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 get irritated and clot under the skin, 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
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Cause
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.
Eventually, the swollen veins stretch the surrounding tissue, and hemorrhoids
develop.
Bowel habits that can cause increased pressure and lead
to the development of hemorrhoids include:
- Rushing to complete a bowel movement. Hurrying
can lead to excessive straining and increase pressure on rectal
veins.
- Persistent diarrhea or constipation, which may cause
straining and increase pressure on veins in the anal canal.
Other factors that can lead to the development of
hemorrhoids include:
- Being overweight. Excess weight, especially in
the abdomen and pelvis, may increase pressure on pelvic
veins.
- Pregnancy and labor. Hormonal changes during pregnancy
increase blood flow to the pelvis and relax supportive tissues while the
growing fetus causes increased pressure on blood vessels. During labor,
hemorrhoids may develop because of the intense pressure on the anal area while
pushing to deliver the baby.
- Medical conditions. For example,
long-term heart and liver disease may cause blood to pool in the abdomen and
pelvic area, enlarging the veins.
Symptoms
Bleeding during bowel movements, itching,
and rectal pain are the most common
hemorrhoid symptoms.
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 straining 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 having a
normal bowel movement. Blood also may be visible on the surface of the
stool.
Other symptoms of internal hemorrhoids may include:
- Itching. This is a frequent complaint,
because internal hemorrhoids often seep mucus, which can irritate the anal skin
and cause itching.
- Skin irritation. Large hemorrhoids that bulge
from the anus may secrete mucus, causing mild
irritation.
- Discomfort. You may still feel the urge to pass stool
right after having 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 greater the
discomfort.
- Pain. Most internal hemorrhoids are not 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 (strangulated
hemorrhoid). Emergency treatment is needed.
Rectal bleeding and pain and recent changes in bowel
habits are also symptoms of colon, rectal, or anal cancer. People who have
these symptoms, especially those age 50 or older or those with a family history
of colon cancer, need to talk to their doctors.
Other conditions with symptoms similar to hemorrhoids include
anal fissures,
anal fistulas,
colon polyps,
rectal prolapse, and
inflammatory bowel disease (IBD).
What Happens
Hemorrhoids form when increased pressure on the pelvic
veins causes veins in the anal canal to swell and gradually stretch out of
shape. Pressure increases can be caused by rushing to complete a bowel
movement, persistent diarrhea or constipation, or other factors including being
overweight or pregnant.
Persistent pressure also weakens tissues
that support the veins in the anal canal. If those tissues become so weak that
they can no longer hold the veins in place, the swollen veins and tissues bulge
into the anal canal (internal hemorrhoids) or under the skin surrounding the
anal opening (external hemorrhoids).
For some people, hemorrhoids
may cause a little discomfort for a limited time. Other people have recurrent
bouts of discomfort when hemorrhoids flare up. Some people struggle with
hemorrhoid pain, discomfort, and itching much of their lives. The degree and
duration of discomfort depend on where the hemorrhoids are.
Hemorrhoids frequently develop during pregnancy because of extra pressure on
veins (from the enlarged uterus).
During labor, hemorrhoids may
start or get worse because of the intense straining and pressure on the anal
area while pushing to deliver the baby. For more information, see the topic
Pregnancy.
External hemorrhoids
Because external hemorrhoids
may not cause any symptoms, you may not be aware that you have
hemorrhoids.
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.
Internal hemorrhoids
Small internal hemorrhoids
may not grow larger if bowel habits or other factors change to lower pressure
on the veins in the bowel.
Large internal hemorrhoids may bulge
from the anus. After bowel movements, you may have to push them back through
the anus. At worst, large internal hemorrhoids stick out all the time.
In rare cases, hemorrhoids may bulge through the anus and swell. Muscles
that control the opening and closing of the anus may cut off a hemorrhoid's
blood supply (strangulated hemorrhoid). This may cause the hemorrhoid tissues
to die. If this happens, you will feel severe rectal pain and may see blood and
pus at the anus. You will need urgent surgery to prevent further complications,
such as death of the affected tissue and infection.
What Increases Your Risk
Bowel habits, physical
stresses, and other conditions can raise the risk of developing
hemorrhoids or make existing hemorrhoids worse. Some
of these factors can be prevented.
Factors that increase your risk
- Persistent constipation or diarrhea. These
conditions may lead to straining with bowel movements.
- Being
overweight
- A family history of hemorrhoids. You may inherit the tendency
to get them.
- Being age 50 or older. Half of people who are older
than 50 seek treatment for hemorrhoids.
- Pregnancy and labor and
delivery. As the fetus grows during the last 6 months of pregnancy, blood
volume and pressure on pelvic blood vessels increase. The strain of labor also
can cause hemorrhoids to start or get worse.
- Liver disease, heart
disease, or both. These conditions may cause blood to back up in the pelvis and
abdomen.
Factors that may make hemorrhoids worse
Hemorrhoids may be made worse by:
- Prolonged sitting or standing. This may cause
blood to pool in the anal area and increase pressure on the
veins.
- Frequent heavy lifting or holding your breath when lifting
heavy objects. This can cause a sudden increase of pressure in blood
vessels.
When To Call a Doctor
Common symptoms of
hemorrhoids may be a sign of other serious health
problems. Colon or rectal cancer and other conditions have many of the same
symptoms as hemorrhoids. Call your doctor if:
- Rectal bleeding occurs that is not associated
with trying to pass stools.
- Stools become more narrow than usual
(may be no wider than a pencil).
- You cannot pass stools, or you
have diarrhea with abdominal bloating.
- Stools are black or
tarry.
- Any unusual material seeps from the anus.
- You
have a fever along with bloody stools or what you think may be
hemorrhoids.
- A lump or bulge that is not tender and does not go
away develops at the anal opening.
If you have hemorrhoids, call your doctor
if:
- Moderate rectal pain lasts longer than 1 week
after home treatment.
- Pain or swelling is
severe.
- Tissue from inside the body bulges from the anus and does
not return to normal after 3 to 7 days of home treatment.
- A lump
inside the anus becomes bigger or more painful.
If rectal bleeding becomes heavy or changes color (such as
from bright red to dark red), or if stools change color (from brown to maroon
or black), be sure to see your doctor.
Watchful Waiting
If you are younger than age 50 and sometimes
have minimal rectal bleeding (bright red blood seen mainly on toilet paper)
from hemorrhoids, you may try home treatment for a week or two if you are
reasonably certain that the bleeding is caused by one of the following:
- Straining to pass stools
- A known
injury to the anus
See the Home Treatment section of this topic for more
information.
In most cases, bleeding caused by hemorrhoids should
stop after 2 to 3 days. Continue home treatment to prevent bleeding from
starting again. Call your doctor if bleeding:
- Occurs for more than 1 week without
improvement.
- Starts again.
- Occurs when there is no
reason to expect it.
If you are older than age 50 or have a family history of
colon cancer, it is a good idea to tell your doctor any time
you have new rectal bleeding, notice blood on your stools, have changes in
bowel habits, or have anal pain. These symptoms may be signs of colon cancer or
other conditions. Your doctor may recommend screening tests to see
if you have a more serious problem. See the Exams and Tests section of this
topic.
Who To See
The following professionals can evaluate and treat
hemorrhoids:
If medical treatment or surgery is necessary, you may be
referred to a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
A doctor can evaluate
symptoms of
hemorrhoids to rule out other, more serious problems.
A number of conditions that affect the anus and colon (large intestine) can
cause bleeding, mucus drainage, itching, and discomfort. Most people who have
these symptoms think they have hemorrhoids, but often they do not.
If hemorrhoids are present, the doctor will evaluate their
location and size and develop a treatment plan based on the hemorrhoids'
degree of severity.
The diagnosis of hemorrhoids is based on a
medical history and
physical exam. A
digital rectal exam and an
anoscopy may be the only tests needed at first. Your
doctor will decide which tests to use. If hemorrhoids are the obvious cause of
rectal bleeding, you are younger than age 50, and you do not have risk factors
for colon cancer, you may not need more tests.
To make sure
nothing else (like colon cancer) is causing your symptoms, you may need other
tests, such as:
These tests are not used routinely to diagnose
hemorrhoids.
Treatment Overview
Most
hemorrhoids can be treated with simple changes to diet
and bowel habits. Most do not require surgery or other treatment unless the
hemorrhoids are very large and painful. For home care and prevention tips, see
the Home Treatment and Prevention sections of this topic.
The
goal of nonsurgical procedures used to treat hemorrhoids, called fixative
procedures, is to reduce the blood supply to the hemorrhoid so it shrinks or
goes away. The scar tissue left in its place helps support the anal tissue and
helps prevent more hemorrhoids from developing.
Fixative
procedures include tying off the hemorrhoids with a rubber band (rubber band
ligation) or using heat, lasers, or electric current to create scar tissue
(coagulation therapy).
Surgical removal of hemorrhoids
(hemorrhoidectomy) can be used for large internal hemorrhoids, when several
small hemorrhoids are present, or when other treatments have not controlled
bleeding. Sometimes a combination of treatments (for example, a fixative
procedure and a hemorrhoidectomy) is the most effective way to treat
hemorrhoids.
Hemorrhoidectomy versus fixative procedures for internal hemorrhoids
- Fixative procedures are usually tried before
surgery if hemorrhoids are small and stick out of the anus during a bowel
movement but return to their normal position afterward (second-degree hemorrhoid). For more information about fixative procedures, see the
Other Treatment section of this topic.
- Hemorrhoidectomy may provide
better long-term results than fixative procedures. But surgery is more
expensive, requires longer recovery times, is usually more painful, and has a
greater risk of complications.
- Fixative procedures are the
preferred treatment for people older than age 70 and those in poor
health.
Hemorrhoids: Which Treatment Should I Use?
Prevention
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. Start with a small dose and very slowly increase the dose over a month or more.
- Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when having a bowel movement.
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.
- If possible, avoid lifting heavy objects
frequently. If you must lift heavy objects, always exhale as you lift the
object. Don't hold your breath when you lift.
- If you are pregnant,
sleeping on your side will lower pressure on the blood vessels in your pelvis.
This can help keep hemorrhoids from becoming bigger.
Home Treatment
Home treatment, which mainly involves
establishing healthy bowel habits, may keep your
hemorrhoids from getting worse. See the Prevention
section of this topic for more on healthy bowel habits.
You can use the following suggestions to keep
hemorrhoids from getting worse or to relieve your symptoms.
Avoid making hemorrhoids worse
- Blot the anus gently with white toilet paper
moistened with water or a cleansing agent (such as Balneol) after bowel
movements. Baby wipes or other premoistened towels (such as Tucks) are also
useful for this purpose.
- 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.
- Use soaps that contain no 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. Follow this by placing 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 you have had a bowel movement. Soak for about 15 minutes at a
time. Be careful! If the water is too warm, it could burn you.
Use nonprescription medicines as recommended by your
doctor or pharmacist. See the Medications section of this topic
for information on nonprescription ointments, creams, and suppositories.
Other comfort measures
- You may need a day or more of bed rest to
take pressure off inflamed, irritated veins. If you are 3 to 6 months pregnant,
you may find it helpful to lie on your side. If you are not pregnant, sleeping
on your stomach with a pillow under your hips will help decrease swelling of
hemorrhoids.
- Try not to sit or stand for a long time when
hemorrhoids are irritated. If you must sit for a long time, sit on a pillow.
Avoid lifting heavy objects.
- Wear cotton underwear to prevent
moisture buildup, which can irritate hemorrhoids. Wear loose clothing to allow
freedom of movement and to reduce pressure on the anal area.
Medications
Medicines can help relieve symptoms of
hemorrhoids. You might try one or more of the
following nonprescription remedies.
- Ointments that protect the skin, such as zinc
oxide or petroleum jelly, are the best nonprescription remedies for
hemorrhoids. Ointments can prevent further injury and reduce itching by forming
a barrier over hemorrhoids.
- Use suppositories like those made by
Preparation H or Tucks (formerly Anusol) for 7 to 10 days to relieve irritation
and lubricate the anal canal during bowel movements. Some of these products
contain substances that can harm anal tissues if they are used for too
long.
- Apply an ointment that contains 1% hydrocortisone, a type of
steroid medicine that may relieve inflammation and itching. Your doctor may prescribe 2.5% hydrocortisone. But these products should not
be used for more than 2 weeks because they can thin the skin.
- Apply products that contain medicine to numb an area (local
anesthetic). These products often have the suffix "-caine" in the name or the
ingredients. Although these products help some people, especially those who
have painful external hemorrhoids, some people become allergic to them. Ask
your doctor before using these products.
- 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.
Surgery
Most
hemorrhoids do not require surgery. It is usually
considered only for severe hemorrhoids.
Surgery may be done if
other treatments (including home treatment) have failed. Surgery is also
considered when symptoms become so bothersome that your lifestyle is affected
or when hemorrhoids create a medical emergency, such as uncontrolled bleeding
or blood and pus at the anus along with severe rectal pain.
External hemorrhoids
External hemorrhoids usually
are not removed with surgery (hemorrhoidectomy) except if they are very large
and uncomfortable or if you are having surgery on the anal area for another
reason, such as internal hemorrhoids or a tear (anal fissure).
Internal hemorrhoids
Surgical removal of
hemorrhoids (hemorrhoidectomy) is a last resort for treating small internal
hemorrhoids.
Hemorrhoidectomy is considered the most successful
way to treat large internal hemorrhoids, especially those that are still a
problem after treatments that cut off blood flow to hemorrhoids (fixative
procedures) have been tried.
Surgery Choices
The surgical option for hemorrhoids is a
hemorrhoidectomy, used mostly for large internal
hemorrhoids.
What To Think About
- Hemorrhoids: Which Treatment Should I Use?
Sometimes, increased pressure on external
hemorrhoids causes them to get irritated and clot. This
causes a lump (thrombosed, or clotted, hemorrhoid) to form. You may suffer from
severe pain at the site of the clotted hemorrhoid.
A procedure to
relieve the pain can be performed in a doctor's office or
outpatient clinic. The doctor applies local anesthesia and then
makes a small
incision where the lump has occurred to remove the
clot and reduce pressure and pain. The procedure works best if it is done less
than 4 or 5 days after the clot has formed.
If the pain is
tolerable, you may choose to wait to see a doctor. The pain
usually goes away in a few days. After 4 or 5 days, the pain from cutting and
draining the hemorrhoid is usually worse than the pain from the clot.
Other Treatment
Many people who have
hemorrhoids find relief from symptoms through home treatment. See the Home
Treatment section of this topic for more information. If medical treatment is
necessary, fixative procedures are the most widely used nonsurgical treatments.
Other Treatment Choices
Fixative procedures include:
What To Think About
Not all doctors have the
experience or the equipment to perform all types of fixative procedures. This
may help you decide which procedure to choose. Ask your doctor which procedure
he or she does the most and how satisfied people have been with the outcomes of
that procedure.
See the Home Treatment section of this topic for
tips on keeping hemorrhoids from becoming worse or coming back after
treatment.
- Hemorrhoids: Which Treatment Should I Use?
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Anne C. Poinier, MD - Internal Medicine |
| Specialist Medical Reviewer |
Brent Shoji, MD - General Surgery |
| Last Revised |
September 22, 2010 |
