Hemorrhoids

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Introduction

What are hemorrhoids?

Hemorrhoids are enlarged, bulging veins in the anus or rectum. They are called external hemorrhoids if they occur outside the anus, or internal hemorrhoids if they are located inside the anus. Hemorrhoids are extremely common, and the risk of developing hemorrhoids increases with age. They are also common in pregnant women and in women who have recently given birth. These distended veins are usually caused by straining that occurs during a bowel movement. In rare cases, hemorrhoids can be a manifestation of liver disease or malformations of the venous system.

External hemorrhoids can be painful, particularly when sitting and during a bowel movement. In addition, a blood clot called a thrombosis can occur along with external hemorrhoids. A thrombosed hemorrhoid may bleed, swell painfully, or form a hard lump. An internal hemorrhoid can protrude or prolapse from the anus. In some cases, hemorrhoids can lead to more serious complications.

Most hemorrhoids can be treated at home, usually through lifestyle and diet changes. A diet high in fiber and plenty of fluids can make bowel movements easier and less likely to produce straining. Over-the-counter creams and ointments can help reduce the swelling, itching and pain of hemorrhoids. Severe hemorrhoids can be treated surgically if they do not respond to other treatment.

Seek prompt medical care if you are being treated for hemorrhoids, but your symptoms persist, recur, or cause you concern.

Symptoms

What are the symptoms of hemorrhoids?

Symptoms of hemorrhoids include anal itching or pain, particularly when you are seated. You may also experience pain during your bowel movements, notice blood in your stool, or have a tender, hard lump near the anus.

Common symptoms of hemorrhoids

You may experience hemorrhoid symptoms daily or just once in a while. At times, any of these hemorrhoid symptoms can be severe:

  • Blood-streaked stools
  • Burning feeling
  • Change in bowel habits
  • Change in bowel movements
  • Constipation
  • Diarrhea
  • Itching feeling
  • Painful bowel movements

Symptoms that might indicate a serious condition

Seek prompt medical care if you, or someone you are with, are being treated for hemorrhoids and the symptoms recur or are persistent.

Causes

What causes hemorrhoids?

Hemorrhoids are most commonly caused by straining to pass a bowel movement. They may also be the result of constipation, diarrhea, or an anal infection. People who sit for long periods of time may also experience hemorrhoids.

Pregnant women and women who have recently given birth are prone to developing hemorrhoids as a result of the increased pressure on the abdomen by the fetus or straining during labor. The hemorrhoids usually resolve with time after childbirth.

What are the risk factors for hemorrhoids?

A number of factors increase the risk of developing hemorrhoids. Not all people with risk factors will get hemorrhoids. Risk factors for hemorrhoids include:

Reducing your risk of hemorrhoids

A diet high in fiber and with plenty of liquids can promote softer bowel movements, which can aid in healing hemorrhoids. You may be able to lower your risk of hemorrhoids by:

  • Avoiding anal intercourse

  • Avoiding irritation of the rectum or anus

  • Drinking plenty of liquids

  • Eating a diet high in soluble fiber

  • Keeping the anal area clean and dry

  • Taking an over-the-counter stool softener, such as psyllium (Fiberall, Metamucil) or methylcellulose (Citrucel)

  • Wiping the anus gently with a cotton pad or moistened cloth after a bowel movement

Treatments

How are hemorrhoids treated?

A diet high in fiber along with plenty of liquids can promote softer bowel movements and prevent strain-induced hemorrhoids. Your health care provider may suggest frequent warm baths to help hemorrhoids heal.

Most hemorrhoids heal on their own. Some hemorrhoids may require a surgical intervention, a procedure known as a hemorrhoidectomy.

Self-care hemorrhoid treatment

Most hemorrhoids can be treated with self-care including:

  • Avoiding irritation to the rectum or anus

  • Drinking plenty of liquids

  • Eating a diet high in soluble fiber

  • Keeping the anal area clean and dry

  • Taking a warm bath after each bowel movement

  • Take an over-the-counter stool softener, such as psyllium (Fiberall, Metamucil) or methylcellulose (Citrucel)

  • Using an over-the-counter numbing cream to relieve pain and itching

  • Wiping the anus gently with a cotton pad or moistened cloth after a bowel movement

Medical treatment for hemorrhoids

Medical treatments for hemorrhoids may include topical medications such as nitroglycerin or nifedipine.

Surgical treatment for hemorrhoids

If your hemorrhoids are severe or recurrent, your health care provider may recommend treatments including:

  • Coagulation therapy to decrease the size of internal hemorrhoids

  • Hemorrhoidectomy (surgical removal of hemorrhoids)

  • Rubber band ligation to remove the hemorrhoids

  • Sclerotherapy (injection of a chemical that causes shrinkage and scarring of hemorrhoids)

What are the potential complications of hemorrhoids?

Complications of untreated or poorly controlled hemorrhoids can be serious. You can help minimize your risk of complications by following the treatment plan that you and your health care provider design specifically for you. Complications of hemorrhoids include:

  • Chronic anal itching, irritation

  • Fecal soiling

  • Severe bleeding

  • Severe discomfort or pain

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Oct 25
  1. Hemorrhoids. American Society of Colon and Rectal Surgeons. http://www.fascrs.org/patients/conditions/hemorrhoids/.
  2. Hemorrhoids. National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids/.
  3. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
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