Hemorrhoids

Topic Overview

What are hemorrhoids?

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. The symptoms and treatment depend on which type you have.

See a picture of hemorrhoids .

Many people have hemorrhoids at some time.

What causes hemorrhoids?

Too much pressure on the veins in the pelvic and rectal area causes hemorrhoids.

Normally, tissue inside the anus fills with blood to help control bowel movements. If you strain to move stool, the increased pressure causes the veins in this tissue to swell and stretch. This can cause hemorrhoids.

Diarrhea or constipation also may lead to straining and can increase pressure on veins in the anal canal.

Pregnant women can get hemorrhoids during the last 6 months of pregnancy. This is because of increased pressure on the blood vessels in the pelvic area. Straining to push the baby out during labor can make hemorrhoids worse.

Being overweight can also lead to hemorrhoids.

What are the symptoms?

The most common symptoms of both internal and external hemorrhoids include:

• Bleeding during bowel movements. You might see streaks of bright red blood on toilet paper after you strain to have a bowel movement.
• Itching.
• Rectal pain. It may be painful to clean the anal area.

Internal hemorrhoids

With internal hemorrhoids, you may see bright red streaks of blood on toilet paper or bright red blood in the toilet bowl after you have a normal bowel movement. You may see blood on the surface of the stool.

Internal hemorrhoids often are small, swollen veins in the wall of the anal canal. But they can be large, sagging veins that bulge out of the anus all the time. They can be painful if they bulge out and are squeezed by the anal muscles. They may be very painful if the blood supply to the hemorrhoid is cut off. If hemorrhoids bulge out, you also may see mucus on the toilet paper or stool.

External hemorrhoids

External hemorrhoids can bleed, and then the blood pools, causing a hard painful lump. This is called a thrombosed, or clotted, hemorrhoid.

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, 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 does not show a clear cause of your problems, your doctor may use a lighted scope (sigmoidoscope) to look at the lower third of your colon. Or your doctor may use another kind of scope (colonoscope) to look at the entire colon to check for other causes of bleeding.

How are they treated?

For most external hemorrhoids, home treatment is all you need. This includes slowly adding fiber to your meals, drinking more water, and using over-the-counter ointments for a limited time to stop itching. You also may use stool softeners. The same home treatment can be used for most internal hemorrhoids.

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.

Healthy habits can help you prevent hemorrhoids or keep them from getting worse. Eat foods that have lots of fiber, such as fruits, vegetables, and whole grains. Also, drink plenty of water, and get plenty of exercise.

Frequently Asked Questions

Learning about hemorrhoids:	What are hemorrhoids? Who gets hemorrhoids? What causes them? How are they treated? Can I prevent hemorrhoids? What are the types of internal hemorrhoids?
Being diagnosed:	How are hemorrhoids diagnosed? What occurs during a physical exam for hemorrhoids? What is anoscopy?
Getting treatment:	What is rubber band ligation? What is infrared photocoagulation? What happens during surgery to remove hemorrhoids? What can I do at home to prevent hemorrhoids or treat minor ones?

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Author:	Monica Rhodes	Last Updated: September 29, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Brent Shoji, MD - General Surgery
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