Hemorrhoids Symptoms, Causes & Treatment Options

Hemorrhoids are swollen veins in the rectum and anus that result in pain and bleeding. They are caused from strain during bowel movements, obesity, or pregnancy.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. Questions Your Doctor May Ask
  7. References

What Is Hemorrhoids?

Summary

Hemorrhoids, also known as piles, are swollen veins in your anus and lower rectum that can cause pain, itching, and rectal bleeding. Hemorrhoids may be seen or felt on the outside of the anus (external) or may be hidden from view inside of the rectum.

Hemorrhoids are common occurring in 10 million Americans per year, or about 4.4 percent of the population [1]. They occur most commonly in adults between 45 and 65 years old [2].

Hemorrhoids are bothersome but they do not usually cause serious health problems. Hemorrhoids may go away on their own, or may be treated with lifestyle changes, medications, or surgery depending on personal preference and severity.

Recommended care

You can treat this at home by eating more fiber and drinking more water, which loosens your stools and allowing the hemorrhoid to heal. Changing your health habits can also help - lose weight and exercise more and keep the anus clean. Topical creams and ointments can help with the pain, as would a warm water spray or sitz baths. If these treatments do not work after some time, simple surgical operations can be done in the primary care office. Or, for very severe cases of hemorrhoids, surgery may be needed to remove the hemorrhoid.

Hemorrhoids Symptoms

Symptoms of hemorrhoids include pain or itching around the anus, rectal bleeding, or bright red blood with stools. Up to 40 percent of hemorrhoids may even be completely asymptomatic [3].

The two types of hemorrhoids, internal and external, can have different symptoms, outlined below:

External hemorrhoid symptoms

External hemorrhoids develop under the skin around the anus and can easily be felt and become irritated or inflamed. Symptoms related to external hemorrhoids include:

Internal hemorrhoid symptoms

Internal hemorrhoids develop in the lower rectum and are often not visible to the eye.Symptoms related to internal hemorrhoids include:

Hemorrhoids Causes

As noted above, two kinds of hemorrhoids can develop, as well asmixed hemorrhoids, which may have both internal and external features. See an image here and here for a visual representation of both types of hemorrhoids.Causes that contribute to the development of hemorrhoids include:

  • Pressure: Pressure from constipation is the common cause of hemorrhoids. Straining during bowel movements and prolonged sitting on the toilet can interfere with blood flow to the anus and lower rectum, causing blood to pool and enlarge the vessels. Pregnancy can cause hemorrhoids in a similar manner, with the uterus pressing on the veins and building pressure below.

  • High resting canal tone: This means that the smooth muscle in the anal canal is tighter than normal, even at rest (when there is not straining occurring). This high resting tone can also cause indirect pressure that can result in hemorrhoids.

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Treatment Options and Prevention for Hemorrhoids

Hemorrhoids can be treated used at-home remedies, over-the-counter medication, and procedures or surgery that can be minimally invasive.

At-home treatments

Hemorrhoids can often be treated or prevented by dietary and lifestyle changes that can take place at home, like the following:

  • Restroom practices: You should avoid straining during bowel movements or lingering on the toilet (for example, reading or checking electronics). Studies have shown that squatting to defecate reduces strain and lowers the time required in the bathroom [4]. New inventions can allow you to squat over your existing toilet so there is no need to renovate.
  • Increasing dietary fiber: High fiber foods such as fruits, vegetables and whole grains can soften stool and prevent constipation [5,6]. Fiber should be combined with drinking 1.5 to 2 liters of water per day to produce soft, regular stools.
  • Fiber supplements: If eating enough fruits and vegetables is difficult or does not provide regularity, fiber supplements are a great option. Fiber may come in the form of psyllium (Metamucil and others), or methylcellulose (Citrucel). These supplements are safe to take every day. These supplements also require drinking 1.5 to 2 liters of water per day [6].
  • Laxatives: Non-fiber laxatives, or stool softeners like docusate sodium may also help prevent straining or lingering on the toilet.
  • Sitz baths: Soaking in a warm sitz bath for 10 to 15 minutes two to three times a day can provide symptom relief and relax muscles around the anus.

Over-the-counter medication

To alleviate pain, itching, or discomfort in the setting of an active hemorrhoid, you can try:

  • Oral pain medications: Over-the-counter pain medications such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol).
  • Ice or cold packs: Placing an ice pack or a cold compress on your anus area can also help relieve pain and swelling.
  • Creams, ointments and pads: There are many over-the counter options in these forms. Make sure to follow the package instructions or your physician's orders to prevent side effects from some of these medications (for example, thinning of skin with prolonged steroid use).

Surgery

Speak with your physician about these therapies as they all have different side effects. In order of invasiveness, methods include:

  • Injections: These can help hemorrhoids shrink.
  • Coagulation techniques: This requires lasers or infrared heat to shrink hemorrhoids.
  • Rubber band ligation: This procedure uses rubber bands to cut off circulation to the hemorrhoid so it falls off.
  • Surgical removal: If medications or the other non-invasive procedures listed prior do not help your symptoms, your physician may recommend a surgical procedure to completely remove or staple the hemorrhoid.

When to Seek Further Consultation for Hemorrhoids

Bleeding during bowel movements is the most common sign of hemorrhoids; however, sometimes it can signal a more serious, underlying condition such as cancer. Do not assume rectal bleeding is hemorrhoids, especially if you are over 40 years old. The risk of cancers such as colorectal and anal cancer increase with age and present similarly.

Make an appointment with your physician promptly if you notice the fowling symptoms:

  • Excessive or frequent bleeding
  • Stool that has changed in color or consistency
  • Lightheadedness, dizziness or faintness in the setting of excessive bleeding

Questions Your Doctor May Ask to Determine Hemorrhoids

To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.

  • Do your symptoms worsen when sitting?
  • Where exactly is your pain?
  • Do you have a rash?
  • Have you had any changes in your weight?
  • Any fever today or during the last week?

If you've answered yes to one or more of these questions

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References

  1. Sanchez C, Chinn BT. Hemorrhoids. Clinics in Colon and Rectal Surgery. 2011;24(1):5-13. NCBI Link
  2. Lohsiriwat V. Hemorrhoids: From Basic Pathophysiology to Clinical Management. World Journal of Gastroenterology. 2012;18(17):2009-2017. NCBI Link
  3. Riss S, Weiser FA, Schwameis K, et al. The Prevalence of Hemorrhoids in Adults. International Journal of Colorectal Disease. 2012;27(2):215-220. NCBI Link
  4. Sikirov D. Copmarison of Straining During Defecation in Three Positions: Results and Implications for Human Health. Digestive Diseases and Sciences. 2003;48(7):1201-1205. NCBI Link
  5. Alonso-Coello P, Guyatt GH, Heels-Ansdell D, et al. Laxatives for the Treatment of Hemorrhoids. Cochrane. Published October 19, 2005. Cochrane Link
  6. Picco MF. Nutrition and Healthy Eating. Mayo Clinic. Published September 26, 2015. Mayo Clinic Link
  7. Bleday R, Breen E. Hemorrhoids: Clinical Manifestations and Diagnosis. UpToDate. Published April 5, 2017. UpToDate Link
  8. Jacobs D. Hermorrhoids. The New England Journal of Medicine. 2014; 371:944-951. NEJM Link
  9. Mott T, Latimer K, Edwards C. Hemorrhoids: Diagnosis and Treatment Options. American Family Physician. 2018;97(3):172-179. American Family Physician Link.
  10. Sun Z, Migaly J. Review of Hemorrhoid Disease: Presentation and Management. Clinics in Colon and Rectal Surgery. 2016;29(1):22-29. NCBI Link
  11. Kopljar M, Balduzzi S, Patrlj L. Topical Treatment for Hemorrhoids. Cochrane. Published November 9, 2011. Cochrane Link