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 rectal bleeding. Hemorrhoids are also called piles. We’re all born with hemorrhoids, but at baseline, they don’t bother us. It’s only when they become swollen and enlarged that they produce irritating symptoms.

How common are hemorrhoids?

An estimated 1 in 20 Americans has symptomatic hemorrhoids. They’re more common as you age, affecting more than half of people over age 50.

Who might get hemorrhoids?

Anyone can get symptomatic hemorrhoids, even teenagers. (But because hemorrhoids take a while to develop, they’re uncommon in children.) You may be more at risk if you:

• Have overweight/obesity.
• Are pregnant.
• Eat a low-fiber diet.
• Have chronic constipation or diarrhea.
• Regularly lift heavy objects.
• Spend a lot of time sitting on the toilet.
• Strain while having bowel movements.

What are the types of hemorrhoids?

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

• External: Swollen veins form underneath the skin around your anus. Your anus is the canal where your poop comes out. External hemorrhoids can be itchy and painful. Occasionally, they bleed. Sometimes, they fill with blood that can clot. This isn’t dangerous, but can result in pain and swelling.
• Internal: Swollen veins form inside your rectum. Your rectum is the part of your digestive system that connects your colon (large intestine) to your anus. Internal hemorrhoids may bleed, but they usually aren’t painful.
• Prolapsed: Both internal and external hemorrhoids can prolapse, meaning they stretch and bulge outside of your anus. These hemorrhoids may bleed or cause pain.

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, a tear in the lining of your anus causes an anal fissure. A healthcare provider will do a physical exam and may order tests to find what’s causing your symptoms.

What causes hemorrhoids?

Straining puts pressure on veins in your anus or rectum, causing hemorrhoids. You might think of them as varicose veins that affect your bottom.

Any sort of straining that increases pressure on your belly or lower extremities can cause anal and rectal veins to become swollen and inflamed. Hemorrhoids may develop due to:

• Pelvic pressure from weight gain, especially during pregnancy.
• Pushing hard to have a bowel movement (poop) because of constipation.
• Straining to lift heavy objects or weightlifting.

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 don’t have symptoms.

If you have symptoms of internal hemorrhoids, you might see blood on toilet paper, in your stool or in the toilet bowl. These are signs of rectal bleeding.

Signs of external hemorrhoids include:

• Itchy anus.
• Hard lumps near your anus that feel sore or tender.
• Pain or ache in your anus, especially when you sit.
• Rectal bleeding.

Prolapsed hemorrhoids can be painful and uncomfortable. You may be able to feel them bulging outside of your anus and gently push them back inside.

What other conditions cause hemorrhoid-type symptoms?

Different gastrointestinal disorders can cause rectal bleeding and other symptoms similar to 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.

Bowel diseases that can cause bleeding include:

• Colon cancer.
• Crohn’s disease.
• Ulcerative colitis.

How are hemorrhoids diagnosed?

A healthcare provider diagnoses hemorrhoids based on symptoms and a physical exam. 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 (lighted tube) 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 (sigmoid) part of your colon and rectum. Procedure types include flexible sigmoidoscopy and rigid sigmoidoscopy (proctoscopy).

These tests may be uncomfortable but aren’t painful. They typically take place in a doctor’s office or outpatient center without anesthesia. You go home the same day.

Your provider may perform a colonoscopy to confirm findings from other tests or check for signs of colon cancer. This outpatient procedure requires anesthesia.

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.
• Infection.
• Skin tags (flap of tissue that hangs off skin).
• Strangulated hemorrhoids (muscles in the anus cut off blood flow to a prolapsed internal hemorrhoid).

How can I treat hemorrhoids at home?

Hemorrhoids often go away on their own without treatment. Symptoms like pain and bleeding may last one week or slightly longer. In the meantime, you can take these steps to ease symptoms:

• Apply over-the-counter medications containing lidocaine, witch hazel or hydrocortisone to the affected area.
• Drink more water.
• Increase fiber intake through diet and supplements. Try to obtain at least 20 to 35 grams of daily fiber intake.
• 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 gently pat and clean your bottom after pooping. You can also use a tissue or washcloth moistened with water. (Discard wipes in the trash, not by flushing. Launder washcloths separately in hot water to avoid spreading infections often found in poop.)

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: A small rubber band placed around the base of a hemorrhoid cuts off blood supply to the vein.
• Electrocoagulation: An electric current stops blood flow to a hemorrhoid.
• Infrared coagulation: A small probe inserted into the rectum transmits heat to get rid of the hemorrhoid.
• Sclerotherapy: A chemical injected into the swollen vein destroys hemorrhoid tissue.

Surgical treatments include:

• Hemorrhoidectomy: Surgery removes large external hemorrhoids or prolapsed internal ones.
• Hemorrhoid stapling: A stapling instrument removes an internal hemorrhoid. Or it pulls a prolapsed internal hemorrhoid back inside of your anus and holds it there.

How can I prevent hemorrhoids?

Hemorrhoids are common as you get older. These steps can help prevent 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 delay bowel movements.
• Drink plenty of water throughout the day.
• Eat more high-fiber foods (fresh fruits, vegetables and whole grains) or take supplements. Generally, women should aim for 25 grams of fiber per day, while men should get 35 grams of fiber.
• Stay physically 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.

What is the prognosis (outlook) for people who have hemorrhoids?

Most hemorrhoid symptoms improve within a week with at-home treatments. If hemorrhoids cause extreme pain and discomfort, a medical procedure or even surgery may help.

When should I call the doctor?

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

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

What questions should I ask my doctor?

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 from getting hemorrhoids again?
• When will symptoms improve?
• Should I look out for signs of complications?