Hemorrhoids, also called "piles", are veins around the anus or lower rectum that have become swollen and inflamed.

Hemorrhoids
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There are 2 types of hemorrhoids

  • External hemorrhoids that form under the skin around the anus
  • Internal hemorrhoid that form in the lining of the anus and lower rectum
Some people may have both.

Who Gets Hemorrhoids?

Hemorrhoids are common in both men and women. About 1/2 of people will develop hemorrhoids by the age of 50. Hemorrhoids may result from straining to move stool, aging, and chronic constipation or diarrhea.

Hemorrhoids are also common during or after pregnancy. The pressure of the fetus on the abdomen, as well as hormonal changes, cause the hemorrhoidal vessels to enlarge. For most women, however, hemorrhoids caused by pregnancy are a temporary problem.

Symptoms of Hemorrhoids

Many anorectal problems, including anal fissures, fistulae, abscesses, anal irritation and anal itching, (also called pruritus ani), have similar symptoms and are incorrectly referred to as hemorrhoids.

Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.

Although many people have hemorrhoids, not all experience symptoms. The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding hemorrhoid.

Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.

Diagnosis of Hemorrhoids

A thorough evaluation and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.

The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an exam with an anoscope, a hollow, lighted tube useful for viewing internal hemorrhoids, or a proctoscope, useful for more completely examining the entire rectum.

To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and lower colon, or sigmoid, with sigmoidoscopy or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures that also involve the use of lighted, flexible tubes inserted through the rectum.

Treatment of Hemorrhoids

How can I treat my hemorrhoids?

You can most often treat your hemorrhoids at home by:

  • eating foods that are high in fiber
  • taking a stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel)
  • drinking water or other nonalcoholic liquids each day as recommended by your health care professional
  • not straining during bowel movements
  • not sitting on the toilet for long periods of time
  • taking over-the-counter pain relievers such as acetaminophen, ibuprofen, naproxen, or aspirin
  •  sitting in a tub of warm water, called a sitz bath, several times a day to help relieve pain

Applying over-the-counter hemorrhoid creams or ointments or using suppositories—a medicine you insert into your rectum—may relieve mild pain, swelling, and itching of external hemorrhoids. Most often, doctors recommend using over-the-counter products for 1 week.

You should follow up with your doctor if the products:

  • do not relieve your symptoms after 1 week
  • cause side effects such dry skin around your anus or a rash

Most prolapsed internal hemorrhoids go away without at-home treatment. However, severely prolapsed or bleeding internal hemorrhoids may need medical treatment.

How do doctors treat hemorrhoids?

Doctors treat hemorrhoids with procedures during an office visit or in an outpatient center or a hospital.
Office treatments include the following:

  • Rubber band ligation. Rubber band ligation is a procedure that doctors use to treat bleeding or prolapsing internal hemorrhoids. A doctor places a special rubber band around the base of the hemorrhoid. The band cuts off the blood supply. The banded part of the hemorrhoid shrivels and falls off, most often within a week. Scar tissue forms in the remaining part of the hemorrhoid, often shrinking the hemorrhoid. Only a doctor should perform this procedure—you should never try this treatment yourself.
  • Sclerotherapy. A doctor injects a solution into an internal hemorrhoid, which causes scar tissue to form. The scar tissue cuts off the blood supply, often shrinking the hemorrhoid.
  •  Infrared photocoagulation. A doctor uses a tool that directs infrared light at an internal hemorrhoid. Heat created by the infrared light causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.
  • Electrocoagulation. A doctor uses a tool that sends an electric current into an internal hemorrhoid. The electric current causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.

Outpatient center or hospital treatments include the following:

  • Hemorrhoidectomy. A doctor, most often a surgeon, may perform a hemorrhoidectomy to remove large external hemorrhoids and prolapsing internal hemorrhoids that do not respond to other treatments. Your doctor will give you anesthesia for this treatment.
  • Hemorrhoid stapling. A doctor, most often a surgeon, may use a special stapling tool to remove internal hemorrhoid tissue and pull a prolapsing internal hemorrhoid back into the anus. Your doctor will give you anesthesia for this treatment.

Sometimes complications of hemorrhoids also require treatment.

Seek care right away

You should seek medical care right away if you have severe anal pain and bleeding from your rectum, particularly with discomfort or pain in your abdomen, diarrhea, or fever.

How can I prevent hemorrhoids?

You can help prevent hemorrhoids by:

  • eating foods that are high in fiber
  • drinking water or other nonalcoholic liquids each day as recommended by your health care professional
  • not straining during bowel movements
  • not sitting on the toilet for long periods of time
  • avoiding regular heavy lifting

Reference: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Last updated January 2019

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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