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Hemorrhoids

Hemorrhoids Can Be Painful And May Bleed, But They Are Treatable.

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Updated April 15, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Hemorrhoid

Inflamed internal hemorrhoids as viewed by cross-section of the rectum.

Image © A.D.A.M.

Hemorrhoids are quite common and frequently affect older people and pregnant women. But anyone, at any stage of life, is at risk for developing hemorrhoids. In fact, more than half of all Americans over age 30 will develop hemorrhoids at some time in their lives. Hemorrhoids are also a common problem for people with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) who have symptoms of diarrhea and/or constipation. The good news is that hemorrhoids rarely cause any serious problems and are typically very treatable.

What Is a Hemorrhoid?

A hemorrhoid results when the veins in and around the rectum and anus become swollen. There are two forms of hemorrhoids: internal and external.

Internal Hemorrhoids. This form of hemorrhoid is located inside the rectum. Internal hemorrhoids usually don't cause pain or protrude from the anus during bowel movements, but they may bleed. An internal hemorrhoid that prolapses, or extends outside the anus, can be quite painful.

External Hemorrhoids. This form of hemorrhoid is located around the anus and when it becomes inflamed, it feels like a hard lump. They are covered by skin, are very sensitive to touch, and can bleed, especially while straining during a hard bowel movement.

What Are the Symptoms of Hemorrhoids?

Symptoms of hemorrhoids include:
  • Anal itching
  • Bleeding during bowel movements (often bright red on the toilet paper or on the outside of the stool)
  • Pain
  • Protrusion during bowel movements
  • Sensitive lumps around the anus

What Causes Hemorrhoids?

There are a variety of situations and conditions that may contribute to the development of hemorrhoids. Some of these include:
  • Age
  • Chronic constipation
  • Chronic diarrhea
  • Pregnancy
  • Straining during bowel movements
  • Overuse of laxatives

How Are Hemorrhoids Diagnosed?

Because the symptoms of hemorrhoids are similar to those of an anal fissure, a fistula, or an abscess, it is important to be seen by a physician and be diagnosed. However, many people treat their hemorrhoids with over-the-counter medications without ever talking to their doctor. Rectal bleeding should always be checked out by a doctor, even if it is suspected to be from a hemorrhoid.

To diagnose hemorrhoids, a physician will need to examine the anal area. Patients may be asked to remove clothing from the waist down, change into a hospital gown and lie on one side on an examination table. The physician will examine around the anus and rectum. A doctor may also perform a quick rectal exam with a gloved and lubricated finger. This may be painful for a moment if external hemorrhoids are present, but is helpful in making a correct diagnosis.

In some cases, the physician may need to take a closer look at the area with an anoscope. An anoscope is a small tube with a light on the end that can help the physician see any internal hemorrhoids when it is inserted into the rectum.

What Is the Treatment for Hemorrhoids?

Mild hemorrhoids. Most hemorrhoids are considered mild, and symptoms are often relieved by a few changes in diet and lifestyle. One goal of treatment is to ensure that stool should is soft and easily passed. Increasing fiber in the diet will help stool to be more easily passed without straining. Drinking more water will help to prevent constipation and hard, difficult to pass stools.

For people with IBS, soluble fiber (such as brown rice, oatmeal, and psyllium husks) is often better tolerated than insoluble fiber (wheat bran, whole grains, cereals, seeds). People with IBD who are following a low-fiber diet on the advice of a physician will want to talk to their doctor before adding fiber to the diet. In both IBS and IBD, treating the underlying symptoms of constipation and diarrhea will help the hemorrhoids to heal more rapidly.

Keeping the anal area clean is also important to recovery. Sitz baths (sitting in warm water) relieves symptoms and can be taken either in the bathtub or with a store-bought plastic seat that fits over the toilet bowl. Over-the-counter wipes for hemorrhoids that contain witch hazel, which is a natural astringent, may also be helpful.

Creams, gels, and suppositories that are also sold over-the-counter may help reduce swelling and provide relief from symptoms. A diagnosing physician may provide a prescription for stronger medications to relieve symptoms.

With proper treatment, hemorrhoids may start to improve over a few days to a week. In four to six weeks, the "lump" from an external hemorrhoid should decrease in size.

Severe hemorrhoids. When hemorrhoids become persistent or very painful, other treatments may be necessary. Most of these treatments have potential complications, and doctors often try to avoid them or use them only as a last resort.

  • Clot removal. This procedure used on clotted external hemorrhoids is minor surgery that is usually done under local anesthetic in a physician's office. A small incision is made and the clot is lifted out.
  • Rubber band ligation. This treatment is often used for internal hemorrhoids that extend beyond the anus during bowel movements. A small rubber band is positioned around the hemorrhoid, which effectively cuts off its blood supply. The band and the hemorrhoid tissue will be discharged in a few days and heal over a period of one to two weeks.
  • Sclerotherapy (injection therapy). This procedure may be used on small internal hemorrhoids. A hardening agent is injected into the hemorrhoid, resulting in a loss of circulation that causes the hemorrhoid to shrivel.
  • Infrared coagulation. Infrared light is aimed at the base of the hemorrhoid, causing it to clot, then shrivel, and finally recede.
  • Hemorrhoidectomy. During this procedure, the hemorrhoid (the tissue that is bleeding or protruding from the anus) is surgically removed under local anesthesia. A recovery period and hospitalization may occasionally be necessary. It may be used when external hemorrhoids clot repeatedly, the rubber band ligation procedure is not successful, a protruding hemorrhoid is not responding to treatment, or there is ongoing bleeding.

Sources:

American Society of Colon & Rectal Surgeons. "Hemorrhoids." FASCRS.org Jan 2008 21 Apr 2011.

Bharucha AE. "Hemorrhoids." National Digestive Diseases Information Clearinghouse Nov 2010. 21 Apr 2011.

FamilyDoctor.org. "Hemorrhoids: Reducing the Pain and Discomfort." American Academy of Family Physicians Nov 2010. 21 Apr 2011.

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