What is hemorrhoids?

Hemorrhoids are swollen veins that develop in the anal canal. Bleeding during bowel movements, itching, and rectal pain are the most common symptoms. Hemorrhoids can be uncomfortable at times, but rarely are they a serious problem.

Most of the time, you can treat them with simple changes to your diet and bowel habits. These changes include eating more fiber and not straining to pass stools. Most hemorrhoids don't need surgery or other treatment unless they are very large and painful or bleed a lot.

For some people, hemorrhoids may cause a little discomfort for a limited time. Other people have recurrent bouts of discomfort when hemorrhoids flare up. Some people struggle with hemorrhoid pain, discomfort, and itching much of their lives. The degree and duration of discomfort depend on where the hemorrhoids are.

Hemorrhoids frequently develop during pregnancy because of extra pressure on veins (from the enlarged uterus).

During labor, hemorrhoids may start or get worse because of the intense straining and pressure on the anal area while pushing to deliver the baby.

External hemorrhoids

Because external hemorrhoids may not cause any symptoms, you may not be aware that you have hemorrhoids.

When a vein within an external hemorrhoid gets irritated, blood may clot under the skin, forming a hard, bluish lump. This is known as a thrombosed, or clotted, hemorrhoid. Thrombosed hemorrhoids can be very painful.

Internal hemorrhoids

Small internal hemorrhoids may not grow larger if bowel habits or other factors change to lower pressure on the veins in the bowel.

Large internal hemorrhoids may bulge from the anus. After bowel movements, you may have to push them back through the anus. At worst, large internal hemorrhoids stick out all the time.

In rare cases, hemorrhoids may bulge through the anus and swell. Muscles that control the opening and closing of the anus may cut off a hemorrhoid's blood supply (strangulated hemorrhoid). This may cause the hemorrhoid tissues to die. If this happens, you will feel severe rectal pain and may see blood and pus at the anus. You will need urgent surgery to prevent further complications, such as death of the affected tissue and infection.

Hemorrhoids may cause:

• Rectal bleeding. You may see bright red blood on the toilet paper or in the toilet after a bowel movement. You may see blood on the stool.
• Itching. Hemorrhoids often seep mucus. It can irritate the skin and cause itching.
• Discomfort. You may still feel the urge to pass stool right after having a bowel movement.
• Pain.
  • When a vein within an external hemorrhoid gets irritated, blood may clot under the skin, forming a hard, bluish lump. This is known as a thrombosed, or clotted, hemorrhoid. Thrombosed hemorrhoids can be very painful.
  • Large internal hemorrhoids that bulge from the anus may be painful if they're squeezed by the anal muscles. They may be very painful if the blood supply to the hemorrhoid is cut off.

For most external hemorrhoids, home treatment is all you need. The same home treatment can be used for most internal hemorrhoids.

• Slowly add fiber to your meals. Eat foods that have lots of fiber, such as fruits, vegetables, and whole grains.
• Use an over-the-counter ointment for a limited time to stop itching. You also may use a stool softener.
• Try suppositories. They can help relieve irritation and lubricate the anal canal during bowel movements.
• Drink plenty of water.
• Get some exercise every day.

If your internal hemorrhoids are severe, you may need other treatment. The doctor may tie off the hemorrhoids with rubber bands or create scar tissue around the hemorrhoids. These treatments reduce the blood supply to the hemorrhoids so they shrink or go away.

Surgery to remove hemorrhoids may be done if other treatments don't work. It may be done to remove large internal or external hemorrhoids that are uncomfortable or painful.

When an external hemorrhoid gets irritated and clots (thrombosed, or clotted, hemorrhoid), a doctor may relieve your pain by removing the contents of the clot. The doctor will use a medicine to numb the anal area (local anesthetic). Then he or she will make a small incision to drain the clot.

This will probably give you immediate and long-lasting relief from the intense pain.

Before you go home, you will be instructed to take daily sitz baths (sit in a shallow tub of warm water for 10 to 15 minutes) and to gently cleanse your anal area with a cleansing agent such as Balneol. Your doctor may give you a cream that contains a local anesthetic to help relieve pain. The wound should heal in about a week.

If your doctor doesn't remove the clot within 3 to 4 days after it forms, the pain will gradually get less over the next few days. The skin covering the clot may break open on its own, causing mild bleeding. With home treatment, pain and bleeding should go away in about a week. But it may take several weeks for the clot to go away.

Your doctor can tell if you have hemorrhoids by asking about your past health and doing a physical exam.

You may not need many tests at first if your doctor thinks that your rectal bleeding is caused by hemorrhoids. Your doctor may just examine your rectum with a gloved finger. Or your doctor may use a short, lighted scope to look inside the rectum.

Rectal bleeding can be a sign of a more serious problem, such as colon, rectal, or anal cancer. So if the first exam doesn't show a clear cause of your problems, your doctor may do tests to check for other causes of bleeding. The doctor may use a lighted scope to look at the lower third of your colon. This is called sigmoidoscopy. Or your doctor may use another kind of scope to look at the entire colon. This is called colonoscopy.

Medicines can help relieve symptoms of hemorrhoids. Over-the-counter (OTC) treatments you can try include:

• Ointments that protect the skin. They form a barrier over hemorrhoids. This can prevent more injury and reduce itching. Examples include zinc oxide and petroleum jelly.
• Suppositories. These can help relieve irritation. They can also lubricate the anal canal during bowel movements. They include Preparation H and Tucks.
• 1% hydrocortisone ointment. This is a type of steroid medicine. It may relieve inflammation and itching.
• Products that numb an area. Although these products help some people, others become allergic to them. Ask your doctor before you use them. These products often have "-caine" in the name or the ingredients.
• OTC pain relievers. Acetaminophen can help with pain. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help with pain and swelling.

The following professionals can evaluate and treat hemorrhoids:

• Family medicine physician
• Internist
• Nurse practitioner (NP)
• Physician assistant (PA)
• Obstetrician
• Gastroenterologist
• Gynecologist
• Surgeon

If medical treatment or surgery is needed, you may be referred to a:

• Gastroenterologist.
• Colon and rectal surgeon.
• Doctor who specializes in problems affecting the rectum and anus (proctologist).

• Sit in a few inches of warm water (sitz bath) 3 times a day and after bowel movements. The warm water helps with pain and itching.
• Put ice on your anal area several times a day for 10 minutes at a time. Put a thin cloth between the ice and your skin. Follow this by placing a warm, wet towel on the area for another 10 to 20 minutes.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• Keep the anal area clean, but be gentle. Use water and a fragrance-free soap, or use baby wipes or medicated pads such as Tucks.
• Wear cotton underwear and loose clothing to decrease moisture in the anal area.
• Eat more fiber. Include foods such as whole-grain breads and cereals, raw vegetables, raw and dried fruits, and beans.
• Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• Use a stool softener that contains bran or psyllium. You can save money by buying bran or psyllium (available in bulk at most health food stores) and sprinkling it on foods or stirring it into fruit juice. Or you can use a product such as Metamucil or Hydrocil.
• Practice healthy bowel habits.
  • Go to the bathroom as soon as you have the urge.
  • Avoid straining to pass stools. Relax and give yourself time to let things happen naturally.
  • Do not hold your breath while passing stools.
  • Do not read while sitting on the toilet. Get off the toilet as soon as you have finished.
• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.

Hemorrhoids are usually caused by too much pressure on the veins in the pelvic and rectal area. If you sit on the toilet a long time or strain to have a bowel movement, the extra pressure causes the veins in this tissue to swell and stretch. The result is hemorrhoids.

Things that can lead to hemorrhoids include:

• Diarrhea, constipation, or rushing to complete a bowel movement. These may lead to straining and can put more pressure on veins in the anal canal.
• Pregnancy and labor. This is because of greater pressure on the blood vessels in the pelvic area. Straining to push the baby out during labor can make hemorrhoids worse.
• Being overweight. This may put more pressure on the pelvic veins.
• Medical conditions, such as severe liver disease.

Things that make hemorrhoids worse include:

• Sitting or standing for a long time. This may cause blood to pool in the anal area and put more pressure on the veins.
• Frequent heavy lifting or holding your breath when lifting heavy objects. This can suddenly put more pressure on blood vessels.