Hemorrhoids

What are hemorrhoids?

Hemorrhoids are swollen veins in the lower rectum and anus. The anus is the lowest part of the rectum. It is the opening where bowel movements pass from your body.

Hemorrhoids are a common problem. They can cause pain, bleeding, and itching. Another name for them is piles.

Hemorrhoids may be external (around the anus) or internal (inside the rectum).

• External hemorrhoids can be seen or felt easily around the anal opening. When the swollen veins are scratched or broken by straining, rubbing, or wiping, they sometimes bleed.
• Internal hemorrhoids are often painless but they sometimes cause a lot of bleeding. The internal veins may stretch and even fall out (prolapse) through the anus to outside the body. The veins may then become irritated and painful.

Usually hemorrhoids do not pose a danger to your health. In most cases the symptoms go away in a few days without treatment. The painful lumps of more severe cases should get better in a week or two with treatment.

What is the cause?

Veins in the rectum and around the anus tend to swell under pressure. Hemorrhoids can result from too much pressure on these veins. You may put pressure on these veins by:

• straining to have a bowel movement when you are constipated
• waiting too long to have a bowel movement
• sitting for a long time on the toilet, which causes strain on the anal area
• sitting anywhere for a long while
• coughing and sneezing often

Hemorrhoids may also develop from:

• diarrhea
• obesity
• injury to the anus, for example, from anal intercourse
• some liver diseases

Flare-ups of hemorrhoids may occur during periods of stress. Some people inherit a tendency to have hemorrhoids.

Pregnant women should try to avoid getting constipated because hemorrhoids are more likely to happen during pregnancy. In the last trimester of pregnancy, the enlarged uterus may press on blood vessels and cause hemorrhoids. Also, the strain of childbirth sometimes causes hemorrhoids after the birth.

What are the symptoms?

Symptoms of hemorrhoids include:

• itching, mild burning, and bleeding around the anus (for example, you might see bright red blood on toilet paper after wiping)
• swelling and tenderness around the anus
• pain with bowel movements
• painful lumps around the anus ranging in size from a pea to a walnut (in severe cases)

How are they diagnosed?

Your healthcare provider will ask about your medical history, including whether you have had constipation. Your provider will examine your rectum and anus. Your provider may use a special lighted tool called a proctoscope or anoscope to look inside the rectum.

How are they treated?

The following treatments usually help to relieve most cases of hemorrhoids:

• High-fiber diet

  Eat more high-fiber foods, which will help prevent constipation. The best sources of fiber are beans (navy, kidney, or black beans); whole-grain cereals, such as shredded wheat or cereals with bran; fresh fruit (apples with skins on); and raw or cooked vegetables, especially cabbage, carrots, corn, and broccoli.

• Fluids

  Drink plenty of water. This helps to soften bowel movements so they are easier to pass.

• Sitz baths and cold packs

  Sitting in lukewarm water 2 or 3 times a day for 15 minutes cleans the anal area and may relieve discomfort. (If the bath water is too hot, swelling around the anus will get worse.) Also, putting a cloth-covered ice pack on the anus or sitting on a covered ice pack for 10 minutes, 4 times a day might help.

• Medicine

  For mild discomfort, your healthcare provider may prescribe a cream or ointment for the painful area. The cream may contain witch hazel, zinc oxide, lidocaine, or petroleum jelly. Your provider may also prescribe medicated suppositories to put inside the rectum.

• Procedures and surgeries

  A number of procedures can be used to remove or shrink hemorrhoids.

  • If you have painful, protruding internal hemorrhoids, your healthcare provider can do a procedure called hemorrhoid banding. Your provider will put a tight band around the swollen vein. He or she may then cut the hemorrhoid open, remove any blood clots, and let the vein heal. Or your provider may let the hemorrhoid dry up and fall off. Hemorrhoid banding is effective in most cases.
  • Your provider can destroy hemorrhoids with freezing, electrical or laser heat, or infrared light.
  • Your provider may shrink the hemorrhoid by injecting a chemical around the swollen vein.
  • For severe cases, a surgical procedure called a hemorrhoidectomy may be done. For this procedure you are first given an anesthetic to keep you from feeling pain. Then your surgeon cuts out the hemorrhoids.

How can I take care of myself?

Always tell your healthcare provider when you have rectal bleeding. Although bleeding is often from hemorrhoids, more serious illnesses, such as colon cancer, can also cause bleeding.

Follow these guidelines to help prevent hemorrhoids and to relieve their discomfort:

• Don’t strain during bowel movements. The straining makes hemorrhoids swell.
• Follow your high-fiber diet and drink plenty of water. If necessary, take a stool softener, such as Haley's M-O, psyllium, Metamucil or Citrucel, or mineral oil. Softer stools make it easier to empty the bowels and reduce pressure on the veins.
• Don't overuse laxatives. Diarrhea can be as irritating to the anus as constipation.
• Ask your healthcare provider what nonprescription product you should buy to relieve pain and itching. Also, ask about side effects of medicine prescribed for you.
• Exercise regularly to help prevent constipation. Ask your healthcare provider for an exercise prescription.
• Avoid a lot of wiping after a bowel movement if you have hemorrhoids. Wiping gently with soft, moist toilet paper (or a commercial moist pad or baby wipe) may relieve discomfort. If necessary, shower instead of wiping, and then dry the anus gently.
• Avoid lifting heavy objects when you have hemorrhoids. It may increase the pressure on the veins and make the hemorrhoids worse.