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Diseases & Conditions

Hemorrhoids - Digestive Disease Institute Overview

(Also Called 'Hemorrhoids Overview')

Hemorrhoids are veins that are varicose, meaning swollen or dilated, located in or around the anus.

Internal hemorrhoids are varicose veins that surround the rectum and, when dilated, protrude inside, sometimes extending out of the anus.

External hemorrhoids are varicose veins located under the skin on the outside of the anus. They are frequently painful and usually arise when a blood clot blocks off the vein.

Causes

Scientists aren't sure why people get hemorrhoids, though they are associated with repeated pressure and strain. They are usually not painful, but they can be bothersome. Hemorrhoid sufferers can frequently and safely push them back inside.

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

  • Trauma during childbirth
  • Pregnancy (because of added weight)  
  • Obesity
  • Chronic constipation with straining
  • Anal intercourse

Rarely, a bulging internal hemorrhoid may thrombose, meaning a blood clot may occur.

Other causes of hemorrhoids include frequent diarrhea and cirrhosis of the liver, which can cause pooling of blood in the vessels around the rectum.

Symptoms

  • Pain and pressure in the anal canal
  • A grapelike 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

Symptoms can be made worse by straining during constipation and overly aggressive wiping of the anus.

Home Treatment

To relieve pain and itching of hemorrhoids:

  • 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.

To prevent 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 also may be helpful.
  • Sparingly use over-the-counter laxatives or stool softeners. Stool softeners are relatively safe, but prolonged use of osmotic or stimulant laxatives is not recommended.
  • 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 is a good time to plan a visit to the bathroom.

Prevention

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, heavy lifting, chronic coughing, straining at stool and aggressive wiping.

When to See a Doctor

Hemorrhoids caused by a blood clot, medically referred to as thrombosed hemorrhoids, need to be treated right away by a doctor. The doctor usually will remove the blood clot.

Otherwise, most cases of hemorrhoids can be treated at home, with the most important aspect of care being good hygiene. Rarely, surgery is required to remove them.

On examination, external hemorrhoids and bulging hemorrhoids may be visible.

When hemorrhoids are not visible beyond the anus, your doctor may 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 or what is called a flexible sigmoidoscopy to ensure that no inflammatory disease is associated with the hemorrhoids, such as Crohn's disease, ulcerative colitis or cancer.

Surgical Treatment

In some cases, hemorrhoids must be treated surgically. Surgery is used to shrink and destroy the hemorrhoidal tissue and is performed during an office or hospital visit.

A number of methods may 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.
  • Sclerotherapy: A chemical solution is injected around the blood vessel to shrink the hemorrhoid.
  • Infrared coagulation: A special device is used to burn hemorrhoidal tissue.
  • Hemorrhoidectomy: Occasionally, extensive or severe internal or external hemorrhoids may require removal by surgery known as hemorrhoidectomy.