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Hemorrhoids are swollen veins in the anal canal. This common problem can be painful, but it's usually not serious. Veins can swell inside the anal canal to form internal hemorrhoids. Or they can swell near the opening of the anus to form external hemorrhoids. You can have both types at the same time.
Hemorrhoids are usually caused by too much pressure on the veins in the pelvic and rectal area. Sitting on the toilet a long time or straining to have a bowel movement creates pressure that causes these veins to swell and stretch. Things that can lead to hemorrhoids include constipation, pregnancy, and being overweight.
The most common symptoms of both internal and external hemorrhoids are bleeding during bowel movements, itching, and rectal pain. You may find streaks of blood on the toilet paper or blood in the toilet bowl after a bowel movement.
Your doctor can tell if you have hemorrhoids by asking about your past health and doing a physical exam. The doctor may examine your rectum with a gloved finger or a lighted scope. If this doesn't show a clear cause of your problems, your doctor may do other tests.
For most external hemorrhoids, home treatment is all you need. This includes slowly adding fiber to your meals, drinking more water, and using an ointment to stop itching. The same treatment can be used for most internal hemorrhoids. If your hemorrhoids are severe, you may need medical treatment to shrink or remove them.
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Hemorrhoids are usually caused by too much pressure on the veins in the pelvic and rectal area. If you sit on the toilet a long time or strain to have a bowel movement, the extra pressure causes the veins in this tissue to swell and stretch. The result is hemorrhoids.
Things that can lead to hemorrhoids include:
Things that make hemorrhoids worse include:
You can help prevent the irritating and painful symptoms of hemorrhoids.
Hemorrhoids may cause:
Hemorrhoids form when increased pressure on the pelvic veins causes veins in the anal canal to swell and gradually stretch out of shape. Pressure increases can be caused by rushing to complete a bowel movement, persistent diarrhea or constipation, or other factors including being overweight or pregnant.
Persistent pressure also weakens tissues that support the veins in the anal canal. If those tissues become so weak that they can no longer hold the veins in place, the swollen veins and tissues bulge into the anal canal (internal hemorrhoids) or under the skin surrounding the anal opening (external hemorrhoids).
For some people, hemorrhoids may cause a little discomfort for a limited time. Other people have recurrent bouts of discomfort when hemorrhoids flare up. Some people struggle with hemorrhoid pain, discomfort, and itching much of their lives. The degree and duration of discomfort depend on where the hemorrhoids are.
Hemorrhoids frequently develop during pregnancy because of extra pressure on veins (from the enlarged uterus).
During labor, hemorrhoids may start or get worse because of the intense straining and pressure on the anal area while pushing to deliver the baby.
Because external hemorrhoids may not cause any symptoms, you may not be aware that you have hemorrhoids.
When a vein within an external hemorrhoid gets irritated, blood may clot under the skin, forming a hard, bluish lump. This is known as a thrombosed, or clotted, hemorrhoid. Thrombosed hemorrhoids can be very painful.
Small internal hemorrhoids may not grow larger if bowel habits or other factors change to lower pressure on the veins in the bowel.
Large internal hemorrhoids may bulge from the anus. After bowel movements, you may have to push them back through the anus. At worst, large internal hemorrhoids stick out all the time.
In rare cases, hemorrhoids may bulge through the anus and swell. Muscles that control the opening and closing of the anus may cut off a hemorrhoid's blood supply (strangulated hemorrhoid). This may cause the hemorrhoid tissues to die. If this happens, you will feel severe rectal pain and may see blood and pus at the anus. You will need urgent surgery to prevent further complications, such as death of the affected tissue and infection.
Common symptoms of hemorrhoids may be a sign of other serious health problems. Colon or rectal cancer and other conditions have many of the same symptoms as hemorrhoids. Call your doctor if you have symptoms like these:
If you have hemorrhoids, call your doctor if:
Watchful waiting is a wait-and-see approach. And in most cases, bleeding caused by hemorrhoids should stop after 2 to 3 days. Continue home treatment to prevent bleeding from starting again. Call your doctor if bleeding:
Your doctor can tell if you have hemorrhoids by asking about your past health and doing a physical exam.
You may not need many tests at first, especially if you are younger than 50 and your doctor thinks that your rectal bleeding is caused by hemorrhoids. Your doctor may just examine your rectum with a gloved finger. Or your doctor may use a short, lighted scope to look inside the rectum.
Rectal bleeding can be a sign of a more serious problem, such as colon, rectal, or anal cancer. So if the first exam doesn't show a clear cause of your problems, your doctor may do tests to check for other causes of bleeding. The doctor may use a lighted scope to look at the lower third of your colon. This is called sigmoidoscopy. Or your doctor may use another kind of scope to look at the entire colon. This is called colonoscopy.
Most hemorrhoids can be treated with simple changes to diet and bowel habits. Most don't require surgery or other treatment unless the hemorrhoids are very large and painful.
For most external hemorrhoids, home treatment is all you need. The same home treatment can be used for most internal hemorrhoids.
The goal of these procedures is to reduce the blood supply to the hemorrhoid so it shrinks or goes away. The scar tissue left in its place helps support the anal tissue and helps prevent new hemorrhoids.
These procedures can only be done on internal hemorrhoids. They include:
Surgery to remove hemorrhoids is called hemorrhoidectomy. It can be used:
Sometimes a combination of treatments (for example, a nonsurgical procedure and surgery) is the best way to treat hemorrhoids.
External hemorrhoids usually aren't removed with surgery unless they are very large and uncomfortable. Or they may be removed if you are having surgery on the anal area for another reason, such as for internal hemorrhoids or a tear (anal fissure). If a blood clot forms in the external hemorrhoid, the clot may need to be removed to relieve pain.
Home treatment may keep your hemorrhoids from getting worse. It mainly involves having healthy bowel habits.
You can use the following suggestions to keep hemorrhoids from getting worse or to relieve your symptoms.
Slowly add fiber to your meals. Eat foods with lots of fiber like fruits, vegetables, and whole grains. And drink plenty of water. These things may help prevent hard stools.
Do this to take pressure off inflamed, irritated veins. If you are pregnant, you may find it helpful to lie on your side. If you aren't pregnant, sleeping on your stomach with a pillow under your hips will help reduce swelling of hemorrhoids.
Limit sitting and standing when hemorrhoids are irritated. If you must sit for a long time, sit on a pillow.
It prevents moisture buildup, which can irritate hemorrhoids.
This reduces pressure on the anal area.
Medicines can help relieve symptoms of hemorrhoids. Over-the-counter (OTC) treatments you can try include:
Current as of:
February 10, 2021
Author: Healthwise StaffMedical Review: Anne C. Poinier MD - Internal MedicineAdam Husney MD - Family MedicineE. Gregory Thompson MD - Internal MedicineKenneth Bark MD - General Surgery, Colon and Rectal Surgery
Current as of: February 10, 2021
Author: Healthwise Staff
Medical Review:Anne C. Poinier MD - Internal Medicine & Adam Husney MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Kenneth Bark MD - General Surgery, Colon and Rectal Surgery
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