Hemorrhoids
Hemorrhoids are swollen veins in or just outside of the anus. If you have hemorrhoids, you might notice a painful lump outside the anus. You might also notice bleeding or itching.
Hemorrhoids are common, and your doctor will usually suggest home treatment.
Symptoms
What are the symptoms of hemorrhoids?
Hemorrhoids may cause:
- Rectal bleeding. You may see bright red blood on the toilet paper or in the toilet after a bowel movement. You may see blood on the stool.
- Itching. Hemorrhoids often seep mucus. It can irritate the skin and cause itching.
- Discomfort. You may still feel the urge to pass stool right after having a bowel movement.
- Pain.
- 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.
- Large internal hemorrhoids that bulge from the anus may be painful if they're squeezed by the anal muscles. They may be very painful if the blood supply to the hemorrhoid is cut off.
Causes
What causes hemorrhoids?
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:
- Diarrhea, constipation, or rushing to complete a bowel movement. These may lead to straining and can put more pressure on veins in the anal canal.
- Pregnancy and labor. This is because of greater pressure on the blood vessels in the pelvic area. Straining to push the baby out during labor can make hemorrhoids worse.
- Being overweight. This may put more pressure on the pelvic veins.
- Medical conditions, such as severe liver disease.
Things that make hemorrhoids worse include:
- Sitting or standing for a long time. This may cause blood to pool in the anal area and put more pressure on the veins.
- Frequent heavy lifting or holding your breath when lifting heavy objects. This can suddenly put more pressure on blood vessels.
Prevention
Preventing hemorrhoids
There are things you can do to help prevent hemorrhoids.
- Avoid constipation.
- Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
- Drink plenty of fluids.
- Get some exercise every day. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week.
- Take a fiber supplement, such as Citrucel or Metamucil, every day if needed. Read and follow all directions on the label.
- Practice healthy bowel habits.
- Go to the bathroom as soon as you have the urge.
- Avoid straining to pass stools. Relax and give yourself time to let things happen naturally.
- Avoid holding your breath while passing stools.
- Avoid reading while sitting on the toilet. Get off the toilet as soon as you have finished.
- Modify your daily activities.
- Avoid prolonged sitting or standing. Take frequent short walks.
- Avoid lifting heavy objects, if possible. If you must lift heavy objects, always exhale as you lift the object. Don't hold your breath when you lift.
- Sleep on your side if you are pregnant. This will lower pressure on the blood vessels in your pelvis. This can help keep hemorrhoids from becoming bigger.
Diagnosis
How are hemorrhoids diagnosed?
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 if 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.
Treatment
How are hemorrhoids treated?
For most external hemorrhoids, home treatment is all you need. The same home treatment can be used for most internal hemorrhoids.
- Slowly add fiber to your meals. Eat foods that have lots of fiber, such as fruits, vegetables, and whole grains.
- Use an over-the-counter ointment for a limited time to stop itching. You also may use a stool softener.
- Try suppositories. They can help relieve irritation and lubricate the anal canal during bowel movements.
- Drink plenty of water.
- Get some exercise every day.
If your internal hemorrhoids are severe, you may need other treatment. The doctor may tie off the hemorrhoids with rubber bands or create scar tissue around the hemorrhoids. These treatments reduce the blood supply to the hemorrhoids so they shrink or go away.
Surgery to remove hemorrhoids may be done if other treatments don't work. It may be done to remove large internal or external hemorrhoids that are uncomfortable or painful.
When to call
Hemorrhoids: When to call
Call 911 anytime you think you may need emergency care. For example, call if:
- You pass maroon or very bloody stools.
Call your doctor now or seek immediate medical care if:
- You have increased pain.
- You have increased bleeding.
Watch closely for changes in your health, and be sure to contact your doctor if:
- Your symptoms have not improved after 3 or 4 days.
Self-care
Caring for yourself when you have hemorrhoids
Home treatment may help relieve your symptoms or keep your hemorrhoids from getting worse. It mainly involves having healthy bowel habits.
- Avoid constipation.
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.
- Avoid making hemorrhoids worse.
- After bowel movements, blot the anus gently with white toilet paper moistened with water or a cleansing agent. Or you can use baby wipes or other premoistened towels (such as Preparation H or Tucks).
- Avoid rubbing the anal area. You can rinse off in the shower or on a bidet instead of wiping yourself with toilet paper. After cleansing, gently pat the anal area dry with a soft, absorbent towel or cloth.
- Don't use soaps that contain perfumes or dyes.
- Relieve pain and itching.
- Take over-the-counter pain relievers. Acetaminophen (Tylenol) can help with pain. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) and naproxen (Aleve) can help with pain and swelling.
- Apply ice several times a day for 10 minutes at a time. Then place a warm compress on the anal area for another 10 to 20 minutes.
- Take a sitz bath. Fill your bathtub with just enough warm water to cover the anal area. Do this several times a day, especially after bowel movements. Soak for about 15 minutes at a time. Be careful! If the water is too warm, it can burn you.
- Use over-the-counter medicines as recommended by your doctor or pharmacist. They include ointments, creams, and suppositories. Examples include zinc oxide, petroleum jelly, and Preparation H.
- Take a day of bed rest.
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.
- Try not to sit or stand for a long time.
Limit sitting and standing when hemorrhoids are irritated. If you must sit for a long time, sit on a pillow.
- Avoid lifting heavy objects.
- Wear cotton underwear.
It prevents moisture buildup, which can irritate hemorrhoids.
- Wear loose clothing.
This reduces pressure on the anal area.
Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.