What are hemorrhoids?

Hemorrhoids are swollen veins in the lower end of your intestine (rectum) or the anus. The anus is the opening where bowel movements pass out of your body.

Hemorrhoids are a common problem. They can cause pain, bleeding, and itching. Another name for them is piles.

Hemorrhoids may be external or internal.

  • External hemorrhoids can be seen or felt easily around the anal opening.
  • Internal hemorrhoids are inside the rectum. Sometimes they may stretch and fall out (prolapse) through the anus to outside the body.

What is the cause?

Hemorrhoids can result from too much pressure on veins in the rectum and around the anus. You may put pressure on these veins by:

  • Straining to have a bowel movement when you are constipated
  • Waiting too long to have a bowel movement
  • Sitting for a long time on the toilet, which causes strain on the anal area
  • Sitting anywhere for a long while
  • Coughing a lot, as happens with some lung diseases

Hemorrhoids may also develop from:

  • Diarrhea
  • Obesity
  • Injury to the anus, for example, from anal sex
  • Some liver diseases

You may have flare-ups of hemorrhoids when you are under stress. Some people inherit a tendency to have hemorrhoids.

Pregnant women should try to avoid getting constipated because hemorrhoids are more likely to happen during pregnancy. In the last trimester of pregnancy, the enlarged uterus may press on veins and cause hemorrhoids. Also, the strain of childbirth sometimes causes hemorrhoids after the birth.

What are the symptoms?

Often hemorrhoids do not cause any symptoms. If you do have symptoms, they may include:

  • Itching, mild burning, and bleeding around the anus. For example, you might see bright red blood on toilet paper after wiping.
  • Swelling and tenderness around the anus
  • Pain with bowel movements
  • Painful lumps around the anus ranging in size from a pea to a walnut (in severe cases)

Internal hemorrhoids are often painless but they sometimes cause a lot of bleeding. If the veins fall outside the anus, they may become irritated and painful.

How are they diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

  • Rectal exam, which your provider does by gently putting a lubricated and gloved finger in your rectum
  • Anoscopy, which uses a small, lighted tube put into your rectum to look for hemorrhoids or other causes of bleeding

How are they treated?

They are a problem only if they are causing discomfort or problems. The following treatments usually help to relieve most cases of hemorrhoids:

  • High-fiber diet

    Eat more high-fiber foods, which can help prevent constipation. The best sources of fiber are beans, such as navy, kidney, or black beans; whole-grain cereals, such as shredded wheat or cereals with bran; fresh fruit, such as apples with the skin; and raw or cooked vegetables, especially cabbage, carrots, corn, and broccoli.

  • Fluids

    Drink plenty of water. This helps to soften bowel movements so they are easier to pass.

  • Sitz baths and cold packs
    • Sitting in a lukewarm bath 2 or 3 times a day for 15 minutes cleans the anal area and may relieve discomfort. (Don’t let bath water get too hot. It could worsen swelling.)
    • Putting a cloth-covered ice pack on the anus or sitting on a covered ice pack for 10 minutes, 4 times a day might help.
  • Medicine

    Ask your healthcare provider or pharmacist what nonprescription products might help relieve pain and itching. If nonprescription medicines don’t help, your provider may prescribe a cream or ointment for the painful area. Your provider may also prescribe medicated suppositories to put inside your rectum.

  • Procedures and surgeries

    A number of procedures can be used to remove or shrink hemorrhoids that are not responding to other treatments, are large and very swollen, or are bothering you. These procedures include:

    • Hemorrhoid banding, which puts tight bands around the swollen veins. After a few weeks the tissue under the bands falls off, leaving a healed scar.
    • Destroying the hemorrhoids with freezing, electrical or laser heat, or infrared light
    • Shrinking the hemorrhoids with injection of a chemical around the swollen vein
    • For severe cases, surgery to cut out the hemorrhoids

How can I take care of myself?

Always tell your healthcare provider when you have rectal bleeding. Although bleeding is often from hemorrhoids, more serious illnesses, such as colon cancer, can also cause bleeding.

Follow these guidelines to help prevent hemorrhoids and to relieve their discomfort:

  • Don’t strain during bowel movements. The straining makes hemorrhoids swell.
  • Eat a high-fiber diet and drink plenty of water.
  • If necessary, take a stool softener. Softer stools make it easier to empty the bowels and reduce pressure on the veins. Stool softeners are available without a prescription at most pharmacies and drug stores. If you have any questions about which product to buy, ask your healthcare provider or pharmacist for more information.
  • Don't overuse laxatives. Diarrhea can be as irritating to the anus as constipation.
  • Exercise regularly to help prevent constipation. Ask your healthcare provider for an exercise prescription.
  • Avoid a lot of wiping after a bowel movement if you have hemorrhoids. Wiping gently with soft, moist toilet paper or a commercial moist pad or baby wipe may relieve discomfort. If necessary, shower instead of wiping and then dry the anus gently.
  • Avoid lifting heavy objects when you have hemorrhoids. It may increase the pressure on the veins and make the hemorrhoids worse.

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Published by RelayHealth.
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