Hemorrhoids
Definition
Hemorrhoids (HEM-uh-roids), also called piles, are swollen and inflamed
veins in your anus and lower rectum. Hemorrhoids may result from
straining during bowel movements or from the increased pressure on these
veins during pregnancy, among other causes. Hemorrhoids may be located
inside the rectum (internal hemorrhoids), or they may develop under the
skin around the anus (external hemorrhoids).
Hemorrhoids are common ailments. By age 50, about half of adults have
had to deal with the itching, discomfort and bleeding that can signal
the presence of hemorrhoids.
Fortunately, many effective options are available to treat hemorrhoids.
Most people can get relief from symptoms using home treatments and
lifestyle changes.
Symptoms
Signs and symptoms of hemorrhoids may include:
- Painless bleeding during bowel movements — you might notice small
amounts of bright red blood on your toilet tissue or in the toilet bowl
- Itching or irritation in your anal region
- Pain or discomfort
- Swelling around your anus
- A lump near your anus, which may be sensitive or painful
- Leakage of feces
Hemorrhoid symptoms usually depend on the location. Internal hemorrhoids
lie inside the rectum. You usually can't see or feel these hemorrhoids,
and they usually don't cause discomfort. But straining or irritation
when passing stool can damage a hemorrhoid's delicate surface and cause
it to bleed. Occasionally, straining can push an internal hemorrhoid
through the anal opening. This is known as a protruding or prolapsed
hemorrhoid and can cause pain and irritation.
External hemorrhoids are under the skin around your anus. When
irritated, external hemorrhoids can itch or bleed. Sometimes blood may
pool in an external hemorrhoid and form a clot (thrombus), resulting in
severe pain, swelling and inflammation.
When to see a doctor
Bleeding during bowel movements is the most common sign of hemorrhoids.
But rectal bleeding can occur with other diseases, including colorectal
cancer and anal cancer. Don't assume that bleeding is coming from
hemorrhoids without consulting a doctor. Your doctor can do a physical
examination and perform other tests to diagnose hemorrhoids and rule out
more serious conditions or diseases. Also consider seeking medical
advice if your hemorrhoids cause pain, bleed frequently or excessively,
or don't improve with home remedies.
If your hemorrhoid symptoms began along with a marked change in bowel
habits or if you're passing black, tarry or maroon stools, blood clots
or blood mixed in with the stool, consult your doctor immediately. These
types of stools can signal more extensive bleeding elsewhere in your
digestive tract.
Seek emergency care if you experience large amounts of rectal bleeding, lightheadedness, dizziness or faintness.
Causes
The veins around your anus tend to stretch under pressure and may bulge
or swell. Swollen veins — hemorrhoids — can develop from an increase in
pressure in the lower rectum. Factors that might cause increased
pressure include:
- Straining during bowel movements
- Sitting for long periods of time on the toilet
- Chronic diarrhea or constipation
- Obesity
- Pregnancy
- Anal intercourse
It's also possible to inherit a tendency to develop hemorrhoids.
Hemorrhoids are more likely as you get older because the tissues that
support the veins in your rectum and anus can weaken and stretch with
aging.
Complications
Complications of hemorrhoids are rare but include:
- Anemia. Chronic blood loss from hemorrhoids may
cause anemia, in which you don't have enough healthy red blood cells to
carry oxygen to your cells, resulting in fatigue and weakness.
- Strangulated hemorrhoid. If blood supply to an
internal hemorrhoid is cut off, the hemorrhoid may be "strangulated,"
which can cause extreme pain and lead to tissue death (gangrene).
Treatments and drugs
Most of the time, treatment for hemorrhoids involves steps that you can
take on your own, such as lifestyle modifications. But sometimes
medications or surgical procedures are necessary.
Medications
If your hemorrhoids produce only mild discomfort, your doctor may
suggest over-the-counter creams, ointments, suppositories or pads. These
products contain ingredients, such as witch hazel or hydrocortisone,
that can relieve pain and itching, at least temporarily.
Don't use an over-the-counter cream or other product for more than a
week unless directed by your doctor. These products can cause side
effects, such as skin rash, inflammation and skin thinning.
Minimally invasive procedures
If a blood clot has formed within an external hemorrhoid, your doctor
can remove the clot with a simple incision, which may provide prompt
relief.
For persistent bleeding or painful hemorrhoids, your doctor may
recommend another minimally invasive procedure. These treatments can be
done in your doctor's office or other outpatient setting.
- Rubber band ligation. Your doctor places one or two
tiny rubber bands around the base of an internal hemorrhoid to cut off
its circulation. The hemorrhoid withers and falls off within a week.
This procedure — called rubber band ligation — is effective for many
people. Hemorrhoid banding can be uncomfortable and may cause bleeding,
which might begin two to four days after the procedure but is rarely
severe.
- Injection (sclerotherapy). In this procedure, your
doctor injects a chemical solution into the hemorrhoid tissue to shrink
it. While the injection causes little or no pain, it may be less
effective than rubber band ligation.
- Coagulation (infrared, laser or bipolar).
Coagulation techniques use laser or infrared light or heat. They cause
small, bleeding, internal hemorrhoids to harden and shrivel. While
coagulation has few side effects, it's associated with a higher rate of
hemorrhoids coming back (recurrence) than is the rubber band treatment.
Surgical procedures
If other procedures haven't been successful or you have large
hemorrhoids, your doctor may recommend a surgical procedure. Surgery can
be performed on an outpatient basis or you may need to stay in the
hospital overnight.
- Hemorrhoid removal. During a hemorrhoidectomy, your
surgeon removes excessive tissue that causes bleeding. Various
techniques may be used. The surgery may be done with a local anesthetic
combined with sedation, a spinal anesthetic or a general anesthetic.
Hemorrhoidectomy is the most effective and complete way to remove
hemorrhoids, but it also has the highest rate of complications. These
may include temporary difficulty emptying your bladder and urinary tract
infections related to this problem. Most people experience some pain
after the procedure. Medications can relieve your pain. Soaking in a
warm bath also may help.
- Hemorrhoid stapling. This procedure, called stapled
hemorrhoidectomy or stapled hemorrhoidopexy, blocks blood flow to
hemorrhoidal tissue. Stapling generally involves less pain than
hemorrhoidectomy and allows an earlier return to work. Compared with
hemorrhoidectomy, however, stapling has been associated with a greater
risk of recurrence and rectal prolapse, in which part of the rectum
protrudes from the anus. Talk with your doctor about what might be the
best option for you.
Lifestyle and home remedies
You can often relieve the mild pain, swelling and inflammation of
hemorrhoids with home treatments. Often these are the only treatments
needed.
- Use topical treatments. Apply an over-the-counter
hemorrhoid cream or suppository containing hydrocortisone, or use pads
containing witch hazel or a numbing agent.
- Soak regularly in a warm bath or sitz bath. Soak
your anal area in plain warm water 10 to 15 minutes two to three times a
day. A sitz bath fits over the toilet. You can get one at most
drugstores.
- Keep the anal area clean. Bathe (preferably) or
shower daily to cleanse the skin around your anus gently with warm
water. Soap isn't necessary and may aggravate the problem. Gently dry
the area with a hair dryer after bathing.
- Don't use dry toilet paper. To help keep the anal
area clean after a bowel movement, use moist towelettes or wet toilet
paper that doesn't contain perfume or alcohol.
- Apply cold. Apply ice packs or cold compresses on your anus to relieve swelling.
- Take oral pain relievers. You can use acetaminophen
(Tylenol, others), aspirin or ibuprofen (Advil, Motrin, others)
temporarily to help relieve your discomfort.
With these treatments, hemorrhoid symptoms often go away in a few days.
See your doctor if you don't get relief in a few days, or sooner if you have severe pain or bleeding.
Prevention
The best way to prevent hemorrhoids is to keep your stools soft, so they
pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids,
follow these tips:
- Eat high-fiber foods. Eat more fruits, vegetables
and whole grains. Doing so softens the stool and increases its bulk,
which will help you avoid the straining that can cause hemorrhoids or
worsen symptoms from existing hemorrhoids. Add fiber to your diet slowly
to avoid problems with gas.
- Drink plenty of fluids. Drink six to eight glasses of water and other liquids (not alcohol) each day to help keep stools soft.
- Consider fiber supplements. Most people don't get
enough of the recommended amount of fiber — 20 to 35 grams a day — in
their diet. Studies have shown that over-the-counter fiber supplements,
such as Metamucil and Citrucel, improve overall symptoms and bleeding
from hemorrhoids. These products help keep stools soft and regular. If
you use fiber supplements, be sure to drink at least eight glasses of
water or other fluids every day. Otherwise, the supplements can cause
constipation or make constipation worse.
- Don't strain. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.
- Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.
- Exercise. Stay active to help prevent constipation
and to reduce pressure on veins, which can occur with long periods of
standing or sitting. Exercise can also help you lose excess weight that
may be contributing to your hemorrhoids.
- Avoid long periods of standing or sitting. Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.