Hemorrhoids

• Hemorrhoid Overview
• Hemorrhoid Causes
• Hemorrhoid Symptoms
• When to Seek Medical Care
• Exams and Tests
• Hemorrhoid Treatment
• Self-Care at Home
• Medical Treatment
• Surgery
• Next Steps
• Follow-up
• Prevention
• Outlook
• Synonyms and Keywords
• Authors and Editors
• Viewer Comments: Hemorrhoids - Effective Treatments

Hemorrhoid Overview

Hemorrhoids are enlarged, painful veins in your rectum.

Hemorrhoids develop from 2 different places. There are 2 sets of veins that drain the blood from the lower rectum and anus.

• The internal veins can become swollen to form internal hemorrhoids. Internal hemorrhoids, unless they are severe, cannot be seen or felt, unlike external hemorrhoids.

• Likewise, the external veins can swell to form external hemorrhoids. External hemorrhoids can be seen around the outside of the anus and, many times, can be felt.

Hemorrhoid Causes

Hemorrhoids are associated with constipation and straining at bowel movements as well as pregnancy. It is thought that these conditions lead to increased pressure in the hemorrhoid veins, thus causing them to swell. Liver disease can also cause increased pressure in the veins and also cause hemorrhoids.

Hemorrhoids are very common and have been estimated to occur in up to half the population by age 50 years.

Hemorrhoid Symptoms

• The symptoms of hemorrhoids are fairly straightforward. The most common complaint from internal hemorrhoids is painless bleeding. You will see bright red blood on the outside of your stool, on the toilet paper, or dripping into the toilet. The bleeding usually does not last long.
  
  
• Hemorrhoids may lead to a condition called prolapsed hemorrhoids.
  
  
  • This occurs when the internal hemorrhoids swell and then extend through the anus.
    
    
  • You then can feel the hemorrhoids, at your anus, from the outside.
    
    
  • Many times you can gently push the hemorrhoids back through the anus and solve the problem.
    
    
  • If the hemorrhoids cannot be pushed back, then they may swell even more and become trapped outside of the anus.
    
    
  • If your hemorrhoids become entrapped, then you will need to see a doctor.
    
    
  • You may develop itching in your anus from prolapsed hemorrhoids. This condition is called pruritus ani.
  
  
• External hemorrhoids may form a painful condition called thrombosed hemorrhoids.
  
  
  • When a blood clot occurs in a hemorrhoid, the hemorrhoid will become even more swollen. This swelling leads to increased pain.
    
    
  • The pain is usually worse with bowel movements or sometimes with sitting.
    
    
  • This too is a condition that may require a doctor's examination and treatment.

When to Seek Medical Care

When to call the doctor

• If you develop bleeding between bowel movements or have a moderate amount of bleeding from hemorrhoids, you should consult your doctor.

• If you are over age 40 years or have a family history of colon cancer, you should see your doctor for rectal bleeding.

• If you have prolapsed hemorrhoids that will not go back through the anus, or you have significant pain from your hemorrhoids, you should consult your doctor.

• Other causes of rectal bleeding exist that are much more serious than hemorrhoids. Inflammatory bowel disease and colorectal cancers can have rectal bleeding. Make your doctor aware of your bleeding. If you are older than 40 years, have a family history of colorectal cancer, prolonged bleeding, or are experiencing other symptoms, you should not delay in seeing a doctor.

When to go to the hospital

Most of the time hemorrhoids can be managed by your doctor. A few situations may require you to go to the emergency department.

• If you have significant pain, bleeding, or a prolapsed hemorrhoid and are unable to contact your doctor, then you should be evaluated in the hospital.

• If you have a large amount of bleeding from your rectum, become weak, or experience dizziness, you should go to your hospital's emergency department.

Exams and Tests

Almost always the doctor will only need a history and physical exam to evaluate your hemorrhoids. Sometimes you may need anoscopy for your exam.

• In anoscopy, a small, lighted scope is placed into your anus to fully see the anus and lower rectum. The procedure is slightly uncomfortable but is easily performed in a doctor's office and does not require sedation.

• If you have had significant bleeding or symptoms of severe blood loss, then your doctor may order a complete blood count to ensure that you are not anemic.

Hemorrhoid Treatment

Self-Care at Home

The treatment for hemorrhoids is different depending on the severity of the problem. Most of the time, the treatment is conservative and performed at home.

• Hot sitz baths
  
  
  • A sitz bath is recommended 3 times a day and after each bowel movement for at least 15 minutes.
    
    
  • For a sitz bath, sit in a few inches of warm water in a tub.
    
    
  • This is the best way to lessen the swelling and the pain.
    
    
  • Be sure to thoroughly dry the skin around your anus after each bath so that it doesn't rub and become torn.
  
  
• Dietary changes
  
  
  • Drink more liquids and eat more leafy green vegetables, which will make stools bulkier and softer to relieve constipation.
    
    
  • Some people with constipation or hard stools may benefit from increasing the amount of bran and fiber in their diet.
  
  
• Stool softeners
  
  
  • Stool softeners might also help.
    
    
  • You should be cautious in choosing a laxative for your constipation.
    
    
  • If a laxative causes watery, runny stools, it could cause an infection in the anus and should not be used.
  
  
• Sitting restrictions
  
  
  • Some doctors also recommend people with hemorrhoids not sit for a long period of time.
    
    
  • Some people feel more comfortable sitting on an air doughnut.
  
  
• Over-the-counter medications
  
  
  • Many creams, ointments, and suppositories are sold as pain relievers and medicines for hemorrhoids.
    
    
  • These medications are of little help and sometimes might even cause the hemorrhoids to take longer to heal, so consult with your doctor first.

Medical Treatment

• Thrombosed hemorrhoids
  
  
  • If you develop a hemorrhoid with a clot (a thrombosed hemorrhoid), you will feel some pain.
    
    
  • If the pain is not severe and the swelling is not too much, many times the doctor can treat you with hot sitz baths and bulking up the stools.
    
    
  • If the pain is not tolerable or a large amount of swelling is present, however, it might be necessary to remove the blood clot. This procedure can be done in a doctor's office or emergency department but must not be attempted at home.
    
    
  • When the clot must be removed, the hemorrhoid is numbed up with an anesthetic, just like at the dentist's office when a cavity must be filled.
    
    
  • After the area is numb, the doctor will make a small cut in the hemorrhoid to remove the blood clot.
    
    
  • A small piece of bandage will be put in the hemorrhoid to stop any bleeding and keep the clot from coming back.
    
    
  • Another bandage will be put on the outside of the hemorrhoid as well. You will be started on sitz baths at home, and the dressing should be removed when you take your first one about 6-12 hours after the clot has been removed.
    
    
  • Almost everyone has great relief of their pain after the clot is removed and needs only acetaminophen (Tylenol) or ibuprofen (Motrin) for pain.
  
  
• Prolapsed internal hemorrhoids
  
  
  • If you have prolapsed internal hemorrhoids, which you are unable to push back through the anus, then your doctor may need to reduce them.
    
    
  • Many times the doctor is able to gently push the hemorrhoids back into place.
    
    
  • If the hemorrhoids are too swollen to be pushed back through the anus, then you may need a surgical procedure to relieve the swelling.
    
    
  • If the hemorrhoids remain swollen and trapped through the anus and nothing is done, then the hemorrhoid will not receive enough blood and start to die.
    
    
  • If this occurs, the hemorrhoid will become infected, and the infection can spread throughout the blood, making you very sick.

Surgery

• If you have continued bleeding, prolapsed hemorrhoids that cannot be pushed back into place, uncontrollable pain, or severe rectal itching, surgery is needed.
  
  
• The surgeon might inject the hemorrhoids with a medicine to shrink them or place small rubber bands around the hemorrhoids to cut off the blood supply so they will die. These procedures are usually done in the office and don't require you to be put to sleep or admitted to a hospital.
  
  
• Less commonly used treatments are cryotherapy in which the hemorrhoid is essentially frozen off, or laser therapy, in which the hemorrhoid is burned off.
  
  
• Sometimes, it is necessary for the surgeon to actually cut the hemorrhoids off. In this case you will need to be put to sleep or have a spinal anesthetic.

Next Steps

Follow-up

• Warm sitz baths 3 times a day and after each bowel movement along with increasing the amount of liquids and leafy vegetables in your diet are beneficial.

• Any pain from hemorrhoids should be managed with over-the-counter pain relievers.

• You may receive prescriptions for stool softeners, and these should be taken as directed by your doctor.

• If you develop worsening pain, bleeding, fever, abdominal pain, or vomiting after being treated for hemorrhoids, then you should contact your doctor or go to the emergency department.

Prevention

No definite way has been found to avoid hemorrhoids. Eating a high-fiber diet and avoiding straining at bowel movements is thought to aid in preventing hemorrhoids, but there is no way to completely eliminate the risk.

Outlook

Most people with hemorrhoids have an excellent prognosis. You may have flare-ups of bleeding or slight discomfort from time to time, but they don't last long and can be relieved with care at home.

Certain people may worsen to the point of needing surgery. This surgery is fairly minor, and most will have significant improvement.

Synonyms and Keywords

internal hemorrhoids, external hemorrhoids, anal itching, anal bleeding, prolapsed hemorrhoid, prolapsed internal hemorrhoid, thrombosed hemorrhoid, piles, pruritus ani, sitz bath, laxative

Authors and Editors

Author: Michael L Peebles, MD, Staff Physician, Department of Emergency Medicine, Charity Hospital, Louisiana State University.

Coauthor(s): Joseph W Hauth, MD, MBA, FACEP, Assistant Clinical Professor, Department of Emergency Medicine, Louisiana State University School of Medicine.

Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Ron Fuerst, MD, Clinical Assistant Professor, Department of Pediatrics, University of South Carolina College of Medicine; Director, Children's Emergency Center, Children's Hospital of Richland Memorial Hospital.

Last Editorial Review: 8/10/2005