identify the source of bleeding.
In summary, the observation of bright red blood is a primary manifestation following a break in hemorrhoidal tissue. Its characteristics, patterns, and association with other symptoms are crucial components in evaluating the nature and extent of the condition and guiding appropriate management strategies. The appearance and volume of blood serve as key indicators, prompting further examination to ensure accurate diagnosis and rule out other potential etiologies of rectal bleeding.
2. Perianal discomfort/pain
The occurrence of perianal discomfort or pain is a common sequel following a hemorrhoidal breach. The intensity of discomfort varies widely among individuals, influenced by factors such as the extent of the rupture, the degree of inflammation, and individual pain tolerance. The disruption of the mucosal lining exposes underlying nerve endings, rendering the area more sensitive to mechanical and chemical stimuli. The passage of stool, particularly if hard or irregular, exacerbates irritation and pain. Pre-existing conditions, such as anal fissures or infections, can compound the level of discomfort experienced. For instance, a person with a pre-existing anal fissure might experience significantly heightened pain levels following a hemorrhoidal rupture as the two conditions synergistically amplify each other’s effects. The practical significance of this understanding lies in tailoring pain management strategies, considering both the hemorrhoidal rupture and any coexisting perianal pathologies.
The pain can manifest in various ways, including a dull ache, a sharp stabbing sensation, or a persistent throbbing. Activities that increase intra-abdominal pressure, such as prolonged sitting, straining during bowel movements, or heavy lifting, can intensify the discomfort. Sphincter muscle spasms can also contribute to the sensation of pain and pressure. A patient might describe a constant ache that worsens after defecation, followed by intermittent sharp pains associated with muscle spasms. Application of topical anesthetics and warm sitz baths offer symptomatic relief by numbing nerve endings and promoting muscle relaxation, respectively. Furthermore, dietary modifications to soften stool reduce strain during bowel movements, thereby minimizing irritation and associated discomfort.
In summary, perianal discomfort or pain is a prevalent and consequential aspect following a disruption in hemorrhoidal tissue. Its severity is influenced by multiple factors, requiring a comprehensive assessment for effective management. Addressing both the immediate symptoms and underlying contributing factors is crucial for improving patient comfort and promoting healing. While pain is a subjective experience, its association with compromised hemorrhoidal tissue highlights the need for targeted interventions that alleviate discomfort, reduce inflammation, and prevent recurrence.
3. Potential for infection
A break in the surface of hemorrhoidal tissue creates a direct pathway for microorganisms to access the underlying tissues. The perianal region, by its nature, harbors a diverse array of bacteria, both commensal and potentially pathogenic. Consequently, the compromise of the mucosal barrier, resulting from a rupture, increases the risk of infection. Fecal matter, which inevitably contaminates the area, further introduces bacteria and increases the likelihood of infectious complications. The presence of pre-existing conditions, such as anal fissures or skin excoriation, exacerbates this risk by providing additional entry points for pathogens. A person with a compromised immune system or uncontrolled diabetes would be particularly vulnerable to developing an infection following this event, owing to diminished defenses against bacterial proliferation.
The symptoms of infection can vary from localized redness, swelling, and tenderness to more systemic manifestations, such as fever and malaise. The formation of an abscess, a localized collection of pus, represents a more severe complication requiring prompt medical intervention. Left untreated, the infection can spread to surrounding tissues, leading to cellulitis or, in rare cases, more serious conditions like sepsis. Practical measures to mitigate infection include meticulous hygiene practices, such as gentle cleansing with mild soap and water after bowel movements. Topical antibiotics or antiseptics may be prescribed to reduce the bacterial load and promote healing. In instances of abscess formation, incision and drainage are necessary to evacuate the purulent material and alleviate pressure.
In summary, the potential for infection is a significant consideration following a breach in hemorrhoidal tissue. Compromised tissue integrity facilitates bacterial entry and increases the risk of localized or systemic infections. Proactive measures, including diligent hygiene, antimicrobial therapy, and prompt management of complications, are essential to minimize the risk of infection and promote optimal healing. Recognizing the increased susceptibility to infection emphasizes the importance of early intervention and preventative strategies in managing the sequelae of disrupted hemorrhoidal tissue.
4. Risk of anemia
Chronic or recurrent blood loss associated with hemorrhoidal rupture can lead to iron deficiency anemia. The severity of this risk is directly proportional to the frequency and volume of blood lost over time. This consequence necessitates careful monitoring and, in some cases, intervention to prevent significant health complications.
-
Gradual Iron Depletion
Persistent bleeding, even if minimal with each occurrence, can gradually deplete the body’s iron stores. Iron is a critical component of hemoglobin, the protein in red blood cells responsible for carrying oxygen. As iron reserves diminish, the body is unable to produce sufficient hemoglobin, leading to a reduction in the number of functional red blood cells. Over time, this iron deficiency progresses to anemia, characterized by fatigue, weakness, and shortness of breath.
-
Impact of Bleeding Frequency
The frequency of hemorrhoidal bleeding is a significant determinant of anemia risk. Infrequent episodes of minor bleeding may not pose a substantial threat to iron levels. However, individuals experiencing bleeding with each bowel movement or multiple times per week are at significantly higher risk of developing iron deficiency anemia. Pre-existing conditions, such as heavy menstrual periods in women, can compound this risk.
-
Vulnerability of Specific Populations
Certain populations are particularly vulnerable to developing anemia as a consequence of hemorrhoidal bleeding. These include pregnant women, who have increased iron requirements, elderly individuals with compromised iron absorption, and individuals with underlying gastrointestinal disorders that impair iron uptake. In these groups, even modest blood loss can precipitate significant anemia.
-
Diagnostic and Therapeutic Approaches
Assessment for anemia in individuals with recurrent hemorrhoidal bleeding typically involves a complete blood count (CBC) and iron studies, including serum iron, ferritin, and transferrin saturation. Treatment strategies may include iron supplementation, either orally or intravenously, to replenish iron stores. Addressing the underlying hemorrhoidal condition through conservative measures, such as dietary modifications and topical treatments, or more invasive procedures, such as rubber band ligation or hemorrhoidectomy, is crucial to prevent further bleeding and resolve the anemia.
The connection between recurrent bleeding and the risk of anemia underscores the importance of early diagnosis and effective management. Monitoring blood counts and iron levels, especially in vulnerable populations, is crucial. Interventions aimed at controlling bleeding and replenishing iron stores are essential to mitigate the long-term health consequences associated with iron deficiency anemia resulting from hemorrhoidal rupture.
5. Tissue Inflammation
Tissue inflammation is a pivotal physiological response intimately linked to the sequelae of hemorrhoidal rupture. It represents a complex cascade of events triggered by the damage to the mucosal lining and underlying tissues, influencing symptom presentation, healing processes, and potential complications.
-
Initiation of the Inflammatory Cascade
The physical breach of the hemorrhoidal tissue instigates the release of various inflammatory mediators, such as histamine, prostaglandins, and cytokines. These substances promote vasodilation, increasing blood flow to the affected area. This augmented vascular permeability leads to edema, contributing to swelling and discomfort. For instance, the release of bradykinin directly stimulates pain receptors, heightening the sensation of perianal discomfort following a rupture. The body’s innate immune system is activated, initiating a cellular response to remove debris and initiate repair processes, which further contributes to the inflammatory milieu.
-
Contribution to Pain and Discomfort
Inflammation significantly amplifies pain and discomfort experienced after a hemorrhoidal rupture. The edema and swelling compress nerve endings in the perianal region, resulting in a heightened sensitivity to pain. Furthermore, inflammatory mediators directly stimulate nociceptors, the pain receptors, thereby exacerbating the perceived pain intensity. The increased pressure from swelling can also cause a throbbing sensation. The resultant pain can be debilitating, affecting daily activities and hindering bowel movements due to the fear of exacerbating the discomfort.
-
Impediment of Healing
While inflammation is a necessary component of the healing process, excessive or prolonged inflammation can impede tissue repair. Chronic inflammation can disrupt the delicate balance between tissue destruction and regeneration, prolonging healing times. The persistent presence of inflammatory mediators can also lead to the formation of scar tissue, potentially causing further complications, such as anal stenosis. For example, persistent inflammation can disrupt collagen deposition, hindering the formation of strong, resilient tissue, leading to a fragile repair site more susceptible to subsequent rupture.
-
Secondary Infections and Complications
Inflamed tissue is more susceptible to secondary infections. The compromised mucosal barrier, coupled with the influx of immune cells, disrupts the normal protective mechanisms of the perianal region. This creates a conducive environment for bacterial colonization and proliferation. Moreover, the presence of edema can impair local blood flow, hindering the delivery of antibiotics and immune cells to the infection site. This increased susceptibility to infection, coupled with the potential for abscess formation, represents a significant complication associated with tissue inflammation following hemorrhoidal rupture.
In summary, tissue inflammation represents a central process following a hemorrhoidal rupture, influencing symptom presentation, healing dynamics, and susceptibility to complications. Its multifaceted effects underscore the importance of targeted anti-inflammatory strategies in managing the consequences of a breach in hemorrhoidal tissue, aiming to mitigate pain, promote healing, and prevent secondary infections.
6. Increased sensitivity
Following a break in hemorrhoidal tissue, increased sensitivity in the perianal region is a common and significant consequence. This heightened responsiveness to stimuli directly impacts the patient’s experience, influencing pain perception, hygiene practices, and overall quality of life. The disruption of the protective mucosal layer exposes nerve endings and inflammatory mediators, leading to a state of heightened excitability.
-
Nerve Ending Exposure
The hemorrhoidal plexus contains a network of sensory nerve fibers that, under normal circumstances, are shielded by the mucosal lining. When this lining is breached, these nerve endings become directly exposed to external stimuli, such as friction, pressure, and chemical irritants present in fecal matter. This direct exposure lowers the threshold for activation, resulting in an amplified perception of pain and discomfort. For instance, activities that would normally be well-tolerated, such as wiping after a bowel movement, can become intensely painful due to the denuded nerve endings.
-
Inflammatory Mediator Sensitization
The inflammatory response triggered by the tissue damage releases various chemical mediators, including prostaglandins, bradykinin, and histamine. These substances not only contribute to vasodilation and edema but also directly sensitize nerve endings. They lower the activation threshold of nociceptors, making them more responsive to stimuli and amplifying pain signals transmitted to the central nervous system. Consequently, even minor irritations can elicit a disproportionately intense pain response, compounding the overall discomfort.
-
Sphincter Spasm Potentiation
The increased sensitivity in the perianal region can trigger reflexive spasm of the internal anal sphincter muscle. This involuntary contraction of the sphincter further contributes to pain and discomfort. The spasm compresses the already inflamed and sensitive tissues, exacerbating pain signals. Additionally, the muscle spasm can impede blood flow to the hemorrhoidal tissues, hindering healing and potentially leading to ischemia. The cyclical interplay between increased sensitivity and sphincter spasm can perpetuate a cycle of pain and discomfort.
-
Impact on Hygiene and Daily Activities
The heightened sensitivity directly influences hygiene practices. Individuals may be reluctant to cleanse the perianal area thoroughly due to the associated pain, leading to inadequate hygiene and an increased risk of secondary infection. This reluctance can create a vicious cycle, where poor hygiene exacerbates inflammation and sensitivity, further hindering effective cleansing. Daily activities, such as sitting, walking, and even sleeping, can be disrupted by the persistent discomfort, significantly impacting quality of life. This necessitates tailored strategies to manage pain and promote hygiene without causing further irritation.
Increased sensitivity represents a significant clinical manifestation following a break in hemorrhoidal tissue. Its multifaceted effects, ranging from direct nerve exposure to inflammation-mediated sensitization and sphincter spasm potentiation, underscore the importance of comprehensive pain management strategies that address both the underlying tissue damage and the resultant heightened sensory perception. Effective interventions aim to reduce inflammation, protect exposed nerve endings, and alleviate muscle spasm, thereby improving patient comfort and facilitating healing.
7. Possible Prolapse
A breach in hemorrhoidal tissue can significantly increase the likelihood of prolapse, where the internal hemorrhoid protrudes through the anal opening. The structural integrity of the hemorrhoidal cushions relies on the surrounding connective tissue and the intact mucosal lining. When the tissue is compromised, the supporting structures weaken, rendering the hemorrhoid more susceptible to displacement, particularly during bowel movements or activities that increase intra-abdominal pressure. For instance, straining during defecation can exert excessive downward force, pushing the weakened hemorrhoid through the anal canal. The practical significance lies in understanding that a ruptured hemorrhoid is not merely a bleeding issue but also a potential precursor to a more severe prolapse, necessitating proactive management to prevent further deterioration.
The prolapsed hemorrhoid, exposed to the external environment, becomes vulnerable to further trauma, irritation, and infection. The mucosal surface may become ulcerated, leading to persistent bleeding and discomfort. Additionally, the prolapsed tissue can interfere with anal hygiene, contributing to perianal skin irritation and an increased risk of infection. In severe cases, the prolapsed hemorrhoid may become incarcerated, meaning it cannot be manually reduced back into the anal canal. This incarceration can lead to strangulation, with compromised blood supply causing intense pain and potentially requiring surgical intervention. A case example involves an individual with chronic constipation who experiences a hemorrhoidal rupture followed by a progressively worsening prolapse, culminating in incarceration and necessitating emergency hemorrhoidectomy. Understanding the progressive nature of this complication underscores the importance of early intervention.
In summary, hemorrhoidal rupture weakens the supporting structures and predisposes the hemorrhoid to prolapse. The consequences of prolapse extend beyond mere protrusion, encompassing increased vulnerability to trauma, infection, and the risk of incarceration. Early diagnosis, conservative management, and, when necessary, surgical intervention are essential to mitigate the potential complications associated with prolapse following hemorrhoidal rupture. The long-term goal focuses on restoring structural integrity and preventing recurrent prolapse, thus improving patient comfort and quality of life.
8. Fecal seepage
Following a hemorrhoidal rupture, the likelihood of fecal seepage increases due to the compromised integrity of the anal canal and the potential disruption of normal sphincter function. The ruptured tissue may create a pathway for stool to leak through, particularly when the hemorrhoids are significantly inflamed or prolapsed. Furthermore, the discomfort associated with the rupture can lead to incomplete bowel movements, leaving residual stool in the rectum, which then seeps out intermittently. As an example, individuals with external hemorrhoids may find that, after a rupture, controlling bowel movements becomes challenging, resulting in unintentional fecal staining of undergarments. This loss of continence, even if minor, can lead to significant distress and social embarrassment, highlighting the practical implications of this connection.
The degree of fecal seepage is often correlated with the severity of the hemorrhoidal disease and the extent of tissue damage. Larger, prolapsed hemorrhoids, particularly after a rupture, can physically interfere with the complete closure of the anal canal, making fecal leakage more pronounced. Pre-existing conditions such as weakened pelvic floor muscles or chronic diarrhea can also exacerbate the problem. Management strategies often focus on addressing the underlying hemorrhoidal condition through conservative treatments like dietary fiber and stool softeners, or more invasive procedures if conservative measures fail. Additionally, pelvic floor exercises may help improve sphincter control and reduce seepage. The assessment of fecal seepage necessitates a thorough evaluation to differentiate it from other causes of incontinence and to determine the most appropriate course of action.
In summary, fecal seepage represents a clinically relevant consequence that arises due to the structural compromise and altered sphincter dynamics following hemorrhoidal tissue compromise. Its occurrence underscores the importance of comprehensive management that addresses not only the hemorrhoidal disease itself but also the associated functional impairments. Recognizing the connection between hemorrhoidal rupture and fecal seepage allows for targeted interventions to alleviate symptoms, improve hygiene, and enhance the patient’s overall well-being. The challenge lies in effectively addressing both the immediate discomfort and the long-term management of continence to restore quality of life.
9. Exacerbation of symptoms
The disruption of hemorrhoidal tissue often leads to a pronounced exacerbation of pre-existing symptoms and the emergence of new complications. This deterioration of the clinical picture necessitates a comprehensive understanding of the contributing factors and appropriate management strategies.
-
Increased Pain Intensity
A break in hemorrhoidal tissue can significantly amplify the sensation of pain. The exposed nerve endings and inflammatory mediators contribute to a heightened level of discomfort, transforming a previously manageable condition into one characterized by intense pain. For instance, an individual experiencing mild discomfort from hemorrhoids may, following a rupture, endure sharp, throbbing pain that interferes with daily activities. This increase in pain intensity frequently prompts individuals to seek immediate medical attention.
-
Enhanced Bleeding Risk
The compromise of the mucosal barrier increases the risk and severity of bleeding. While bleeding may have been a sporadic symptom previously, a breach in the tissue can result in more frequent and profuse bleeding. The blood loss can range from spotting on toilet paper to a significant flow requiring medical intervention. Continued or increased bleeding elevates the risk of anemia and necessitates a thorough investigation to rule out other potential sources of hemorrhage.
-
Elevated Prolapse Potential
Disruption of the supporting tissues surrounding hemorrhoids weakens their structural integrity, thereby increasing the likelihood of prolapse. The weakened hemorrhoids become more prone to protrusion through the anal canal, particularly during bowel movements or activities that increase intra-abdominal pressure. This prolapse can lead to further irritation, pain, and difficulty in maintaining hygiene, thus compounding the overall symptom burden. The frequency and extent of prolapse may increase significantly.
-
Heightened Infection Susceptibility
The breach in the mucosal barrier creates a direct portal of entry for bacteria and other microorganisms, increasing the risk of infection. The perianal region, naturally colonized with a diverse microbial population, can readily contaminate the exposed tissues. An infection can manifest as localized redness, swelling, and tenderness, or progress to more severe complications such as abscess formation or cellulitis. The presence of infection complicates the healing process and necessitates antimicrobial therapy.
The exacerbation of symptoms underscores the significance of prompt and effective management following hemorrhoidal disruption. Addressing the underlying causes and implementing appropriate interventions are crucial in mitigating the potential for further complications. These multifaceted effects emphasize the need for tailored strategies to manage pain, control bleeding, prevent prolapse, and minimize the risk of infection, ultimately improving patient outcomes.
Frequently Asked Questions
The following addresses commonly encountered queries concerning the consequences and management of compromised hemorrhoidal tissue.
Question 1: What is the primary indicator that a hemorrhoid has undergone tissue compromise?
The principal sign is typically the presence of bright red blood originating from the anus, often observed during or following a bowel movement. The volume of blood may vary.
Question 2: Is a hemorrhoidal rupture a life-threatening condition?
In the vast majority of instances, such an event is not life-threatening. However, persistent or profuse bleeding can lead to anemia and necessitates medical evaluation.
Question 3: What are the potential infectious risks following tissue disruption?
The compromised mucosal barrier increases susceptibility to infection, ranging from localized perianal infections to, in rare cases, more systemic complications. Meticulous hygiene is critical.
Question 4: How does tissue compromise influence the likelihood of hemorrhoidal prolapse?
The weakening of supporting structures associated with tissue damage increases the risk of prolapse, where the hemorrhoid protrudes through the anal opening, requiring prompt management.
Question 5: What measures can be implemented to alleviate pain and discomfort?
Symptomatic relief may be achieved through topical anesthetics, warm sitz baths, and dietary modifications aimed at softening stool and reducing straining during bowel movements.
Question 6: Is medical intervention always required following a hemorrhoidal rupture?
Not all cases necessitate immediate medical intervention. However, persistent or severe symptoms, such as profuse bleeding, intense pain, or signs of infection, warrant prompt medical evaluation and management.
Understanding these common concerns and their corresponding answers facilitates informed decision-making and promotes effective management of the condition.
The succeeding sections will detail specific management strategies and preventative measures to mitigate the risk of hemorrhoidal rupture and its associated complications.
Mitigating Risks Associated with Hemorrhoidal Tissue Disruption
The following recommendations aim to reduce the likelihood of complications following a break in hemorrhoidal tissue, emphasizing preventative strategies and appropriate management techniques.
Tip 1: Maintain Optimal Hydration: Adequate fluid intake promotes softer stools, thereby minimizing straining during bowel movements and reducing pressure on hemorrhoidal tissues. Aim for at least eight glasses of water daily.
Tip 2: Incorporate Dietary Fiber: A high-fiber diet contributes to regular bowel movements and softer stools, preventing constipation and reducing the risk of hemorrhoidal irritation and rupture. Include sources such as fruits, vegetables, and whole grains.
Tip 3: Practice Proper Bowel Habits: Avoid prolonged sitting on the toilet and refrain from straining during bowel movements. Respond to the urge to defecate promptly to prevent stool from hardening and becoming more difficult to pass.
Tip 4: Employ Gentle Cleansing Techniques: After bowel movements, cleanse the perianal area gently with mild soap and water or use moistened wipes specifically designed for hemorrhoidal care. Avoid harsh scrubbing, which can irritate the delicate tissues.
Tip 5: Consider Topical Treatments: Over-the-counter creams and suppositories containing ingredients such as hydrocortisone or witch hazel can provide temporary relief from pain, itching, and inflammation associated with hemorrhoids. Consult a healthcare professional for appropriate product selection.
Tip 6: Engage in Regular Exercise: Routine physical activity promotes healthy bowel function and reduces the risk of constipation. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
Tip 7: Avoid Prolonged Sitting or Standing: Prolonged periods of sitting or standing can increase pressure on the hemorrhoidal veins. Take regular breaks to move around and alleviate pressure. Consider using a cushion to reduce pressure when sitting.
Adhering to these guidelines can significantly reduce the potential for complications arising from compromised hemorrhoidal tissue. Early intervention and consistent adherence to these practices are crucial for long-term management.
The subsequent section will summarize the key findings and provide concluding remarks regarding the understanding and management of conditions stemming from incidents of this nature.
Conclusion
This exploration of “what happens when hemorrhoids rupture” reveals a spectrum of potential consequences extending beyond mere discomfort. Hemorrhage, pain, increased susceptibility to infection, prolapse risk, and functional impairments such as fecal seepage represent significant clinical concerns. Understanding the pathophysiology and the array of potential sequelae enables informed decision-making regarding management and preventative strategies. Prompt recognition and appropriate intervention are essential to mitigate these risks.
The information detailed underscores the importance of proactive management in individuals susceptible to hemorrhoidal disease. Vigilance regarding bowel habits, dietary considerations, and hygiene practices plays a crucial role in preventing tissue disruption and minimizing associated complications. Continued research and advancements in treatment modalities offer promise for improved patient outcomes and enhanced quality of life for those affected by this condition.
