You have clumps of veins in and around your anus and lower rectum that can stretch and swell with pressure. When these veins get swollen or bulge, they’re called hemorrhoids. They can be inside or just on the outside. They're usually not serious, but can sometimes hurt, itch, or bleed.
One of the most common signs of hemorrhoids is painless bleeding -- usually when you go to the bathroom. You might notice a little blood on the toilet paper or in the bowl. You may also have itching, pain, or tiny bulges around your anus. Because there can be many reasons for these symptoms, see your doctor as soon as you notice any of them. That way, you can rule out other problems.
What Causes Them?
We're not sure what exactly causes hemorrhoids. You could have them if you get constipated or have diarrhea often. Straining to lift heavy objects or to go to the bathroom might be to blame. You might be more likely to get them if you spend a lot of time on the toilet. Hemorrhoids are also more common as you get older and if you are overweight. If you're pregnant or your parents had them, you may get them, too.
How Are They Diagnosed?
Your doctor will ask you about bleeding, itching, or other symptoms. He will look at your bottom for hemorrhoids. He may also put a gloved finger inside to check for them there. To take a closer look, he may use a small tube called an anoscope. Your doctor may also suggest a flexible sigmoidoscopy or colonoscopy. These tests let your doctor look inside your colon and rectum with a lighted, flexible tube to rule out other causes for your symptoms.
Veins inside your rectum can grow large or swell. Even if they bleed, internal hemorrhoids usually don't hurt. Sometimes they can swell and stick out just outside your body. This is called a prolapsed hemorrhoid and can be painful or itchy.
Hemorrhoids can form just underneath the skin near your anus. These can also itch and hurt. They might bleed. You might feel a lump if a blood clot forms inside one. That is called a thrombosis and it, too, can hurt.
Prolapse and Thrombosis
When an internal hemorrhoid is pushed outside or "prolapses," it can bleed and be painful and itchy. When the swelling goes down, it may go back in on its own or you can gently nudge it back. If a blood clot forms in a hemorrhoid outside your body, it might get hard and sore. It can bleed if it breaks. The clot might go away and leave behind a little piece of skin -- called a skin tag -- that can bother you.
Food Can Help
What you eat can help prevent hemorrhoids or at least ease symptoms. Add high-fiber foods to soften your stool. Try to get more leafy vegetables, fresh fruits, beans, and whole-grain breads and cereals. Your doctor may also suggest a fiber supplement. Add it slowly because too much at once can cause gas or bloating. Drink lots of water to help prevent constipation and to make it easier to go to the bathroom.
Treatment at Home
Try nonprescription creams and wipes -- or even a small ice pack -- to ease pain and swelling. Soak in a bathtub filled with a few inches of warm water 2-3 times a day and then pat dry gently. There are also special "sitz baths" you can place directly in your toilet seat. Try a stool softener to make it easier to go.
If at-home remedies don't work, your doctor can help. She may put special rubber bands or rings around internal hemorrhoids to cut off the blood supply until they shrink. This process is ligation. Another option uses heat to get rid of internal hemorrhoids, this is known as coagulation. Your doctor may also inject a chemical into the swollen tissue to break it down. This is called sclerotherapy.
For very large hemorrhoids or those that just won't go away, you might need surgery. In the most basic type the swollen tissues are simply cut out. This surgery, called a hemorrhoidectomy, usually works but often has a long, painful recovery. A newer surgery is less painful with a faster recovery. It uses staples to hold hemorrhoids in place instead of removing them.
Anyone Can Get Them
Hemorrhoids aren't a rare, strange condition. Many people -- men and women alike -- have them. It's only when they swell and cause problems that you realize they're there. About half of people bleed, have pain, or other symptoms by the time they turn 50. Women may have them during pregnancy.
First, your health care provider will look at your anal area, perhaps by inserting a lubricated gloved finger or an anoscope (a hollow, lighted tube for viewing the lower few inches of the rectum) or a proctoscope (which works like an anoscope, but provides a more thorough rectal exam).
Hemorrhoids may or may not cause symptoms. Symptoms may include:
Pain and discomfort around the anus.
Moist, pink pads of skin protruding from the anus; sometimes they may appear purple or blue.
Bleeding from the anus.
To see further into the anal canal (into the lower colon, or sigmoid), sigmoidoscopy may be used, or the entire colon may be viewed with colonoscopy. For both procedures, a lighted, flexible viewing tube is inserted into the rectum. A barium X-ray can also show the outline of the entire colon's interior. First, a barium enema is given, then X-rays are taken of the lower gastrointestinal tract.
What Are the Treatments for Hemorrhoids?
Once you develop hemorrhoids, they don't usually go away completely unless you undergo one of the procedures below. They can get better, however, so that living with them is tolerable. Both conventional and alternative practitioners consider diet the best treatment for hemorrhoids. A diet rich in high-fiber foods and low in processed foods is essential. Increasing fluid intake to six to eight eight-ounce glasses a day also is important. Check with your health care provider about your fluid needs if you have any medical problems or take medication. Dietary changes will be needed even if medication or surgery is prescribed.
Most hemorrhoid treatments aim to minimize pain and itching. Warm (but not hot) sitz baths are the most time-honored and suggested therapy: Sit in about three inches of warm water for 15 minutes, several times a day, especially after a bowel movement. This helps reduce the swelling in the area and relaxes spasm of the sphincter muscle. If you are pregnant, discuss any treatment, including dietary changes, with your health care provider before proceeding.
If you have been diagnosed with hemorrhoids, a high-fiber diet combined with sitz baths and Tylenol as prescribed often reduces discomfort within two weeks. If symptoms persist or are severe your health care provider may suggest one of the following procedures. Many can be performed in your doctor's office.
Injection. An internal hemorrhoid can be injected with a solution which creates a scar and closes off the hemorrhoid. The injection hurts only a little, as any injection does.
Banding. Prolapsed hemorrhoids are often removed using rubber-band ligation. A special tool secures a tiny rubber band around the hemorrhoid, shutting off its blood supply almost instantly. Within a week, the hemorrhoid shrivels and falls off.
Coagulation or cauterization. Using either an electric probe, a laser beam, or an infrared light, a tiny burn painlessly seals the end of the hemorrhoid, causing it to close off and shrink. This is most useful for prolapsed hemorrhoids.
Surgery. For large internal hemorrhoids or extremely uncomfortable external hemorrhoids (such as thrombosed hemorrhoids that are too painful to live with), your doctor may elect traditional surgery, called hemorrhoidectomy.
Hemorrhoid removal treatments are very effective, but unless dietary and lifestyle changes are made, hemorrhoids may recur.
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.