Hemorrhoids: How to Get Relief
What is a hemorrhoid?
Hemorrhoids happen when the small blood vessels around your anus become swollen and inflamed.
Internal hemorrhoids are a swelling of blood vessels inside your rectum. (The rectum is the last part of your large intestine, right before your anus.) External hemorrhoids bulge out on the skin around your anus.
The blood vessels can become swollen for different reasons, but usually because you’re straining when you’re trying to go to the bathroom. Though it can happen even if you don’t strain.
Hemorrhoids (also called piles) are very common. Typically, internal hemorrhoids bleed and external hemorrhoids are painful. They usually go away, and you can treat any symptoms with over-the-counter medications.
Internal hemorrhoids usually aren’t painful, but you may have blood in your stool (poop). You’ll see blood in the toilet or on the toilet paper upon wiping.
External hemorrhoids cause itching and pain around your anus.
The symptoms of hemorrhoids can be confused with anal fissures or intestinal diseases such as intestinal polyps. Your doctor will be able to help diagnose what is causing your symptoms by examining you for hemorrhoids. If you’re experiencing pain or bleeding with bowel movements, it’s important to talk to your doctor about this, even if you think it’s just hemorrhoids. There are other more serious illnesses that cause blood in bowel movements.
- Rectal bleeding: small amounts of bright red blood during bowel movements or on wiping
People often don’t speak with their doctors about this, but tell your doctor about your bowel habits. Are they regular? Are they soft? Are you straining? —Dr. Shria Kumar
When you put pressure on your abdomen, it can cause the blood vessels around your rectum and anus to swell. Part of this is normal, but on occasion, it causes the tissue to stretch, bulge, and swell. That leads to the itching, discomfort, and pain.
As you age, you may be more susceptible because the tissue around your anus and rectum become weaker. These are some of the factors that can lead to hemorrhoids:
- Straining for a long time while trying to go to the bathroom
- Sitting for a long time on the toilet
- You have hard stool or are constipated
- Being pregnant
- Having a vaginal delivery
- Being overweight or obese
- Having a build-up of fluid in your abdomen (called ascites)
- Not eating enough fiber
- Lifting heavy objects
Is there blood on the toilet paper, particularly after a hard bowel movement? Itching? Are you constipated normally? What are your bowel habits like? Are there other symptoms? Things like fever, abdominal pain, nausea, vomiting, are unlikely to be caused by hemorrhoids. —Dr. Kumar
How do hemorrhoids go away?
There are a number of over-the-counter treatment options that can help the itching, pain, and discomfort. First, you should talk to your doctor if you think you are experiencing hemorrhoid symptoms. They may recommend some of the following:
- A stool softener can help reduce straining. This can help prevent hemorrhoids and makes it less painful to pass stool when you have them.
- Laxatives are helpful if you are not having regular bowel movements.
- Topical (applied externally) medications (like Preparation H) can reduce the discomfort and pain, and help shrink the hemorrhoids.
- You can also soak daily in a warm bath or a sitz bath (a warm, shallow bath that fits over your toilet).
It can take anywhere from a few days to over a week for the swelling to go down and the symptoms to go away. If your symptoms do not get better with these treatments, your doctor may suggest an in-office procedure to remove your hemorrhoids. These procedures are usually done using a local anesthetic, but depending on the procedure may cause some pain and discomfort following the procedure.
A common misconception is that once you have hemorrhoids they never go away. In fact, they can go away! Explore all the options, which focus on avoiding constipation and hard bowel movements. If you’re having pain, topical treatment can be given as well. If nothing helps, there are small procedural options that a gastroenterologist or a surgeon can offer to treat your hemorrhoids. —Dr. Kumar
How to prevent recurring hemorrhoids
If your hemorrhoids keep coming back, you can make some changes to your diet to help soften your stool and prevent straining.
Drink plenty of water and eat a high-fiber diet. Foods like bananas, oranges, apples, berries, dark green leafy vegetables, beans, and legumes are high in fiber.
In addition, exercise regularly to maintain a healthy weight. Avoid lifting heavy objects, which puts a strain on your abdomen.
Try not to strain during your bowel movements, and ensure you are having soft, daily bowel movements. Try to avoid sitting on the toilet for a long time as this puts pressure on your rectum and anus.
Dr. Dasani is a resident physician at Penn and Brigham and Women's Hospitals. She graduated from Columbia University in 2013 with a BA in Neuroscience and Behavior. Upon graduation, she served as a Fulbright scholar on the island, Bangka, Indonesia. After her Fulbright, she pursued a MD/MBA at Penn during which she worked on various health care consulting projects solving problems across multiple sectors of the health care system. She is currently a medicine resident physician at Penn and is planning to continue her anesthesia training at Harvard starting in July 2020. She is primarily interested in increasing the efficiency of health systems delivery with attention to patient safety, specifically within the perioperative realm.