Hemorrhoids
Hemorrhoids, also called piles, are swollen, enlarged veins that form inside and outside of the anus and rectum. They are caused by too much pressure and irritation on the veins in the anus or rectum from straining or pushing to have a bowel movement, lifting heavy objects or weightlifting, sitting on the toilet for extended periods of time, having chronic diarrhea or constipation, and/or eating a low fiber diet. Although hemorrhoids may bleed, itch, or cause pain, they are not usually a sign of a more serious condition. Symptoms from hemorrhoids can often be treated at home and managed through lifestyle changes.
Symptoms
Symptoms of hemorrhoids differ depending on the location and type of hemorrhoid.
- Internal hemorrhoids are swollen veins inside the rectum that often bleed but aren’t usually painful. Blood may be present with wiping.
- External hemorrhoids are swollen veins underneath the skin around the anus that can be itchy and painful. External hemorrhoids may be felt or seen. Blood may be present with wiping.
- Prolapsed hemorrhoids are internal hemorrhoids that bulge out of the anus and bleed and cause pain. These may be hard lumps that feel tender or sore.
- Thrombosed hemorrhoids are from a blood clot forming in an external hemorrhoid that are painful and cause a purple/blue lump outside the anus.
Hemorrhoids also look different depending on the type. An internal hemorrhoid can’t be seen unless it prolapses. A prolapsed internal hemorrhoid is a small lump near the anus that can be pushed back in. Non-thrombosed external hemorrhoids are usually the color of the surrounding skin, are soft to touch, and cannot be pushed back in. Thrombosed external hemorrhoids can be black, blue, or purple, are firmer to touch, and are often more painful.
Risk Factors
Hemorrhoids are caused by too much pressure on the veins in the anus or rectum. The pressure and irritation lead to swelling and inflammation in the veins causing hemorrhoids. As people age, the risk of hemorrhoids increases because the tissues that support the veins in the rectum and anus can weaken and stretch. This also occurs in pregnancy from the baby’s weight putting pressure on the anal area. Irregular bowel movements also increase a person’s risk of developing hemorrhoids. Other activities or conditions that cause pressure and lead to or worsen hemorrhoids are:
- Straining or pushing to have a bowel movement
- Straining to lift heavy objects or weightlifting
- Sitting on the toilet for long periods of time
- Having chronic constipation or diarrhea
- Having anal intercourse
- Eating a low-fiber diet
When to Seek Care
Hemorrhoids can be diagnosed by a healthcare provider based on symptoms and a physical exam. Patients should seek medical evaluation if symptoms worsen or interfere with daily life or sleep or if symptoms don’t improve after a week of home therapies. Patients experiencing large amounts of rectal bleeding, lightheadedness, dizziness, or fainting should seek emergency care.
Treatment
Small hemorrhoids will often resolve in response to dietary and toilet habit changes, although pain and bleeding may last longer than a week. The pain, swelling, and inflammation of hemorrhoids can usually be treated with home therapies such as:
- Using topical over-the-counter medications containing lidocaine, witch hazel, or hydrocortisone
- Increasing dietary fiber intake by eating foods high in fiber or taking fiber supplements
- Drinking more water
- Soaking in a warm bath or sitz bath for 10-20 minutes per day
- Taking over-the-counter pain relievers (such as acetaminophen or ibuprofen)
While many hemorrhoids don’t cause complications and will improve or resolve with therapeutic management, some may linger or worsen requiring procedural or surgical intervention by a specialist.
Prevention
Hemorrhoids are common and can’t always be prevented but some steps can help reduce the risk of developing hemorrhoids:
- Stay active
- Drink lots of water throughout the day
- Don’t sit too long or push too hard on the toilet
- Use the toilet when the need arises – don’t wait or hold it in
- Eat high-fiber foods (fresh fruits, vegetables, and whole grains) or take fiber supplements
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