Hemorrhoids are an irritating, often painful condition that occurs when the veins around the anus or lower part of the rectum become swollen and inflamed as a result of too much pressure. External hemorrhoids develop underneath the skin around the anus, while internal hemorrhoids develop in the lining of the tissues.
Hemorrhoids affect about 1 in 20 Americans, and about half of adults over age 50 have them. Age is one factor; as we get older, the supporting tissues in the rectum and anus become weaker and more vulnerable to pressure.
Pregnancy also can weaken these tissues, which is why pregnant women often experience hemorrhoids. Other potential causes include chronic constipation or diarrhea, straining during bowel movements and sitting on the toilet for extended periods. Also, frequently lifting heavy objects may increase the likelihood of hemorrhoids.
Hemorrhoid symptoms vary depending on whether the inflamed veins are external or internal.
External hemorrhoids may cause itching and pain, especially while seated. Also, you may feel one or more tender lumps around the anal area. Scratching, rubbing or excessively cleaning the area can make symptoms worse.
With internal hemorrhoids, you may notice bright red blood when you have a bowel movement. Internal hemorrhoids are not usually painful unless they fall through the anal opening, called prolapsing.
While hemorrhoids are not dangerous, they can develop complications. An external hemorrhoid may become infected or develop blood clots. Internal hemorrhoid bleeding may lead to anemia, or a low red blood cell count.
In many cases, hemorrhoids will go away on their own within a few days, including prolapsed hemorrhoids. You can help reduce the irritation by eating more high-fiber foods, such as whole grains and green, leafy vegetables and drinking plenty of fluids (minimize coffee and alcoholic beverages, which can further irritate the area).
Try to avoid straining during a bowel movement, as this can make hemorrhoids worse. A fiber supplement or gentle stool softener may help.
If you have pain, try taking a warm bath or a sitz bath, which is a shallow plastic tub that allows you to sit in just a few inches of water. Sitz baths are available over the counter; adding Epsom salt may help to soothe the irritation. Be sure to dry the area thoroughly after a bath.
Over-the-counter hemorrhoid creams or suppositories can help relieve mild symptoms, such as itching, pain and swelling. Follow the directions carefully.
If at-home remedies do not provide relief, it may be time to see a doctor.
“Hemorrhoids are the most common cause of bleeding, but we want to rule out other conditions that can cause bleeding, such as Crohn’s disease, ulcerative colitis and cancer.”
If you have severe pain or bleeding, call your doctor right away, especially if you also have fever or abdominal pain. Your doctor will start with a physical exam and medical history. External hemorrhoids often can be diagnosed with a visual exam. Internal hemorrhoids may be diagnosed with a digital rectal exam or an anoscopy, which uses a device called an anoscope inserted into the rectum to examine the area.
“If medical treatment for hemorrhoids is needed, we may use various procedures to cut off the blood supply and/or cause scar tissue to form, both of which shrink the hemorrhoid,” says Dr. Dajani.
In some cases, a surgeon may perform a hemorrhoidectomy to remove large external hemorrhoids and prolapsing internal hemorrhoids.
Some people do have recurring hemorrhoids. While weakened supporting tissues in the rectum and anus can raise your risk of hemorrhoids, you can make lifestyle changes to help prevent them.
Be sure to eat plenty of high-fiber foods, and talk to your doctor about adding a fiber supplement to your diet. Also, stay hydrated, which can help keep stools soft and easier to pass. Try not to spend more time sitting on the toilet than necessary. If you are not ready to go, try again later.