What You Need To Know About Hemorrhoids

What are hemorrhoids?

Hemorrhoids are inflamed and swollen veins around the anus and lower rectum. Depending on what type you have, they may cause itching, bleeding, and discomfort.

Symptomatic hemorrhoids are common. Around one in 20 Americans experiences them. They are often caused by increased pressure on the veins during bowel movements.

Hemorrhoids can be uncomfortable, but they aren’t usually causing for serious concern. They are not contagious and will often clear up on their own without any intervention.

Over-the-counter and at-home treatments can help speed up the healing process. The need for surgical removal or another type of intervention is rare.

If hemorrhoids are persistent or start to cause severe pain, a doctor can prescribe pain management medications.

There are two types of hemorrhoids:

External hemorrhoids

These form on the outer part of the anal opening and are more likely to be symptomatic. They often cause the most discomfort, making it painful to sit due to irritation and pain.

External hemorrhoids also pose a risk of blood clots, which can cause severe and sudden pain.

External hemorrhoids may go away on their own or with at-home treatments. They sometimes leave behind skin tags that cause further irritation.

Internal hemorrhoids

This type of hemorrhoid forms inside the anus or in the lower rectum. They don’t always cause pain and may only be noticeable when they leave blood on tissue in the toilet after a bowel movement.

There is a risk of prolapse with internal hemorrhoids. This occurs when the swollen tissue inside the anus or lower rectum protrudes outside of the anus. This can cause irritation, itching, and discomfort.

Statistics

  • 50% of adults over the age of 50 have hemorrhoids.¹

  • Hemorrhoids affect men and women. Some medical professionals believe more women get them due to the increased risk of hemorrhoids during pregnancy.² However, certain studies refute this claim, finding no notable difference.

  • 40% of people with hemorrhoids don’t get any symptoms.³

  • Hemorrhoids can develop at any age. However, they are most likely to occur after the age of 30, with the risk peaking between the ages of 45 and 65.⁴

  • Having a high BMI can increase your risk of developing hemorrhoids.⁵

  • In one international survey study, more than 70% of respondents reported that their hemorrhoid symptoms were low in severity.³ 60% of participants said the pain was one of their first symptoms, with bleeding and discomfort being the next most common symptoms.

Symptoms

Your symptoms will depend on the type of hemorrhoids you have.

Internal hemorrhoids symptoms

  • Bright red blood on the tissue or in the toilet bowl after a bowel movement

  • Lumps around the opening of the anus where hemorrhoids have prolapsed

Internal hemorrhoids don’t normally cause discomfort or pain unless they have prolapsed. You may not know you have internal hemorrhoids unless they bleed or cause pain.

External hemorrhoids symptoms

  • Itching around the anus

  • Pain around the anus, which may worsen when you sit

  • Lumps around the anal opening which may feel itchy or tender

Hemorrhoids are rarely serious, but these symptoms could indicate a different health condition. Tell your doctor if you notice anal bleeding or lumps. They can carry out tests to rule out Crohn’s disease or colorectal cancer.

Hemorrhoids complications

Hemorrhoids usually go away on their own within a few days, but they can become more serious, causing pain, blood clots, and other complications.

The condition can lead to more serious medical concerns in some cases, such as infection. There is also a small risk of excessive bleeding with internal hemorrhoids.¹ This can lead to anemia.

Contact your doctor immediately if you are experiencing significant blood loss through the anus or bleeding that doesn’t stop on its own.

Some hemorrhoids can also become prolapsed or swollen and protrude from the anus.² Anal prolapse can cause symptoms such as pain, bleeding, and itching.

With anal prolapse, you might experience complications, like trouble going to the toilet (fecal incontinence or constipation). This occurs because the bulging hemorrhoids don’t allow the anus to fully close. This creates pressure like you need to have further bowel movements.

Prolapsed hemorrhoids can become strangulated when obstructed or trapped,³ which causes an acute onset of pain. This occurs when the blood supply to the hemorrhoids gets cut off. You might need topical treatments and stool softeners or, in some cases, surgery to remove the hemorrhoids.

Causes

Hemorrhoids are caused when the blood flow to and from the area around the anus is interrupted.¹ This causes blood to pool in the blood vessels in the anus and lower rectum, causing inflammation and swelling. This results in hemorrhoids.

Blood flow to the anus and rectum may be interrupted for several reasons, including:

  • Chronic constipation or diarrhea

  • Sitting for long periods of time, especially on the toilet

  • Pregnancy, which causes the uterus to push on veins supplying blood to the area

  • Straining to lift heavy objects or have a bowel movement

  • Eating a low-fiber diet, causing constipation

Hemorrhoids are also caused by a weakening of the connective tissues in the anus. This happens naturally as you get older.² Straining and being overweight can put extra pressure on these tissues and cause an increased risk of internal hemorrhoid prolapse.

Risk factors

You are more likely to get hemorrhoids if you:³

  • Are overweight or obese

  • Are between the ages of 45 and 65

  • Are pregnant

  • Have a history of chronic constipation or diarrhea

  • Have a sedentary lifestyle

  • Sit on the toilet for prolonged periods, often straining to have a bowel movement

Diagnosis

Your doctor will start by taking your personal and family medical history. Then, they will typically perform a physical examination to look for signs of external hemorrhoids. They will examine the anal area, looking for lumps, swelling, skin tags, or prolapsed internal hemorrhoids.

Your physical examination may also include a digital rectal exam, which involves your doctor placing a gloved, lubricated finger into the anal opening to check for tenderness, bleeding, or signs of internal hemorrhoids. This can also help them evaluate anal muscle tone, which can become weaker as you age and increase your risk of developing hemorrhoids.

Your doctor may also use special diagnostic equipment to examine the inner part of the rectum. This can allow them to detect internal hemorrhoids and check for other medical conditions that could be causing your symptoms.

These imaging procedures might include:

  • Anoscopy — uses a small funnel-shaped instrument called an anoscope to examine the inner tissue of your anus and lower rectum

  • Proctosigmoidoscopy — uses a proctoscope that’s slightly longer than an anoscope and allows your doctor to see further inside the rectum

  • Colonoscopy — allows your doctor to examine the entire length of the colon

Your doctor will recommend a treatment plan if they diagnose hemorrhoids. In serious cases, you might need to undergo a procedure or surgery to remove the hemorrhoids.

Treatments

Hemorrhoids often go away on their own, but you may need treatment.

Contact your doctor if your hemorrhoids are painful, causing you discomfort, or haven’t gone away within a week of using at-home treatments. They will recommend other treatment options, including pain management, lifestyle changes, or medical procedures to remove the hemorrhoids.

Home management of hemorrhoids

Pain is one of the primary concerns with hemorrhoids. While most internal hemorrhoids are painless unless they prolapse, external hemorrhoids can cause intense pain and ongoing discomfort. These symptoms may worsen when sitting, particularly on hard surfaces.

Your doctor may recommend at-home pain management techniques, such as:

  • Over-the-counter creams and ointments. These topical solutions contain ingredients like steroids, vasoconstrictors (which cause the blood vessel walls to narrow), and topical anesthetics to help reduce inflammation and swelling and numb the painful, itchy areas. These can help ease your symptoms but won’t cure your hemorrhoids.

  • Witch hazel wipes. Witch hazel has anti-inflammatory properties that may reduce swelling and irritation.¹ These wipes also help keep the area around the anus clean, which can lessen itching and discomfort and speed up healing.

  • Ice packs and heating pads. Sitting on an ice pack to reduce swelling or a heating pad to improve blood flow can help ease the pain.

  • Hemorrhoid pillow. If you have difficulty sitting, try adding a soft cushion to your seat or buy a doughnut ring cushion. These are circular pillows with a hole in the middle, resembling a doughnut. They help ease pressure on the anus, making sitting for long periods more comfortable.

  • Sitz baths. A sitz bath is a shallow bowl of warm water that you sit in. Try soaking for 10 to 15 minutes once or twice a day.

  • Hygiene measures. Keep the anal area clean. Improving anal hygiene can help reduce irritation, avoid infection, and encourage the healing process. Don’t use soap on your anal area directly, as this could dry out and irritate your hemorrhoids. Instead, gently flush warm water over your skin.

  • Wet wipes. Dry toilet paper may irritate your hemorrhoids. Use a flushable wet wipe to wipe gently after a bowel movement.

  • Increase your fiber intake. Dietary fiber can aid bowel movements and improve constipation and straining (which can cause or worsen hemorrhoids).² Supplement with extra portions of fruits, vegetables, and legumes at each meal and with snacks. More fiber in your diet also reduces bleeding.

  • Drink fluids. Consuming extra fluids throughout the day helps soften stools. Be sure to drink plenty of fluids if you are taking fiber supplements.

  • Pain medicine. You can also take over-the-counter pain relievers such as ibuprofen or acetaminophen to help reduce swelling and ease your pain.

  • Stool softeners. Talk to your doctor about taking a mild stool softener to help you pass stool without straining. This can help you if you suffer from chronic constipation that does not improve with dietary measures.

Medical procedures

In-office procedures are sometimes needed to treat hemorrhoids. These are outpatient procedures and usually require very little recovery time.

In rare cases, hemorrhoids require surgical intervention. Fewer than 10% of patients who seek medical attention for their hemorrhoids will need surgery.³

Procedural options for treating hemorrhoids include:

  • Rubber band ligation. This is one of the most common treatment options for internal hemorrhoids.⁴ During this procedure, a doctor will use a small camera inside the anus to locate hemorrhoids and place a rubber band around the base. This will cut off the blood supply, causing them to shrink and eventually fall off.

  • Infrared photocoagulation. Infrared light generates heat that stops blood flow to hemorrhoid, causing it to shrivel and fall off over time.

  • Electrotherapy. This procedure is similar to infrared photocoagulation, but it uses an electrical current to cauterize the vein supplying blood to the hemorrhoids. This causes them to shrink.

  • Sclerotherapy. Your doctor will inject a special chemical solution into your hemorrhoids, causing the veins inside them to collapse. They will shrink after about four to six weeks. This procedure is especially effective if you have multiple hemorrhoids that need treatment or if they are too small for rubber band ligation.⁵

  • Hemorrhoidectomy. This is the surgical removal of hemorrhoids.² During this procedure, a surgeon will make incisions to cut away the hemorrhoids. Compared to other treatment options, hemorrhoidectomy carries a greater risk of complications, but it can be very effective. Your doctor may recommend this procedure if your hemorrhoids are especially severe or don’t respond to other treatments.

  • Stapled hemorrhoidectomy. This procedure also surgically removes hemorrhoids, but in this case, a doctor will use a device similar to a stapler to cut off the blood supply. This causes hemorrhoids to gradually shrink and wither.

  • Hemorrhoidal artery ligation. Your doctor will insert a device into the anus that locates the arteries supplying the hemorrhoids and cuts them off.

Prevention

You can prevent hemorrhoids with diet and lifestyle changes.

Diet

Adding more fiber to your diet can help soften your stool, making it easier to pass without straining.¹

Fiber has many other health benefits, including supporting a healthy gut microbiome, aiding weight loss, and preventing high blood sugar levels, cardiovascular disease, and cancer.²

High-fiber foods include:

  • Whole grains

  • Fruits

  • Vegetables

  • Legumes, including beans, peas, and lentils

Only plant foods contain fiber. Animal foods have none. Avoid eating lots of processed foods and animal products, including dairy. Dairy can also contribute to constipation.

You should also increase your water consumption, as this helps to retain fluid in your stool, making it easier to pass.

Lifestyle

Losing weight can help reduce pressure on the areas of the body where hemorrhoids develop. Excess pressure can restrict blood flow, which leads to hemorrhoids.

Avoiding a sedentary lifestyle can also help. A sedentary lifestyle involves not getting enough physical activity during the day. This can cause constipation and may lead to an increased risk of hemorrhoids.³

If you are currently experiencing discomfort from hemorrhoids, avoid activities that irritate the area, such as riding a bike. Instead, try walking, swimming, or yoga.

Increased exercise can improve your gut motility, which leads to more regular bowel movements. It also improves your circulation and strengthens muscle tone, which can help prevent hemorrhoids.

Try to practice healthy toilet habits. Don’t sit for long stretches on the toilet and try not to strain during a bowel movement. Dietary measures can help with this.

You should also go to the toilet as soon as you need to move your bowels. Don’t wait or hold in your stool for long periods.

Having a bowel movement while in the squatting position can also help. Get a small stool or place a stack of books in front of the toilet on each side and rest your feet on them. This can help reduce strain and make your bowel movements easier.

  1. Eating, diet, & nutrition for hemorrhoids | NIH: National Institute of Diabetes and Digestive and Kidney Disease

  2. The health benefits of dietary fibre (2020)

  3. Lifestyle and risk factors in hemorrhoidal disease (2021)

Doctors & specialists

When to see a doctor

Hemorrhoids are rarely cause for concern, but speak to your doctor if you experience any of the following symptoms:

  • Bleeding from the anus or blood in your stool

  • Pain or discomfort when having a bowel movement

  • Lumps or tenderness around the anus

You can try at-home hemorrhoid treatments but speak to your doctor if they haven’t helped after one week.

These symptoms could indicate hemorrhoids or more serious health concerns, like Crohn’s disease and bowel cancer. Testing can help your doctor determine the cause of your symptoms and recommend treatment options.

Which doctors/specialists treat hemorrhoids?

Your general practitioner can diagnose hemorrhoids and help you develop a treatment plan. They may also recommend seeing a specialist for further testing and management. These specialists may include:

  • Gastroenterologists — specialists in treating the intestinal tract and liver. Gastroenterologists can diagnose hemorrhoids, recommend treatments, and advise you on lifestyle changes to help reduce your risk of developing hemorrhoids again.

  • Proctologists — specialize in treating conditions of the anus, rectum, and colon. A proctologist can also provide non-invasive hemorrhoid treatments.

  • Colorectal surgeons — specialize in the surgical treatment of medical conditions affecting the colon, rectum, and anus.

These specialists may coordinate care with your general practitioner to help treat your hemorrhoids, get them under control, and prevent them from reoccurring.


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