Hemorrhoids

What are hemorrhoids?

Hemorrhoids are swollen, enlarged veins that form inside and outside of your anus and rectum. They can be painful and uncomfortable and cause bleeding. Hemorrhoids are also called piles.

We’re all born with hemorrhoids, but they typically don’t bother us. It’s only when they swell and enlarge that they produce irritating symptoms.

An estimated 1 in 20 Americans have hemorrhoids that are bothersome. They affect people of all ages, races and ethnicities. They’re more common as you age, affecting more than half of people over age 50.

Types of hemorrhoids

Hemorrhoids can happen inside or outside of your rectum. The type depends on where the swollen vein develops. Types include:

• Internal. Swollen veins form inside your rectum. Internal hemorrhoids may bleed, but they usually aren’t painful.
• External. Swollen veins form underneath the skin around your anus. Your anus is the hole where your poop comes out. External hemorrhoids can be itchy and painful. Occasionally, they bleed. You can usually see or feel external hemorrhoids.
• Prolapsed. Internal hemorrhoids can prolapse or bulge outside of your anus (butthole). These hemorrhoids may bleed or cause pain.
• Thrombosed. A blood clot forms in an external hemorrhoid. These types are usually painful and cause a purple/blue lump to form outside of your anus. (This clot only affects your anus and doesn’t move to other parts of your body.)

What are the symptoms of hemorrhoids?

Internal hemorrhoids rarely cause pain (and typically can’t be felt) unless they prolapse. Many people with internal hemorrhoids don’t know they have them because they’re inside your rectum. If you have symptoms of internal hemorrhoids, you might see bright red blood on toilet paper, in your poop or in the toilet. If an internal hemorrhoid prolapses through your anus, you may be able to gently push it back inside.

External hemorrhoids tend to be a little more noticeable because they happen outside your anus. Signs and symptoms of external hemorrhoids include:

• Itchiness or irritation around your anus
• Hard lumps near your anus that feel sore or tender
• Pain or ache in your anus, especially when you sit
• Bleeding when you wipe

A thrombosed hemorrhoid is when blood pools inside an external hemorrhoid. This can cause similar symptoms like swelling, inflammation and pain, but it’s typically much more severe and sudden.

What does a hemorrhoid look like?

Hemorrhoids look different depending on the type. You won’t see an internal hemorrhoid unless it protrudes (prolapses). A prolapsed internal hemorrhoid is usually a small lump around your butthole that you can push back in.

Non-thrombosed external hemorrhoids are usually the color of your skin. They’re soft to the touch and you can’t push them back in. Thrombosed external hemorrhoids may appear blue, black or purple and be firmer to touch. They’re often more painful.

Keep in mind that not all lumps are hemorrhoids. It’s important to contact a healthcare provider for a diagnosis.

What causes hemorrhoids?

Too much pressure on the veins in your anus or rectum, as well as irregular bowel movements, cause hemorrhoids. This pressure and irritation lead to swelling and inflammation of your veins.

Some activities or conditions that cause pressure and lead to (or worsen) hemorrhoids are:

• Pushing hard to have a bowel movement (poop)
• Straining to lift heavy objects or weightlifting
• Sitting on the toilet for long periods of time
• Having chronic constipation or diarrhea
• Eating a low-fiber diet
• Being pregnant
• Having overweight/obesity
• Having anal intercourse

What are the complications of hemorrhoids?

Hemorrhoids can be uncomfortable and painful, but they don’t tend to cause serious problems. Rarely, people with hemorrhoids develop:

• Anemia
• Blood clots in external hemorrhoids (thrombosed)
• Infection
• Skin tags
• Strangulated hemorrhoids (muscles in the anus cut off blood flow to a prolapsed internal hemorrhoid)

How are hemorrhoids diagnosed?

A healthcare provider diagnoses hemorrhoids based on symptoms and a physical exam. They may be able to see an external hemorrhoid or a prolapsed hemorrhoid just by looking. You may also have:

• Digital rectal exam. Your provider inserts a gloved, lubricated finger into your rectum to feel for swollen veins.
• Anoscopy. Your provider uses an anoscope (tube with light at the end) to view the lining of your anus and rectum.
• Sigmoidoscopy. Your provider uses a sigmoidoscope (lighted tube with a camera) to view inside the lower part of your colon and rectum. Procedure types include flexible sigmoidoscopy and rigid sigmoidoscopy.

These tests may be uncomfortable, but they aren’t painful. They typically take place in your provider’s office. A sigmoidoscopy may take place at an outpatient center with or without (twilight) anesthesia. You go home the same day.

How can I treat hemorrhoids at home?

Smaller hemorrhoids often go away with eating more fiber and changes to your toilet habits. Symptoms like pain and bleeding may last one week or slightly longer. In the meantime, you can take these steps to help ease your symptoms:

• Apply over-the-counter medications containing lidocaine, witch hazel or hydrocortisone to the affected area.
• Drink more water.
• Increase how much fiber you eat or take fiber supplements.
• Soak in a warm bath (sitz bath) for 10 to 20 minutes a day.
• Soften stool by taking laxatives.
• Take nonsteroidal anti-inflammatory drugs(NSAIDs) for pain and inflammation.
• Use toilet paper with lotion or flushable wet wipes to pat and clean your bottom after pooping. You can also use a tissue or washcloth moistened with water.

How do healthcare providers treat hemorrhoids?

You should see your healthcare provider if symptoms get worse or interfere with your daily life or sleep. Also, seek help if signs don’t improve after a week of at-home treatments. Your provider may treat hemorrhoids with:

• Rubber band ligation. Your provider places a small band around the base of a hemorrhoid to cut off blood supply to the vein.
• Electrocoagulation. An electric current stops blood flow to a hemorrhoid.
• Infrared coagulation. A small probe in your rectum releases heat to get rid of the hemorrhoid.
• Sclerotherapy. Your provider injects a chemical into the swollen vein to destroy hemorrhoid tissue.

Surgical treatments include:

• Hemorrhoidectomy. Surgery removes large external hemorrhoids or prolapsed internal ones.
• Transanal hemorrhoidal dearterization (THD). Internal hemorrhoids are tied off and pulled back into your rectum with sutures.
• Hemorrhoid stapling. A stapling instrument removes an internal hemorrhoid. Or it pulls a prolapsed internal hemorrhoid back inside your anus and holds it there.

How can I prevent hemorrhoids?

Hemorrhoids are common and you can’t always prevent them. But these steps can help reduce your risk of hard stools and constipation that can lead to hemorrhoids:

• Don’t sit too long or push too hard on the toilet.
• Go to the toilet when the urge hits — don’t wait or hold it in.
• Drink plenty of water throughout the day.
• Keep your stool soft and formed. Eat more high-fiber foods (fresh fruits, vegetables and whole grains) or take fiber supplements. Generally, 25 to 38 grams of fiber is enough for most adults.
• Stay active. Being on the move keeps bowels moving.
• Take laxatives or use enemas only as recommended by your healthcare provider. Too many laxatives or enemas can make it hard for your body to regulate how you poop.

When should I call my healthcare provider?

Most hemorrhoid symptoms improve within a week with at-home treatments.

You should call your healthcare provider if you have hemorrhoids and experience:

• Abdominal pain
• Chronic constipation or diarrhea
• Fever and chills
• Nausea and vomiting
• Severe rectal bleeding and pain

Other gastrointestinal disorders can cause rectal bleeding and symptoms like hemorrhoids. Some of these disorders are life-threatening. For this reason, it’s important to let a healthcare provider know when you’re having symptoms.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• Why did I get hemorrhoids?
• What’s the best treatment for me?
• What lifestyle changes can I make to keep me from getting hemorrhoids again?
• When will symptoms improve?
• Should I look out for signs of complications?

What’s the difference between hemorrhoids and anal fissures?

Hemorrhoids and anal fissures cause similar symptoms, such as itching, pain and bleeding. While swollen veins cause hemorrhoids, an anal fissure is a tear in the lining of your anus. Similar issues with irregular bowel movements and straining can cause both. A healthcare provider will do a physical exam and may order tests to find what’s causing your symptoms.