What Increases Your Risk

Bowel habits, physical stresses, and other conditions can raise the risk of developing hemorrhoids or make existing hemorrhoids worse. Some of these factors can be prevented.

Factors that increase your risk

• Persistent constipation or diarrhea. These conditions may lead to straining with bowel movements.
• Being overweight
• A family history of hemorrhoids. You may inherit the tendency to get them.
• Being age 50 or older. Half of people who are older than 50 seek treatment for hemorrhoids.
• Pregnancy and labor and delivery. As the fetus grows during the last 6 months of pregnancy, blood volume and pressure on pelvic blood vessels increase. The strain of labor also can cause hemorrhoids to start or get worse.
• Liver disease, heart disease, or both. These conditions may cause blood to back up in the pelvis and abdomen.

Factors that may make hemorrhoids worse

Hemorrhoids may be made worse by:

• Prolonged sitting or standing. This may cause blood to pool in the anal area and increase pressure on the veins.
• Frequent heavy lifting or holding your breath when lifting heavy objects. This can cause a sudden increase of pressure in blood vessels.

When To Call a Doctor

Common symptoms of hemorrhoids may be a sign of other serious health problems. Colon or rectal cancer and other conditions have many of the same symptoms as hemorrhoids. Call your doctor if:

• Rectal bleeding occurs that is not associated with trying to pass stools.
• Stools become more narrow than usual (may be no wider than a pencil).
• You cannot pass stools, or you have diarrhea with abdominal bloating.
• Stools are black or tarry.
• Any unusual material seeps from the anus.
• You have a fever along with bloody stools or what you think may be hemorrhoids.
• A lump or bulge that is not tender and does not go away develops at the anal opening.

If you have hemorrhoids, call your doctor if:

• Moderate rectal pain lasts longer than 1 week after home treatment.
• Pain or swelling is severe.
• Tissue from inside the body bulges from the anus and does not return to normal after 3 to 7 days of home treatment.
• A lump inside the anus becomes bigger or more painful.

If rectal bleeding becomes heavy or changes color (such as from bright red to dark red), or if stools change color (from brown to maroon or black), be sure to see your doctor.

Watchful Waiting

If you are younger than age 50 and sometimes have minimal rectal bleeding (bright red blood seen mainly on toilet paper) from hemorrhoids, you may try home treatment for a week or two if you are reasonably certain that the bleeding is caused by one of the following:

• Straining to pass stools
• A known injury to the anus

See the Home Treatment section of this topic for more information.

In most cases, bleeding caused by hemorrhoids should stop after 2 to 3 days. Continue home treatment to prevent bleeding from starting again. Call your doctor if bleeding:

• Occurs for more than 1 week without improvement.
• Starts again.
• Occurs when there is no reason to expect it.

If you are older than age 50 or have a family history of colon cancer, it is a good idea to tell your doctor any time you have new rectal bleeding, notice blood on your stools, have changes in bowel habits, or have anal pain. These symptoms may be signs of colon cancer or other conditions. Your doctor may recommend screening tests to see if you have a more serious problem. See the Exams and Tests section of this topic.

Who To See

The following professionals can evaluate and treat hemorrhoids:

• Family medicine doctor
• Internist
• Nurse practitioner
• Physician assistant
• Obstetrician
• Gastroenterologist
• Gynecologist
• General surgeon

If medical treatment or surgery is necessary, you may be referred to a:

• Gastroenterologist.
• General or colorectal surgeon.
• Doctor who specializes in problems affecting the rectum and anus (proctologist).

To prepare for your appointment, see the topic Making the Most of Your Appointment.