What is Hemorrhoids?
Hemorrhoids (often called piles or haemorrhoids) are swollen and inflamed veins in the anus and rectum.
Hemorrhoids are an especially common disorder. By age 50, about half of
adults deal with the itching, bleeding and pain that often signal the presence
of this condition. Men are more likely than women to suffer from hemorrhoids
that require professional medical treatment. Hemorrhoids usually are not
dangerous or life threatening, often go unnoticed and usually clear up after
a few days, but can cause long-lasting discomfort, bleeding and be excruciatingly painful.
Symptoms of hemorrhoids include: anal itching, anal ache or pain, especially
while sitting, bright red blood on toilet tissue, stool, or in the toilet
bowl; pain during bowel movements; one or more hard tender lumps near the
anus. Hemorrhoids can mask a more serious disorder and, therefore, must
be evaluated and diagnosed properly by a physician. People with hemorrhoids
who work closely with their physician are usually assured a good outcome
and relief from this common disorder.
Types of Hemorrhoids
Hemorrhoids can develop inside the anal canal (internal) or
near the anal opening (external). Both types can occur at the same time.
Internal hemorrhoids lie inside the anus or lower rectum,
beneath the anal or rectal lining. They usually don't hurt but they may bleed painlessly. Rectal bleeding is the most common symptom
of internal hemorrhoids. You may notice bright red streaks of blood on toilet
paper or bright red blood in the toilet bowl after having a normal bowel movement.
When hemorrhoids remain inside the anus they are almost never
painful, but they can prolapse (protrude outside the anus) and become irritated
and sore. Sometimes prolapsed hemorrhoids move back into the anal canal
on their own or can be pushed back in, but at other times they remain permanently
outside the anus until treated by a doctor. These can be very painful.
Internal hemorrhoids are classified by degree of severity according to the extent of prolapse:
- First degree: hemorrhoid does not prolapse from the anus.
- Second degree: hemorrhoid prolapse from the anus during a bowel movement
but returns to the anal canal afterward.
- Third degree: hemorrhoid prolapse from the anus during a bowel movement,
but can be pushed inside the anus manually.
- Fourth degree: hemorrhoid is always outside the anus and cannot be
pushed into the anal canal (incarcerated, irreducible prolapse).
External hemorrhoids lie outside the anal opening below the pectinate line. External
hemorrhoids are masses of veins located underneath the skin at the anus. These
are different than internal hemorrhoids, which are veins located beneath the
lining of the rectum, just above the anus.
External piles seldom produce symptoms unless thrombosis occurs. External hemorrhoids can cause
itching, burning, and irritation. You might notice streaks of bright red
blood on toilet paper after straining to have a bowel movement, and it may
be difficult to clean the anal area. When a blood clot forms in an external
hemorrhoid (creating a thrombosed hemorrhoid), the skin around
the anus becomes inflamed and a very painful lump develops. On rare occasions
the clot will begin to bleed after a few days and leave blood on the underwear.
A thrombosed hemorrhoid will not cause an embolism.
Common symptoms of hemorrhoids include:
- Anal itching
- Anal ache or pain
- Painless bleeding
- Bright red blood on toilet tissue, stool, or in the toilet bowl
- Pain during bowel movements
- One or more hard tender lumps near the anus
Hemorrhoids causes and risk factors
Precisely why hemorrhoids develop is unknown. The major contributing factor
appears to be too much pressure on the veins in the rectum. If the pressure
continues, the veins become enlarged and protrude.
Common causes and risk factors of hemorrhoids include:
- Constipation is one of the main causes of hemorrhoids.
This is because constipated individuals tend to consistently strain to
evacuate their bowels, increasing pressure in the rectum.
- Diarrhea. Frequent diarrhea can be caused by illness, diet, disease,
and the misuse of laxatives.
- Genetic predisposition (heredity). Because the tendency to develop
hemorrhoids seems to run in families, doctors believe that at least part
of the risk for hemorrhoids is genetic (inherited).
- Overuse of laxatives. Frequent use of laxative may result in
diarrhea, and increase your likelihood of getting hemorrhoids.
- Pregnancy and labor. Hemorrhoids are a common, usually temporary
problem among pregnant women caused by hormonal changes and increased
pressure by the growing fetus which forces the veins to work harder to
pump blood. During labor, hemorrhoids may develop because of the intense
pressure on the anal area while pushing to deliver the baby.
- Chronic venous insufficiency. Hemorrhoids can be a sign of general
weakness in the veins. Contributing factors are standing or sitting for
long periods, being overweight, not exercising enough, and smoking.
- Inflammatory bowel disease. Ulcerative colitis or Crohn's disease
may be the underlying cause of hemorrhoids.
- Portal hypertension. Increased pressure within the portal vein
blood from the intestines to the liver. Liver cirrhosis (scarring) is
the most common cause.
- Aging. Starting in the thirties, there is a progressive weakening
of the support structures in the area. Half of people who are older than
50 seek treatment for hemorrhoids.
- Excessive pressure on the veins in the pelvic and rectal area
causes hemorrhoids. As pressure increases, blood pools in veins and causes
them to swell, stretching the surrounding tissue and forming hemorrhoids.
- Excess weight, especially in the abdomen and
pelvis, may increase pressure on pelvic veins.
- Spending long periods of time on the toilet (like reading).
- Prolonged sitting or standing. This may cause blood to pool in
the anal area and increase pressure on the veins.
- Frequent heavy lifting. This can cause a sudden increase of pressure
in blood vessels
- Sedentary lifestyle.
- Lack of fiber.
- Low daily intake of fluids.
- Anal intercourse
However, some people will have none of these conditions and still develop
hemorrhoids. Humans are prone to hemorrhoids because erect posture puts
a lot of pressure on the veins in the anal region.
Hemorrhoids home-based remedies
Home treatment is the first step in treating hemorrhoids. Hemorrhoids
can often be effectively dealt with by dietary and lifestyle changes. Home
treatment includes adjusting your diet to avoid constipation, using a stool
softener, or using ointments to relieve symptoms.
- Sitz baths. A sitz bath is a warm water bath for the buttocks
and hips (the name comes from the German "sitzen," meaning "to sit").
It can relieve itching, irritation, and spasms of the sphincter muscle.
Most experts recommend a 20-minute sitz bath after each bowel movement
and two or three times a day in addition. Take care to gently pat the
anal area dry afterward; do not rub or wipe hard.
- Ice packs. Putting cold packs on the anus for short durations
help reduce swelling and pain. It can also provide relief from the itching
and burning experienced even if it is only temporary.
- Medications. Hemorrhoidal creams or suppositories can relieve
pain, reduce swelling, protect skin and/or reduce bleeding. Creams that
contain hydrocortisone can be used for itching or pain.
- Stool softeners may be used to avoid straining and constipation and are helpful for prolapsed and strangulated hemorrhoids.
- Fiber shows a consistent beneficial effect for
relieving hemorrhoid symptoms and bleeding. It softens the stool and increases its bulk, which will help lessen
the straining that can cause hemorrhoids. Fruit, leafy vegetables, and
whole-grain breads and cereals are good sources of fiber. Another fiber
source is Metamucil, which can take up to a week to work. Fiber and bran
retain water in the stool, producing soft, bulky stools which are easier
to pass and reduce the tendency to develop hemorrhoids.
- Fluids. Drink 6 to 8 eight ounce glasses of water each day to
help keep stools soft.
- Bioflavonoids are a type of plant compound that
stabilizes and strengthens blood vessel walls and decreases inflammation.
They have been found to reduce anal discomfort, pain, and anal discharge
during an acute hemorrhoid attack
- Keep the anus and hemorrhoids as dry as possible, using talcum
powder and a pad of soft tissue to absorb moisture.
- Do not strain during bowel movements. Trying to force a bowel
movement can make hemorrhoids worse and straining for more than 5 minutes
can be harmful. Try not to stay on the toilet any longer than necessary.
- Don't scratch. While scratching can make a hemorrhoid feel temporarily
better, scratching can damage the walls of the veins and create more problems.
- After each bowel movement, wiping with a moistened tissue or pad sold
for that purpose helps lessen irritation.
When painful hemorrhoids do not respond to home-based remedies, professional
medical treatment is necessary. See your doctor if hemorrhoids are extremely
uncomfortable and bleed frequently. While hemorrhoids are not a serious
or life-threatening condition, it is important to see a doctor for any type
of rectal bleeding, which can be a sign of other, more serious desease.
Prevention of hemorrhoids
Prevention of hemorrhoids includes drinking more fluids, eating more fiber,
exercising, practicing better posture, and reducing bowel movement strain and time.
The following practices can help:
- Drink plenty of liquids. The exact amount of water and other
fluids you should drink each day varies and depends on your age, sex,
health, activity level and other factors. Avoid liquids that contain caffeine
(such as coffee and tea) or alcohol. These liquids may cause dehydration,
which can lead to constipation.
- Consider fiber supplements. Over-the-counter products such as
Metamucil and Citrucel can help keep stools soft and regular. Check with
your doctor about using stool softeners. If you use fiber supplements,
be sure to drink at least eight to 10 glasses of water or other fluids
every day. Otherwise, fiber supplements can cause constipation or make
constipation worse. Add the fiber gradually to avoid problems with gas.
- Exercise. Stay active to reduce pressure on veins, which can
occur with long periods of standing or sitting, and to help prevent constipation.
Exercise can also help you lose excess weight.
- Avoid long periods of standing or sitting. If you must sit for
long periods, don't use an inflatable doughnut cushion to pad your chair.
It can increase the pressure on the veins in the anus. Always stand and
walk during your breaks at work and try to stand and walk at least 5 minutes
- Avoid straining during bowel movements. Straining and holding
your breath when trying to pass a stool creates greater pressure in the
veins in the lower rectum.
- Avoid reading or spending excess time on the toilet. If it takes
you more than 3-5 minutes to have a bowel movement, then something is
wrong. Reading in the bathroom is considered a bad idea, because it adds
to the time one spends on the toilet and may increase the strain placed
on the anal and rectal veins.
- Go as soon as you feel the urge. Do not delay or try to prevent
a bowel movement when the urge is present. If you wait to pass a bowel
movement and the urge goes away, your stool could become dry and be harder to pass.
- Train your digestive tract to have regular bowel movements. Schedule
a 10-minute period to sit on the toilet at approximately the same time
each day. The best time to do this is usually right after a meal.
- Avoid the overuse of laxatives, type of medication that affects
the bowels, because they may cause diarrhea, which can irritate hemorrhoids.
Use laxatives only when absolutely necessary.
- Keep the area around the anus clean and dry.
- Wipe gently. Blot the anus gently with white toilet paper moistened
with water or a cleansing agent after bowel movements.
Baby wipes or other premoistened towels are also useful for this purpose.
- Avoid rubbing the anal area. You can rinse off in the shower
or on a bidet instead of wiping yourself with toilet paper. Washing with cool water
provides instant relief for nagging pains and discomfort. After
cleansing, gently pat the anal area dry with a soft, absorbent towel or cloth.
- Soap or toilet paper that is perfumed may irritate the anal area and
should be avoided.
- 1. Lee JH, Kim HE, Kang JH, Shin JY, Song YM. Factors associated with hemorrhoids in korean adults: korean national health and nutrition examination survey. Korean J Fam Med. 2014 Sep;35(5):227-36 PubMed
- 2. Fox A, Tietze PH, Ramakrishnan K. Anorectal conditions: hemorrhoids. FP Essent. 2014 Apr;419:11-9. PubMed
Created: August 18, 2006
Last updated: February 24, 2016