What Are Hemorrhoids?
Hemorrhoids are swollen veins in the lowest part of your rectum and anus. Sometimes, the walls of these blood vessels stretch so thin that the veins bulge and get irritated, especially when you poop. Hemorrhoids are also called piles.
Hemorrhoids are one of the most common causes of rectal bleeding. They often go away on their own. Treatments can also help.
Symptoms of Hemorrhoids
Internal hemorrhoids are so far inside your rectum that you can't usually see or feel them. They don't generally hurt because you have few pain-sensing nerves there. Symptoms of internal hemorrhoids include:
- Blood on your poop, on toilet paper after you wipe, or in the toilet bowl
- Tissue that bulges outside your anal opening (prolapse). This may hurt, often when you poop. You might be able to see prolapsed hemorrhoids as moist bumps that are pinker than the surrounding area. These usually go back inside on their own. Even if they don't, they can often be gently pushed back into place.
External hemorrhoids are under the skin around your anus, where there are many more pain-sensing nerves. Symptoms of external hemorrhoids include:
A blood clot can turn an external hemorrhoid purple or blue. This is called a thrombosis or a thrombosed hemorrhoid. You may notice symptoms like:
- Severe pain
When to call your doctor
Hemorrhoids are rarely dangerous. If the symptoms don’t go away in a week or if you have bleeding, see your doctor to make sure you don’t have a more serious condition.
Causes and Risk Factors of Hemorrhoids
You may be more likely to get hemorrhoids if other family members, like your parents, had them.
Pressure building up in your lower rectum can affect blood flow and make the veins there swell. That may happen from:
- Pushing during bowel movements
- Straining when you do something that's physically hard, like lifting something heavy
- Extra weight, like obesity
- Pregnancy, when your growing uterus presses on your veins
- A diet low in fiber
- Anal sex
People who stand or sit for long stretches of time are at greater risk, too.
Your doctor will ask about your medical history and symptoms. They’ll probably need to do one or both of these examinations:
- Physical exam. Your doctor will look at your anus and rectum to check for lumps, swelling, irritation, or other problems.
- Digital rectal exam. Your doctor will put on gloves, apply lubrication, and insert a finger into your rectum to check muscle tone and feel for tenderness, lumps, or other problems.
To diagnose internal hemorrhoids or rule out other conditions, you might need a more thorough test, including:
- Anoscopy. Your doctor uses a short plastic tube called an anoscope to look into your anal canal.
- Sigmoidoscopy. Your doctor looks into your lower colon with a flexible lighted tube called a sigmoidoscope. They can also use the tube to take a bit of tissue for tests.
- Colonoscopy. Your doctor looks at all of your large intestine with a long, flexible tube called a colonoscope. They can also take tissue samples or treat other problems they find.
Hemorrhoid symptoms usually go away on their own. Your doctor’s treatment plan will depend on how severe your symptoms are.
- Home remedies. Simple lifestyle changes can often relieve mild hemorrhoid symptoms within 2 to 7 days. Add fiber to your diet with over-the counter supplements and foods like fruit, vegetables, and grains. Try not to strain during bowel movements; drinking more water can make it easier to go. Warm sitz baths for 20 minutes several times a day may also make you feel better. Ice packs can ease pain and swelling.
- Nonsurgical treatments. Over-the-counter creams and other medications ease pain, swelling, and itching.
- Surgical treatments. If you have large hemorrhoids, or if other treatments haven’t helped, you might need surgery. Your doctor can use chemicals, lasers, infrared light, or tiny rubber bands to get rid of them. If they’re especially large or keep coming back, your doctor might need to remove them with a sharp tool called a scalpel.
Rarely, hemorrhoids could lead to problems such as:
- Skin tags. When the clot in a thrombosed hemorrhoid dissolves, you may have a bit of skin left over, which could get irritated.
- Anemia. You might lose too much blood if you have a hemorrhoid that lasts a long time and bleeds a lot.
- Infection. Some external hemorrhoids have sores that get infected.
- Strangulated hemorrhoid. Muscles can block the blood flow to a prolapsed hemorrhoid. This may be very painful and need surgery.
To prevent hemorrhoid flare-ups, try these steps:
- Eat fiber. It helps food pass through your system easier. A good way to get it is from plant foods: vegetables, fruits, whole grains, nuts, seeds, beans, and legumes. Aim for 20 to 35 grams of dietary fiber a day.
- Use fiber supplements. Over-the-counter supplements can help soften stool if you don’t get enough fiber from food. Start with a small amount, and slowly use more.
- Drink water. It will help you avoid hard stools and constipation, so you strain less during bowel movements. Fruits and vegetables, which have fiber, also have water in them.
- Exercise. Physical activity, like walking a half-hour every day, keeps your blood and your bowels moving.
- Don't wait to go. Use the toilet as soon as you feel the urge.
- Don’t strain during a bowel movement or sit on the toilet for long periods. This puts more pressure on your veins.
- Keep a healthy weight.