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What Are Hemorrhoids?
Hemorrhoids are enlarged and swollen veins around the outside of the anus or in the lower rectum, the last part of the bowel that leads to the anus.
Hemorrhoids may be painful and particularly bothersome if they are recurrent, but they're rarely serious, and symptoms usually go away on their own. Several treatment options exist for more problematic hemorrhoids.
Here’s what to know about the types, symptoms, and treatments for hemorrhoids and how to prevent them from forming.
There are four types of hemorrhoids.
Internal Hemorrhoids These develop inside the rectum and are not usually visible to the naked eye. Internal hemorrhoids generally don't hurt, but they often bleed.
Prolapsed In some cases, internal hemorrhoids may protrude through the anus and can be seen, which is known as prolapse. These may bleed or cause pain. Prolapsed hemorrhoids will usually shrink back inside the rectum on their own, but sometimes they may need to be pushed back in.
External Hemorrhoids These hemorrhoids develop under the skin around the outside of the anus. These may be itchy, painful, and lumpy. They may also bleed.
Thrombosed Hemorrhoids When a blood clot forms within an external hemorrhoid, this is known as a thrombosed hemorrhoid. These can cause severe, ongoing pain, pressure, and general discomfort. Sometimes clots dissolve on their own. If they don’t, a doctor may need to remove them.
Hemorrhoid symptoms depend on the type.
Internal
Internal hemorrhoids often do not cause any ongoing symptoms, though straining when passing a bowel movement may cause painless bleeding. You may notice bright red blood in the toilet.
Prolapsed
If the internal hemorrhoid pushes through the anal opening, it may cause pain and itchiness. You may also feel the hemorrhoid when wiping.
External
External hemorrhoids can cause:
- Swelling around the anus
- Itching or irritation in the anal region
- Discomfort or pain
- Bleeding
Thrombosed
A thrombosed hemorrhoid occurs when blood pools and collects in the tissue. Symptoms include:
- Swelling
- Severe pain
- A discolored, hard lump near the anus
- Inflammation
Hemorrhoids occur when there is too much pressure on the veins in your anus or rectum, causing them to swell and become inflamed.
Activities and conditions that can lead to hemorrhoids or irritate them if they already exist include:
- Consuming a low-fiber diet
- Pushing hard to have a bowel movement
- Pregnancy
- Engaging in anal intercourse
- Being overweight or obese
- Chronic constipation or diarrhea
- Straining when weight lifting or lifting heavy objects
- Sitting on the toilet for long periods of time
Other risk factors can include:
- A family history of hemorrhoids
- Rectal surgery
- Spinal injury
- A sedentary lifestyle
- Inflammatory bowel disease (IBD)
- Aging
Your doctor will typically review your personal and family medical history and your symptoms before performing a physical examination of your anus and rectum. This can involve visual inspection as well as a digital rectal exam, in which a doctor inserts a gloved finger into the anus and rectum to feel the tissue.
For internal hemorrhoids, your doctor will need to use an anoscope. This finger-size instrument allows the doctor to determine the hemorrhoid’s bulk. It also allows them to see the entire anal canal.
You may also need a sigmoidoscopy for further examination. Similar to a colonoscopy, this procedure involves using a tube-like instrument with a camera that can give a clear view of the lower part of the colon. This can help rule out other possible causes of symptoms, such as cancer, polyps, and other conditions that may cause bleeding.
Fortunately, most hemorrhoids can be treated at home or with simple medical procedures in a doctor’s office. More severe hemorrhoids may need a surgical procedure.
Medications
Hemorrhoids that cause only minor discomfort or itchiness may only need topical medications. These can include creams, ointments, pads, and suppositories. These medications often contain lidocaine, hydrocortisone, or witch hazel to relieve pain and itchiness.
Your doctor may also recommend oral medications, such as stool softeners. These can help reduce straining and difficulty in passing stool.
Sitz Baths
Sitz baths involve sitting in shallow, warm water to clean the genital and anal areas, increase blood flow to the area, and relax the pelvic muscles. You can take a sitz bath in your bathtub or use a sitz bath bowl that fits over the toilet.
To ease hemorrhoids, use a sitz bath for 10 to 15 minutes, two to three times a day.
Wash the bathtub or sitz bath bowl with soap and water after each use.
Surgery
Several minimally invasive procedures can help a doctor treat more aggressive or painful hemorrhoids.
Options include:
- Sclerotherapy In this procedure, a doctor injects a small amount of medication into the hemorrhoid to help shrink it. Though painless, it is often less effective than other methods of removal.
- Rubber Band Ligation In this procedure, a doctor places one or more small rubber bands around the base of a hemorrhoid. This helps to cut off the blood supply to the hemorrhoid and causes it to fall off within a few days. The procedure can be uncomfortable and cause bleeding within two to four days. More major complications are rare.
- Coagulation In this procedure, a doctor uses infrared light, lasers, electrical currents, or heat to cause small, bleeding hemorrhoids to harden and shrivel. It is generally not painful and has few side effects.
More invasive surgical interventions may be needed for more severe hemorrhoids or ones that do not respond to other treatment methods. Surgical treatments can include:
- Transanal Hemorrhoidal Dearterialization (THD) During this procedure, a surgeon ties off hemorrhoids and pulls them back into the anus. They secure them with stitches.
- Hemorrhoidectomy A hemorrhoidectomy removes either a prolapsed internal hemorrhoid or large external hemorrhoids.
- Hemorrhoid Stapling This procedure uses a stapling instrument to remove hemorrhoids or to pull them back into the anus and keep them secure.
Keeping your stool soft and having regular bowel movements is one of the best ways to prevent hemorrhoids. The following tips may help you prevent constipation.
Get plenty of fiber in your diet. A high-fiber diet can make stool softer and bulkier so that it passes easily. According to the USDA's Dietary Guidelines for Americans, adult men younger than 50 should aim for at least 34 grams (g) of fiber a day, and adult women under 50 should aim for 25 g. For people older than 50, the recommendation is slightly lower: 28 g for men and 22 g for women. Be careful to add fiber to your diet slowly to avoid excessive gas or bloating.
Fiber-filled foods include fruits such as berries, avocados, and pears (especially when you eat the skin), and vegetables like broccoli, artichokes, and Brussels sprouts. Whole grains, such as brown rice, quinoa, and oatmeal, are also an important source. Eating legumes — including lentils, beans, and green peas — as well as nuts and seeds, will also help you meet your dietary fiber needs.
If you're having trouble getting enough fiber in your regular diet, consider talking to your doctor about a fiber supplement.
If you experience chronic constipation and suspect that it may be contributing to your hemorrhoids, avoid eating too many foods that contain little or no fiber, such as cheese and fast and processed foods.
Drink plenty of water and other fluids. Recommendations for daily water intake vary and depend on the individual, but the Institute of Medicine of the National Academies has set adequate intake levels at 2.7 liters (91 ounces [oz]) for women and approximately 3.7 liters (125 oz) for men. Fluids can come from beverages other than water. But alcohol can be dehydrating and should not be counted in reaching this intake goal. Coffee and sugar-sweetened beverages also have less of a hydrating effect than drinks without caffeine or added sugar.
Exercise regularly. Exercise can help keep bowel movements regular. Regular exercise may also help you lose weight; excess weight may contribute to hemorrhoids. Aim to move at least 30 minutes every day in a way that is enjoyable and sustainable for you, but note that heavy weight lifting and similar activities that lead to straining may worsen symptoms.
Other tips for preventing hemorrhoids include:
- Try to use the bathroom at the same time each day — such as first thing in the morning or after breakfast — to train the bowels to move regularly.
- Avoiding straining or holding your breath during bowel movements. Straining can put excess pressure on veins and lead directly to hemorrhoid development. Stress reduction techniques such as deep breathing can be helpful to avoid straining.
- Go to the bathroom as soon as you feel the urge. Letting the urge subside can make your stool harder to pass.
Avoiding sitting on the toilet for too long. Sitting on the toilet for too long can stress veins in the anus. Avoid using your phone or reading while on the toilet since that will likely keep you there longer. Using a toilet stool that elevates the feet and legs relaxes the pelvic floor muscles and makes passing stool easier.
How long hemorrhoids last depends on their severity and type.
Internal hemorrhoids generally have a good prognosis. They will often resolve with minimal medical intervention. With minimal treatment, the recurrence rate is about 10 to 50 percent within five years. With surgical treatment, the recurrence rate is less than 5 percent.
External hemorrhoids may also spontaneously heal or improve with minimal medical interventions. In some cases, however, they can recur, leading to infections, thrombosis, or, potentially, incontinence.
Recurrence rates for external hemorrhoids following minimal treatment are more than 50 percent. Following surgical treatment, the recurrence rate is about 5 to 10 percent.
Hemorrhoid complications are rare. When they occur, they may include:
- Anemia Bleeding from chronic hemorrhoids can cause anemia, or a deficiency in red blood cells. Red blood cells carry oxygen throughout the body, so having anemia can make you feel tired, weak, or short of breath.
- Strangulated Hemorrhoid In rare situations, swelling may cut off the oxygen supply to a hemorrhoid that has prolapsed, causing a strangulated hemorrhoid. This can be extremely painful and incapacitating, and surgery may be needed to treat it.
- Blood Clots Thrombosed hemorrhoids can be very painful, though they are not generally dangerous. In some cases, a doctor may need to drain them.
Surgery to remove hemorrhoids can cause complications including:
- Ongoing bleeding
- Incontinence
- Infection
- Problems urinating
Hemorrhoids are common in both men and women, affecting about 1 in 20 Americans. They affect nearly half of all people over the age of 50.
Hemorrhoids are also common in pregnancy, affecting about 30 to 40 percent of pregnant women.
It’s estimated that 75 percent of Americans will have hemorrhoids at some point in their lives. Hemorrhoids are the third most common outpatient gastrointestinal diagnosis in the United States, accounting for about four million office and emergency department visits every year. The overall prevalence of hemorrhoids is estimated to be between 4 and 40 percent.
Some evidence suggests that white people between the ages of 45 to 65 from higher socioeconomic statuses have higher rates of hemorrhoids than people of other races. This statistic may be artificially high, though, because of selection biases and better access to care.
Hemorrhoids are most common in older adults between the ages of 45 and 65 and least common in people under age 20.
Conditions that may have similar symptoms to hemorrhoids include:
- Anal fissures: These are small tears in the lining of the anus that can cause pain and bleeding.
- Rectal prolapse: With rectal prolapse, part of the rectum slips outside the anus; this can look like external hemorrhoids.
- Ulcerative colitis: Ulcerative colitis is a type of inflammatory bowel disease (IBD) that can cause rectal bleeding.
- Anal fistulas or abscesses: These may cause swelling, pain, or discharge near the anus.
Colorectal polyps or colorectal cancer can also cause rectal bleeding in some cases.
The Takeaway
- Hemorrhoids are swollen, enlarged veins around the anus and rectum.
- Signs and symptoms of hemorrhoids include blood on toilet paper or in stool after a bowel movement, itching or pain in the anal area, pain during bowel movements, and hard, painful lumps around the anus.
- Causes include chronic diarrhea and constipation, straining too hard, and sitting on the toilet for too long. Risk factors include being overweight, a lack of fiber in the diet, aging, and pregnancy.
- Hemorrhoids can usually be treated at home, and they tend to go away in a week or so. For persistent or more complicated types of hemorrhoids, a surgical procedure may be necessary.
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