Hemorrhoids are swollen veins in your anus and lower rectum, which looks like varicose veins. Hemorrhoids, also called piles, may be caused by straining during bowel movements or from the increased pressure on these veins during pregnancy. Hemorrhoids located inside the rectum are called internal hemorrhoids, while those that develop under the skin around the anus are called external hemorrhoids.
Hemorrhoids are very common. Nearly three out of four adults will have hemorrhoids from time to time. Sometimes they don’t cause symptoms but at other times they may result in bleeding, itching, or discomfort.
When a clot form in a hemorrhoid, it is called thrombosed hemorrhoid. These are not dangerous but can be excruciatingly painful and sometimes need to be punctured and drained.
Fortunately, many effective options are available to treat hemorrhoids.
Symptoms of Hemorrhoids
Signs and symptoms of hemorrhoids may include:
- Painless bleeding during bowel movements
- A lump near your anus, which may be sensitive or painful (may be a thrombosed hemorrhoid)
- Itching or irritation in your anal region
- Swelling around your anus
- Pain or discomfort
Hemorrhoid symptoms usually depend on the location.
Internal hemorrhoids: You usually can’t see or feel these hemorrhoids because they lie inside the rectum, and they rarely cause pain. However straining when passing stool can injure the surface of a hemorrhoid, causing it to bleed.
Sometimes, straining can push an internal hemorrhoid through the anal opening. This is known as a protruding or prolapsed hemorrhoid and can cause severe pain.
External hemorrhoids: These are located under the skin around your anus. When irritated, external hemorrhoids can itch or bleed.
Thrombosed hemorrhoids: Sometimes blood may gather in an external hemorrhoid and form a clot (thrombus) that can cause inflammation, severe pain, and swelling and form a hard lump near your anus.
Causes of Hemorrhoids
The veins around your anus tend to stretch under pressure and may bulge. Hemorrhoids can develop from increased pressure in the lower rectum due to:
- Straining during bowel movements
- Low-fiber diet
- Sitting for long periods of time on the toilet
- Chronic diarrhea or constipation
- Anal intercourse
Also, the aging process can cause hemorrhoids because the tissues that support the veins in your rectum and anus can wane and stretch.
Complications of hemorrhoids are very rare but include:
- Chronic blood loss from hemorrhoids may cause anemia in rare cases, in which you don’t have enough healthy red blood cells to carry oxygen to your cells.
- Strangulated hemorrhoid.If the blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be “strangulated,” which can cause of life-threatening pain.
The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:
- Eat high-fiber foods.Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can cause hemorrhoids. Your fiber consumption should be slowly to avoid problems with gas.
- Drink lots of fluids.Drink six to eight glasses of water and other liquids each day to help keep stools soft. Avoid intake of alcohol.
- Consider fiber supplements.Over-the-counter fiber supplements, such as Metamucil and Citrucel, improve overall symptoms and bleeding from hemorrhoids. These products help keep stools soft and regular.
If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause constipation or worsen symptoms.
- Don’t strain.Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.
- Go as soon as you feel the urge.If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.
- Exercise:Be active, avoid sitting or standing for too long. Exercise can also help you lose excess weight that may be contributing to your hemorrhoids.
- Avoid long periods of sitting:Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.
When to see a doctor
One of the most common sign of hemorrhoid is bleeding during bowel movements. Your doctor can do a physical examination and perform other tests to confirm hemorrhoids and rule out other conditions or diseases.
Also talk to your doctor if you know you have hemorrhoids and they cause pain, bleed frequently, or don’t improve with home remedies.
Don’t assume rectal bleeding is due to hemorrhoids, especially if you are over 40 years old. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer. If you have bleeding along with a marked change in bowel habits or if your stools change in color or consistency, see your doctor.
If you have external hemorrhoids, your doctor may simply examine it. Tests and procedures to diagnose internal hemorrhoids may include examination of your anal canal and rectum:
- Digital examination.During a digital rectal exam, your doctor inserts a gloved, lubricated finger into your rectum. He or she feels for any abnormalities, such as growths. The exam can suggest to your doctor whether additional testing is needed.
- Visual inspection.Because internal hemorrhoids are often too soft to be felt during a rectal exam, your doctor may also examine the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope.
You can often relieve the mild pain, swelling and inflammation of hemorrhoids with home treatments. Often these are the only treatments needed.
- Eat foods with high-fiber contents.Eat more fruits, vegetables and whole grains to soften the stool and increases its bulk, which will help you avoid the straining that can aggravate symptoms from existing hemorrhoids. Add fiber to your diet slowly to avoid problems with gas.
- Soak regularly in a warm bath or sitz bath.Soak your anal area in plain warm water 10 to 15 minutes two to three times a day. A sitz bath fits over the toilet.
- Keep the anal area clean.Bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Avoid alcohol-based or perfumed wipes. Gently pat the area dry or use a hair dryer.
- Don’t use dry toilet paper.To help keep the anal area clean after a bowel movement, use moist towelettes or wet toilet paper that doesn’t contain perfume or alcohol.
- Apply cold.Apply ice packs or cold compresses on your anus to relieve swelling.
- Use topical treatments.Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a numbing agent.
- Take oral pain relievers.You can use acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin IB, others) temporarily to help relieve your discomfort.
With these treatments, hemorrhoid symptoms often go away within a week. See your doctor if you don’t get relief in a week, or sooner if you have severe pain or bleeding.
If your hemorrhoids produce only mild pain, your doctor may suggest over-the-counter creams, ointments, suppositories or pads. These products contain ingredients, such as witch hazel, or hydrocortisone and lidocaine that can relieve pain and itching, at least temporarily.
Don’t use an over-the-counter steroid cream for more than a week unless directed by your doctor because it may lead to thinning of skin.
External hemorrhoid thrombectomy
If a painful blood clot (thrombosis) has formed within an external hemorrhoid, your doctor can remove the clot with a simple incision and drainage, which may provide quick relief. This procedure is most effective if done within 72 hours of developing a clot.
Minimally invasive procedures
For continuous or painful hemorrhoids, your doctor may recommend one of the other minimally invasive procedures available. These treatments can be done in your doctor’s office or other outpatient setting and do not usually require anesthesia.
- Rubber band ligation.Your doctor places one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation. The hemorrhoid withers and falls off within a week. This procedure is effective for many people.
Hemorrhoid banding can be uncomfortable and may cause bleeding, which might begin two to four days after the procedure but is rarely severe. Occasionally, more-serious complications can occur.
- Injection (sclerotherapy).In this procedure, your doctor injects a chemical solution into the hemorrhoid tissue to shrink it. While the injection causes little or no pain, it may be less effective than rubber band ligation.
- Coagulation (infrared, laser or bipolar).Coagulation techniques use laser or infrared light or heat. They cause small, bleeding, internal hemorrhoids to harden and shrivel.
While coagulation has few side effects and may cause little immediate discomfort, it’s associated with a higher rate of hemorrhoids coming back (recurrence) than is the rubber band treatment.
If other procedures haven’t been successful or you have large hemorrhoids, your doctor may recommend a surgical procedure. Your surgery may be done as an outpatient or may require an overnight hospital stay.
- Hemorrhoid removal.In this procedure, called hemorrhoidectomy, your surgeon removes excessive tissue that causes bleeding. Various techniques may be used. The surgery may be done with a local anesthetic combined with sedation, a spinal anesthetic or a general anesthetic.
Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. Complications may include temporary difficulty emptying your bladder and resulting urinary tract infections.
Most people experience some pain after the procedure. Medications can relieve your pain. Soaking in a warm bath also may help.
- Hemorrhoid stapling.This procedure blocks blood flow to hemorrhoidal tissue. It is used only for internal hemorrhoids. Stapling involves less pain than hemorrhoidectomy and allows for earlier return to regular activities. Compared with hemorrhoidectomy, however, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus.