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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?

    The most common symptoms of both internal and external hemorrhoids are bleeding during bowel movements, itching, and rectal pain.

    Rectal bleeding and pain and recent changes in bowel habits are also symptoms of colon, rectal, and anal cancer. If you have these symptoms, talk to your doctor, especially if you are age 50 or older or have a family history of colon cancer.

    External hemorrhoids

    Rectal pain occurs mainly with external hemorrhoids. Blood may pool under the skin, forming a hard, painful lump. This is called a thrombosed, or clotted, hemorrhoid.

    You might also notice streaks of blood on the toilet paper after you strain to pass a stool.

    Internal hemorrhoids

    The most common symptom of internal hemorrhoids is rectal bleeding. You may find bright red streaks of blood on the toilet paper or bright red blood in the toilet bowl after you have a normal bowel movement. You may also see blood on the surface of the stool.

    Other symptoms of internal hemorrhoids may include:

    Itching.

    This is a common symptom. Internal hemorrhoids often seep mucus. It can irritate the anal skin and cause itching.

    Skin irritation.

    Large hemorrhoids that bulge from the anus may seep mucus, causing mild irritation.

    Discomfort.

    You may still feel the urge to pass stool right after you have a bowel movement. This uncomfortable feeling is caused by the bulging of the hemorrhoid in the end portion of the large intestine (anal canal). In general, the larger the hemorrhoid, the more discomfort.

    Pain.

    Most internal hemorrhoids aren't painful. But large hemorrhoids that bulge from the anus may become painful if they swell and are squeezed by the muscles that control the anus. Severe pain may be a sign that the blood supply to the hemorrhoid is being cut off. (This is called a strangulated hemorrhoid.) Emergency treatment is needed.

  • Causes

    What causes hemorrhoids?

    Hemorrhoids are usually caused by increased pressure on the veins in the pelvic and rectal area. As pressure increases, blood pools in veins and causes them to swell. Over time, the swollen veins stretch the surrounding tissue, and hemorrhoids form.

    Bowel habits that can lead to hemorrhoids include:

    Rushing to complete a bowel movement.

    Hurrying can lead to straining. It can increase pressure on rectal veins.

    Persistent diarrhea or constipation.

    These may cause straining and increased pressure on veins in the anal canal.

    Other things that can lead to hemorrhoids include:

    Being overweight.

    Excess weight, especially in the belly and pelvis, may increase pressure on pelvic veins.

    Pregnancy and labor.
    • Hormone changes during pregnancy increase blood flow to the pelvis and relax supportive tissues while the growing fetus puts more pressure on blood vessels.
    • During labor, pushing to deliver the baby creates intense pressure on the anal area.
    Medical conditions.

    For example, long-term heart and liver disease may cause blood to pool in the belly and pelvic area. This can enlarge the veins.

  • Prevention

    Preventing hemorrhoids

    You can help prevent the irritating and painful symptoms of 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, enough so that your urine is light yellow or clear like water.
      • 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. It's fine to be active in blocks of 10 minutes or more throughout your day and 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. The only tests you need at first may be:

    • Digital rectal exam. Your doctor may examine your rectum with a gloved finger.
    • Anoscopy. Your doctor may use a short, lighted scope to look inside your rectum.

    If the doctor finds hemorrhoids, he or she will evaluate their location and size. Then the doctor will make a treatment plan based on their degree of severity.

    Other tests

    You may not need more tests if hemorrhoids are the clear cause of rectal bleeding, you are younger than age 50, and you don't have risk factors for colon cancer.

    But rectal bleeding can be a sign of a more serious problem, such as colon, rectal, or anal cancer. To make sure that nothing else is causing your symptoms, you may need other tests, such as:

    • Flexible sigmoidoscopy. This test allows a doctor to look inside the anus, rectum, and lower part of the large intestine (colon) for abnormal growths or other signs of disease.
    • Colonoscopy. This lets a doctor look at the entire colon to check for other causes of bleeding.
    • Barium enema.

    These tests aren't used routinely to diagnose hemorrhoids.

  • 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.
    • 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 scar the tissue around the hemorrhoids. These treatments reduce the blood supply to the hemorrhoids so that they shrink or go away.

    Surgery to remove hemorrhoids may be done if other treatments don't work.

  • 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, which mainly involves having healthy bowel habits, may keep your hemorrhoids from getting worse.

    You can use the following suggestions to keep hemorrhoids from getting worse or to relieve your symptoms.

    • Avoid making hemorrhoids worse.
      • After bowel movements, blot the anus gently with white toilet paper moistened with water or a cleansing agent (such as Balneol). 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 nonprescription 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 nonprescription 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 allows freedom of movement. And it reduces pressure on the anal area.


    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.