Hemorrhoids

Medically Reviewed By William C. Lloyd III, MD, FACS
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What are hemorrhoids?

Hemorrhoids are enlarged, bulging veins in the anus or rectum. They are external hemorrhoids if they occur outside the anus or internal hemorrhoids if they are inside the anus.

Hemorrhoids are extremely common, and the risk of developing hemorrhoids increases with age. They are also common during pregnancy or after recently giving birth. These distended veins are usually the result of straining that occurs during a bowel movement. In rare cases, hemorrhoids can be a manifestation of liver disease or malformations of the venous system.

External hemorrhoids can be painful, particularly when sitting and during a bowel movement. In addition, a blood clot, or thrombosis, can occur along with external hemorrhoids. A thrombosed hemorrhoid may bleed, swell painfully, or form a hard lump. An internal hemorrhoid can protrude or prolapse from the anus. In some cases, hemorrhoids can lead to more serious complications.

You can treat most hemorrhoids at home, usually through lifestyle and diet changes. A diet high in fiber and plenty of fluids can make bowel movements easier and less likely to produce straining. Over-the-counter creams and ointments can help reduce the swelling, itching and pain of hemorrhoids. Doctors may need to surgically treat severe cases if they do not respond to other hemorrhoids treatments.

Seek prompt medical care if you are being treated for hemorrhoids, but your symptoms persist, recur, or cause you concern.

What are the symptoms of hemorrhoids?

Hemorrhoids symptoms include anal itching or pain, particularly when you are sitting. You may also experience pain during your bowel movements, notice blood in your stool, or have a tender, hard lump near the anus.

Common symptoms of hemorrhoids

You may experience hemorrhoids symptoms daily or just once in a while. At times, any of these hemorrhoids symptoms can be severe:

  • Blood-streaked stools

  • Burning feeling

  • Change in bowel habits

  • Change in bowel movements

  • Constipation

  • Diarrhea

  • Itching feeling

  • Painful bowel movements

Symptoms that might indicate a serious condition

Seek prompt medical care if you are being treated for hemorrhoids and the symptoms recur or are persistent.

What causes hemorrhoids?

Hemorrhoids are most commonly the result of straining to have a bowel movement. Other hemorrhoids causes include constipation, diarrhea, or an anal infection. People who sit for long periods of time may also experience hemorrhoids.

Pregnancy and postpartum recovery can both increase the risk of developing hemorrhoids as a result of the increased pressure on the abdomen from the fetus or straining during labor. The hemorrhoids usually resolve with time after childbirth.

What are the risk factors for hemorrhoids?

A number of factors increase the risk of developing hemorrhoids. Not all people with risk factors will get hemorrhoids. Risk factors for hemorrhoids include:

How do you prevent hemorrhoids?

A diet high in fiber and with plenty of liquids can promote softer bowel movements. This can be helpful in both preventing and healing hemorrhoids. You may be able to lower your risk of hemorrhoids by:

  • Avoiding anal intercourse

  • Avoiding sitting for prolonged periods, which puts pressure on anal veins

  • Eating a diet high in soluble fiber and drinking plenty of liquids

  • Getting regular physical activity to help prevent constipation and maintain a healthy body weight, which can reduce pressure on anal veins

  • Having a bowel movement as soon as you feel the urge and not straining

  • Keeping the anal area clean and dry to avoid irritation of the rectum or anus

  • Taking an over-the-counter stool softener, such as psyllium (Fiberall, Metamucil) or methylcellulose (Citrucel)

  • Wiping the anus gently with a cotton pad or moistened cloth after a bowel movement

What are the diet and nutrition tips for hemorrhoids?

The goal of a hemorrhoid diet is to keep stools soft and easy to pass. This prevents constipation and straining to have a bowel movement. A hemorrhoid diet is basically the healthy diet everyone should be eating. It centers on eating high-fiber foods and drinking plenty of fluids.

Current guidelines suggest eating 14 grams of fiber for every 1,000 calories you consume. For an average 2,000 to 2,500 calorie per day diet, this means eating 28 to 35 grams of fiber. Reading food labels can tell you how much fiber you can get from packaged foods.

Foods you should eat to prevent or treat hemorrhoids include:

  • Beans and legumes

  • Fresh or dried fruits, such as prunes

  • Fresh or cooked vegetables

  • Whole grain starches and cereals

Drinking plenty of liquids is important when you eat fiber. It ensures fiber can do its job of absorbing fluids to keep stools soft. The best choice is water, but fruit juices and clear broths can also be helpful.

There are also foods you should limit if you are prone to developing hemorrhoids. These foods tend to contribute to constipation and harder stools:

  • Cheese

  • Chips and other snack foods

  • Fast food

  • Meat

  • Prepared foods, such as frozen entrees, and processed foods, such as hot dogs

Ask your healthcare provider for guidance before making significant changes to your diet or limiting a food group.

What are some conditions related to hemorrhoids?

An anal fissure can cause symptoms like a hemorrhoid. This includes rectal bleeding, itching and pain, especially with bowel movements. So, it is easy to confuse the two conditions. However, an anal fissure does not involve veins. Instead, it is a tear in the lining of the anal canal.

Initial treatment of an anal fissure is similar to treating hemorrhoids. However, chronic or recurrent anal fissures require treatments different than hemorrhoids. Knowing which one you have is important. See a doctor any time you have persistent rectal bleeding or other rectal symptoms.

When should you see a doctor for hemorrhoids?

See your doctor if you have hemorrhoids that last more than a week despite home care. You should also see your doctor any time you have:

  • Bleeding with bowel movements

  • Chronic changes in bowel habits or stool consistency

  • Persistent rectal bleeding

These symptoms can occur with more serious conditions, such as IBD (inflammatory bowel disease) and cancer.

Call 911 or go to your nearest emergency room for severe rectal bleeding with or without any of the following symptoms:

How do doctors diagnose hemorrhoids?

To diagnose hemorrhoids, your doctor will take a medical history and perform a physical exam. Questions your doctor may ask about your hemorrhoids include:

  • What symptoms are you experiencing?

  • When did your symptoms start? Did anything happen to start them, such as an episode of constipation?

  • How severe are your symptoms? How much discomfort do they cause?

  • What, if anything, seems to make your symptoms better or worse?

  • How often do you typically have a bowel movement? Has this changed recently?

  • Has the consistency of your stool changed recently?

  • Describe your diet. How much fiber do you eat?

  • Do you have a family history of hemorrhoids or other bowel problems?

Your doctor will likely be able to diagnose external hemorrhoids by visually examining your anal area. To diagnose internal hemorrhoids, your doctor will perform a DRE (digital rectal exam). This involves inserting a gloved, lubricated finger into your rectum.

Depending on the results of this exam, your doctor may perform an anoscopy or rigid proctosigmoidoscopy. Both exams are office procedures that involve inserting a thin instrument to examine the lining of the anus and rectum. Either exam is necessary to confirm a diagnosis of internal hemorrhoids.

How do you treat hemorrhoids?

A diet high in fiber along with plenty of liquids can promote softer bowel movements and prevent strain-induced hemorrhoids. Your healthcare provider may suggest frequent warm baths to help hemorrhoids heal.

Most hemorrhoids heal on their own. Some hemorrhoids may require a surgical intervention, a procedure known as a hemorrhoidectomy.

Self-care hemorrhoid treatment

Most hemorrhoids can be treated with self-care including:

  • Avoiding irritation to the rectum or anus

  • Drinking plenty of liquids

  • Eating a diet high in soluble fiber

  • Keeping the anal area clean and dry

  • Taking a warm bath after each bowel movement

  • Take an over-the-counter stool softener, such as psyllium (Fiberall, Metamucil) or methylcellulose (Citrucel)

  • Using an over-the-counter numbing cream to relieve pain and itching

  • Wiping the anus gently with a cotton pad or moistened cloth after a bowel movement

Medical treatment for hemorrhoids

Medical treatments for hemorrhoids may include topical medications, such as nitroglycerin or nifedipine.

Surgical treatment for hemorrhoids

If your hemorrhoids are severe or recurrent, your healthcare provider may recommend treatments including:

  • Coagulation therapy to decrease the size of internal hemorrhoids

  • Hemorrhoidectomy (surgical removal of hemorrhoids)

  • Rubber band ligation to remove the hemorrhoids

  • Sclerotherapy (injection of a chemical that causes shrinkage and scarring of hemorrhoids)

What are the potential complications of hemorrhoids?

Complications of untreated or poorly controlled hemorrhoids can be serious. You can help minimize your risk of complications by following the treatment plan that you and your healthcare provider design specifically for you. Complications of hemorrhoids include:

  • Chronic anal itching, irritation

  • Chronic bleeding, which can lead to anemia

  • Fecal soiling

  • Infection

  • Severe discomfort or pain if the hemorrhoid forms a clot or strangulates (cuts off blood supply)
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Oct 6
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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