What are hemorrhoids?

The anal canal consists of three columns of anal cushions that have a nonvascular and vascular component to them. This is considered a normal part of human anatomy. The function of these anal cushions is to provide some of our ability to hold stool (continence) and protect the sphincter muscle complex (the muscles that give us the ability to defer a bowel movement so we can make it to the bathroom) during defecation.

Hemorrhoids are when these anal cushions in and around your anus and lower rectum become swollen and irritated. This happens when there is extra pressure on these veins.

Hemorrhoids can be either inside the anus (internal), under the skin around the anus (external) or mixed (internal-external). Symptoms from each may be due to location.

They are very common in both men and women. About half of all people will have hemorrhoids by age 50.

Many women get hemorrhoids during pregnancy and childbirth. The pressure of carrying a baby puts extra stress on the blood vessels in your pelvic area. Straining to push the baby out when giving birth also puts extra pressure on these blood vessels.

What causes hemorrhoids?

You may get hemorrhoids if you:

• Often strain during bowel movements

• Are pregnant

• Have a family history of hemorrhoids

• Are older

• Have long-term or chronic constipation or diarrhea

Who is at risk for hemorrhoids?

Hemorrhoids are very common. Most people will have a hemorrhoid at some time in their life.

You are more likely to get hemorrhoids if you:

• Are pregnant

• Sit on the toilet for too long

• Are obese

• Do things that make you strain more, such as heavy lifting

• Have a family history of hemorrhoids

• Have long-term or chronic constipation or diarrhea

• Are between 45 and 65 years old

What are the symptoms of hemorrhoids?

Each person’s symptoms may vary. Some of the most common symptoms include:

• Bright red blood in your stool, on toilet paper, or in your toilet bowl

• Pain and irritation around your anus

• Swelling or a hard lump around your anus

• Itching

Hemorrhoid symptoms may look like other health problems. Always see your health-care provider to be sure.

How are hemorrhoids diagnosed?

Having blood in your stool can also be a sign of other digestive disorders, such as colorectal cancer. It’s important to see your health-care provider for a complete exam.

To see if you have hemorrhoids, your provider may do several tests, including:

• Physical exam. This is done to check your anus and rectum and look for swollen blood vessels that are a sign of hemorrhoids.

• Digital rectal exam. Your provider inserts a gloved, greased (lubricated) finger into your rectum to check for any problems.

• Anoscopy. A hollow, lighted tube is put into your anus. This is used to see internal hemorrhoids.

• Proctoscopy. A lighted tube is put into your anus. This gives a view of your entire rectum.

• Sigmoidoscopy. This test checks the inside of part of your large intestine. It helps to tell what is causing diarrhea, belly pain, constipation, abnormal growths and bleeding. A short, flexible, lighted tube (sigmoidoscope) is put into your intestine through the rectum. This tube blows air into your intestine to make it swell. This makes it easier to see inside. A tissue sample (biopsy) can be taken if needed.

• Colonoscopy. This test looks at the full length of your large intestine. It can help check for any abnormal growths, tissue that is red or swollen, sores (ulcers), or bleeding. A long, flexible, lighted tube called a colonoscope is put into your rectum up into the colon. This tube lets your provider see the lining of your colon and take out a tissue sample to test it. They may also be able to treat some problems that may be found.

How are hemorrhoids treated?

Treatment will depend on your symptoms, age and general health. It will also depend on how bad the condition is.

The main goal of treatment is to reduce your symptoms. This may be done by:

• Sitting in plain, warm water in a bathtub several times a day (sitz bath)
• Using ice packs to reduce swelling
• Using hemorrhoid creams or medicines inserted into your rectum (suppositories)

Your provider may also suggest that you add more fiber and fluids to your diet to help soften your stools. Having softer stools means you don’t have to strain during bowel movements. This reduces the pressure on your hemorrhoids.

Adding more fiber to your diet means eating more:

• Fruits
• Vegetables
• Whole grains

Your health-care provider may also suggest that you take stool softeners, laxatives or fiber supplements.

In some cases, surgery is needed. There are several types of procedures and surgeries used to remove or reduce internal and external hemorrhoids. These include:

• Rubber band ligation. A rubber band is placed around the base of the hemorrhoid inside your rectum to cut off circulation to the hemorrhoid. The hemorrhoid shrinks and goes away in a few days.
• Sclerotherapy: A chemical solution is shot (injected) around the blood vessel to shrink the hemorrhoid.
• Electrical coagulation, also called infrared photo coagulation. A special device uses a beam of infrared light to burn hemorrhoid tissue.
• Hemorrhoidectomy and hemorrhoidopexy. These procedures permanently remove your hemorrhoids.

What are possible complications of hemorrhoids?

In rare cases, hemorrhoids may cause other problems. These may include:

• Having a low blood count that makes you tired (anemia). This can happen because of bleeding from a long-term or chronic hemorrhoid.
• Blood flow being cut off from a hemorrhoid that is sticking out (prolapsed). This can happen when the blood supply to the hemorrhoid is cut off. This can be very painful and cause bleeding. You may need surgery.

What can I do to prevent hemorrhoids?

It’s not always possible to stop hemorrhoids from happening. But you may reduce your risk of getting hemorrhoids if you:

• Eat a healthy diet, with plenty of fiber and liquids.
• Limit the amount of time you sit on the toilet.
• Work with your health-care provider to manage constipation/diarrhea and prevent straining.
• Stay at a healthy weight.

When should I call my health-care provider?

Call your provider if your symptoms get worse or if you notice any new symptoms. Also, call if you see blood in your stool or on toilet paper for the first time, or if you see more blood than normal.

Next Steps

Tips to help you get the most from a visit to your health-care provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time and purpose for that visit.
• Know how you can contact your provider if you have questions, especially after office hours or on weekends.