What Are Hemorrhoids?
Hemorrhoids are swollen veins, similar to varicose 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. You might also hear them called piles.
Hemorrhoids aren't serious, but they can cause unpleasant symptoms. They're one of the most common causes of rectal bleeding. They often go away on their own. Treatments can also help.
Hemorrhoids are very common, especially in older people. About 1 in every 20 people in the U.S. has them. They affect over half of people over 50.
Types of Hemorrhoids
You might hear about several types of hemorrhoids:
These 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.
You get these under the skin around your anus, where there are many more pain-sensing nerves.
These happen when an internal hemorrhoid stretches down so far that it bulges outside your anal opening. They usually go back inside your body on their own. Even if they don't, they can often be gently pushed back into place.
A blood clot can turn an external hemorrhoid purple or blue. This is called a thrombosis or a thrombosed hemorrhoid.
Symptoms of Hemorrhoids
Internal hemorrhoids may have no symptoms at all. You might notice blood on your poop, on toilet paper after you wipe, or in the toilet bowl.
Prolapsed hemorrhoid symptoms might include:
- Pain, especially when you poop
- Moist bumps that look pinker than the surrounding area
External hemorrhoid symptoms may include:
Thrombosed hemorrhoid symptoms may include:
- Serious pain
What's the difference between hemorrhoids and anal fissures?
Both conditions can cause pain, bleeding, and itching in the anal area. But while a hemorrhoid results from swollen blood vessels, an anal fissure is a tear or cut in the lining of your anus. Constipation and straining to poop can cause either problem.
What causes hemorrhoids?
Pressure building up in your lower rectum can affect blood flow and make the veins there swell. That may happen because of:
- Pushing when you poop
- 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
A few things can raise your risk of this condition:
You may be more likely to get hemorrhoids if other family members, like your parents, had them.
Older people may be more likely to get them because tissues in the anal area tend to grow weaker as you age.
Pregnancy raises your risk in a couple of ways. The weight of the fetus puts extra pressure on your rectum. You're more prone to constipation, too.
Too much sitting
A mostly sedentary lifestyle, or a job in which you have to sit for long stretches, also raises your risk. When you don't move around a lot, blood can pool in your anal area and put pressure on the blood vessels there.
Your doctor will ask about your medical history and symptoms. They'll probably need to do one or both of these exams:
- 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.
Treatment and Medication
Symptoms usually go away on their own. Your doctor's treatment plan will depend on how serious your symptoms are. Most hemorrhoid treatments and home remedies are safe even when you're pregnant.
Simple lifestyle changes can often relieve mild symptoms within 2-7 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 poop.
- Warm sitz baths for 20 minutes several times a day may also make you feel better.
- Ice packs can ease pain and swelling.
Over-the-counter creams, pads, and suppositories temporarily ease pain, swelling, and itching. Most contain ingredients like lidocaine, hydrocortisone, or witch hazel.
Don't use an over-the-counter hydrocortisone medication for longer than a week unless your doctor tells you do.
If you have large hemorrhoids, or if other treatments haven't helped, you might need surgery or another procedure to remove or shrink them.
Your doctor can:
- Inject the hemorrhoid with a chemical that shrinks it
- Use a laser to seal off the vessels that provide blood to the hemorrhoid
- Place a tiny rubber band around it to block its blood supply
- Use a staple to cut off its blood flow
If hemorrhoids are especially large or keep coming back, your doctor might remove them with a sharp tool called a scalpel. This surgery is called hemorrhoidectomy.
Witch hazel is a herb you can buy in liquid form at the drugstore. It can temporarily ease symptoms when you use it in a sitz bath or apply it to the affected area. Witch hazel is the active ingredient in some hemorrhoid treatments.
Less is known about the safety and effectiveness of some other herbs that are sometimes used as alternative treatments. They include:
- Gotu kola
Some people also take supplements containing fiber or probiotics, microorganisms that help promote gut health.
Talk to your doctor before trying any of these.
Rarely, hemorrhoids could lead to problems such as:
- Skin tags. When the clot in a thrombosed hemorrhoid dissolves, it can leave behind a bit of skin, 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 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 like vegetables, fruits, whole grains, nuts, seeds, beans, and legumes. Aim for 20-35 grams of fiber a day.
- Use fiber supplements. Over-the-counter supplements can 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 also have water in them.
- Exercise. Physical activity, like walking half an 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. Some people find it easier to poop when they put their feet up on a stepstool while on the toilet.
- Keep a healthy weight.
- Create better bathroom habits. Try scheduling a time, perhaps after a meal, to sit on the toilet for a while.
Living With Hemorrhoids
To reduce discomfort, sit on a hemorrhoid cushionor other soft surface rather than a hard chair. This can ease swelling of hemorrhoids and prevent new ones.
Over-the-counter pain relievers like aspirin or acetaminophen can help when your hemorrhoids hurt.
To avoid irritation, take care not to wipe too hard after using the bathroom. Using damp toilet paper can make things easier. Avoid heavily scented wipes.
When should I call my 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.
What questions should I ask my doctor?
Some questions you might ask during a doctor visit include:
How do they fix hemorrhoids? Hemorrhoids can be treated with lifestyle changes, medications, or medical procedures. Your doctor can recommend a treatment suitable for you.
What happens if you let hemorrhoids go untreated? If they don't go away, or if your symptoms get worse, you'll need treatment to get relief from your symptoms. If you have bleeding from your bottom, see a doctor. This can also be a symptom of other, more serious conditions.
How long do hemorrhoids last? They usually get better in a few days. Some people have repeated cases of hemorrhoids.
Here are some frequently asked questions about this condition:
Who is more likely to get hemorrhoids?
You're more likely to get them if you:
- Are 45-65 years old
- Have obesity
- Are pregnant
- Have close relatives who've had them
- Often have constipation or diarrhea
- Do heavy lifting or other activities that put a strain on your body
What is the fastest way to heal hemorrhoids?
For most people, sitz baths and a high-fiber diet should do the trick.
How do I prevent hemorrhoids?
The main way to prevent them is to avoid straining when you poop. To prevent constipation, drink plenty of water and eat a lot of fruits, vegetables, and whole grains.
Can I treat hemorrhoids myself?
You can often treat mild cases with lifestyle changes, home remedies like sitz baths, and over-the-counter treatments. But tell your doctor if you don't get better within a week.
Hemorrhoids are a common problem and not usually serious. Lifestyle changes and over-the-counter treatments are often enough to treat them. Make an appointment with your doctor if your symptoms are serious or don't go away after a few days.