Hemorrhoids

Hemorrhoids are veins covered with the lining of the anal canal located in or around the anus. Hemorrhoids can be external, internal or a combination of both (interno-external). External hemorrhoids can be skin alone or skin with a vein underneath. Internal hemorrhoids are dilated veins which protrude inside when small or can sometimes extend outside the anus either after a bowel movement; they can also be present externally all the time.

Hemorrhoids are usually not painful. Small hemorrhoids cannot be seen but can bleed after a hard bowel movement/straining or too frequent bowel movements. Hemorrhoids that protrude out after a bowel movement often go back in spontaneously. Occasionally they have to be manually pushed in. Hemorrhoids that protrude out and do not go back in can sometimes get large and form a clot; these are called thrombosed prolapsed hemorrhoids.

External hemorrhoids can also form a clot and this can be very painful; this is called a thrombosed external hemorrhoid.

Certain conditions may cause internal hemorrhoids to bulge, become irritated, and bleed, including:

• Trauma during childbirth
• The extra weight of pregnancy
• Obesity
• Chronic constipation with straining
• Anal intercourse

What are the symptoms of internal hemorrhoids?

• Painless rectal bleeding on the toilet paper or in the toilet bowl is the most common symptom.
• Pain can occur with thrombosed hemorrhoids or hemorrhoids that can suddenly not be reposited in the anal canal.
• Another symptom is the protrusion of the hemorrhoids after a bowel movement; the hemorrhoids either spontaneously go back in or have to be pushed in manually.

What are the symptoms of external hemorrhoids?

• A grape-like lump on the anus
• Itching and soreness in and around the anus
• Blood on underwear, toilet paper, the surface of the stool, or in the toilet bowl

What causes hemorrhoids?

Hemorrhoids are caused by repeated pressure and strain, which might be caused by:

• Straining at stool
• Frequent constipation (hard or difficult bowel movements)
• Diarrhea (frequent, loose, watery stool)
• Pregnancy (especially in the third trimester)
• Cirrhosis of the liver (can cause pooling of blood in the vessels around the rectum)

How are hemorrhoids diagnosed?

Usually, an explanation of your symptoms is an important clue to your doctor. On examination, external hemorrhoids and bulging hemorrhoids may be visible.

When hemorrhoids are not visible beyond the anus, your doctor will examine the inside of the anal canal using a lighted instrument called an anoscope.

Often, your doctor will recommend a detailed examination of your sigmoid colon and rectum using a lighted scope (a procedure called flexible sigmoidoscopy) to ensure that there is no inflammatory disease such as Crohn's disease or ulcerative colitis or cancer.

How can I relieve the acute pain?

• Take warms soaks in the bath (sitz baths). Sit in plain, warm water for about 10 minutes several times a day.
• Apply a hemorrhoid cream, or use a suppository. Follow the directions on the package.
• Don't strain during bowel movements.
• Keep stools soft.
• See your doctor.

How can I relieve constipation?

• Increase the amount of fiber in your diet. Good sources of fiber are fruits, vegetables, and whole grains. Five to ten servings of fruits and vegetables are recommended each day. Fiber supplements might be helpful — examples include Metamucil^® and Citrucel^®.
• Sparingly use over-the-counter laxatives or stool softeners. Stool softeners such as Colace^® are relatively safe, but prolonged use of osmotic or stimulant laxatives might not be.
• Exercise regularly. Even walking regularly helps improve the normal flow of material through the intestine.
• Empty the bowels when you feel the urge to do so. Immediately following a meal, the body will have a natural urge to defecate. That's a good time to plan a visit to the bathroom.

How can I prevent hemorrhoids?

The best way to prevent hemorrhoids is to keep bowel movements regular and stool soft. Try some of the tips for relieving constipation listed above. Also, avoid prolonged standing, sitting, and heavy lifting, and chronic coughing, straining at stool, and aggressive wiping.

How are hemorrhoids treated?

• Occasional rectal bleeding can be controlled by keeping the stools regular and soft.
• An examination is essential to rule out other causes of bleeding.
• Painful hemorrhoids can be treated with: Warm tub baths several times a day in plain, warm water for about 10 minutes

In some cases, hemorrhoids must be treated surgically. Surgery is used to shrink and or excise (cut out) the hemorrhoidal tissue.

A number of methods might be used to remove or reduce the size of internal hemorrhoids. These techniques include:

• Rubber band ligation — A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, causing the hemorrhoid to wither away within a few days. This can be done in an office setting and does not need anesthesia.
• Sclerotherapy — A chemical solution is injected around the blood vessel to shrink the hemorrhoid. This is not done routinely for hemorrhoids.
• Infrared coagulation — A special device is used to burn hemorrhoidal tissue. This can treat small hemorrhoids.
• Procedure for prolapsed hemorrhoids (PPH) — This is done for hemorrhoids that come out of the anal canal. This is done under anesthesia and uses a device to fix the hemorrhoids at the position from where they came down.
• Hemorrhoidal arterial ligation — This can be done for different grades of hemorrhoids and uses a Doppler probe to identify and tie the vessels feeding the hemorrhoid, thereby shrinking it.
• Hemorrhoidectomy — Occasionally, extensive or severe internal or external hemorrhoids might require removal by surgery known as hemorrhoidectomy. This procedure involves excision of the hemorrhoid and the skin overlying it.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/23/2009…#4242