What Are Hemorrhoids?

Definition

Hemorrhoids are a normal part of the human body. Many adults will experience symptoms from hemorrhoids at some point in their lifetime. They are swollen blood vessels in your rectum and anal canal, the last part of the intestine. When they become swollen, they can cause symptoms like bleeding, itching, and pain. 

There are two different types of hemorrhoids: 

1. Internal hemorrhoids: These occur inside the rectum. In other words, they are usually not visible when you look from the outside. 

2. External hemorrhoids: These usually lie in the external skin around the anus. These are the ones that people can see and feel. 

Causes

Hemorrhoids are normal. The three main reasons people develop hemorrhoids are:

1. Increased number of bowel movements

2. Prolonged time spent sitting on the toilet

3. Increased straining when having a bowel movement

There are many reasons that the above situations can occur. Factors that have been associated with hemorrhoids include:

• Chronic constipation

• Diarrhea

• Pregnancy

• Low fiber diet

• Straining while doing heavy lifting

• Advanced age

• Prolonged sitting

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Symptoms

Hemorrhoids can cause a variety of symptoms. The most common ones include: 

• Irritation or itching: This affects the anal skin around the hemorrhoid. It can be worsened by aggressive wiping or cleaning around the rectum.

• A lump or swelling: This occurs around the anus or rectum. People can usually feel this with their fingers. 

• Bleeding: The blood tends to be bright red. People notice blood dripping into the toilet bowl, on top of a bowel movement, or on toilet paper after wiping.

• Pain: A blood clot inside the hemorrhoid and the blood supply to the hemorrhoid being affected both cause pain. 

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Diagnosis

External hemorrhoids are easy to diagnose based on symptoms and a quick physical exam. 

Since internal hemorrhoids are not visible from the outside, they can be diagnosed in a number of ways, including:

• Digital rectal exam: a provider examining the rectum by feeling with a finger

• Anoscopy: a small tube that allows a provider to see the inside of a rectum

Sometimes internal hemorrhoids are detected during a colonoscopy. During this procedure, a provider inserts a camera up the rectum to look at the intestine. This procedure is used to look for something other than hemorrhoids, but it will detect hemorrhoids if they are there. 

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Treatments

Hemorrhoids only need to be treated if they are causing symptoms. If you do have symptoms, there are a few things you can try at home. These include:

• Increasing your fiber intake (20 g to 30 g per day) 

• Increasing your water intake (six to eight glasses per day)

• Taking sitz baths, which means you sit in warm water up to your hips

• Getting topical relief with Tucks pads (witch hazel wipes) or ice packs

• Using a hydrocortisone suppository or other steroid ointment

• Taking stool softeners like docusate

If you have significant pain or bleeding, or your hemorrhoid symptoms don’t improve with the above treatments, it is time to go see your provider. They can perform some simple procedures in the office to help reduce the hemorrhoids or refer you to a specialist who is trained in hemorrhoid procedures. 

Office-based and surgical treatment options include:

• Rubber band ligation (also called banding): This procedure cuts off blood supply by encircling the hemorrhoid with a band.

• Surgical removal (also called hemorrhoidectomy): This is a little more involved and requires a surgeon to actually cut out the hemorrhoid.

• Sclerotherapy: This treatment involves injecting a medicine directly into the hemorrhoid. The medicine cuts off blood flow to the hemorrhoid so that it eventually shrinks.

• Infrared coagulation: This technique uses an infrared-heated device to burn the blood vessels that supply the hemorrhoid.

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Prevention

There are lifestyle modifications you can make to help lower the chances of developing hemorrhoids. These include:

• Eating more fiber (20 g to 30 g per day)

• Taking an over-the-counter medication for constipation, like Miralax or docusate

• Drinking more water (six to eight glasses per day)

• Avoiding holding in your stool when you need to go to the bathroom

• Minimizing time spent on the toilet, even if just browsing on your phone

• Exercising, which helps keep the bowels moving

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