What Is It?

A hemorrhoid is a bulging, distended vein in the area around the anus, the opening through which stool passes. An increase in pressure within the abdomen causes blood to back up inside blood vessels, making them bulge and stretch out of shape.

In most cases, the increase in abdominal pressure that triggers hemorrhoids is related to one or more of the following:

• Repeated straining to have a bowel movement, especially in people who suffer from frequent constipation
• The pressure of the fetus in pregnant women
• Repeated episodes of diarrhea
• Obesity
• Work that requires prolonged standing (traffic officer, waitress, cashier), sitting (truck driver) or heavy lifting (packing clerk, furniture mover)
• Cirrhosis of the liver, in rare cases

Internal hemorrhoids, which develop inside the passageway of the anus, are usually painless, although they sometimes cause vague discomfort and minimal bleeding if a hard stool rubs against them during a bowel movement. Internal hemorrhoids also may protrude (prolapse) outside the anus, where they appear as small, grape-like masses. These can be painful.

External hemorrhoids, which develop around the rim of the anus, are often fairly painful, because the skin around them is unusually sensitive. External hemorrhoids sometimes rupture and bleed. When an external hemorrhoid becomes filled with a blood clot (thrombosed), it typically appears as a firm swelling or lump around the rim of the anus.

Hemorrhoids are a very common health problem, affecting about half of all men and women by age 50. Because the tendency to develop hemorrhoids seems to run in families, doctors believe that at least part of the risk for hemorrhoids is genetic (inherited). For many people, this inherited risk is aggravated by a low fiber diet and a sedentary lifestyle that lead to repeated episodes of constipation and straining to have bowel movements.

Symptoms of hemorrhoids include:

• Bright red blood on the toilet paper after having a bowel movement, especially if the stool was very hard or very large; blood also may streak the surface of the stool, or lightly color the water inside the toilet bowl
• A vague ache in the anus after having a bowel movement
• For a prolapsed hemorrhoid, a soft, grape-like mass protruding from the anus that may be itchy or painful or may leak a watery fluid or mucus. In some cases, you can gently press the prolapsed hemorrhoid back into the anus with your fingertips.
• For an external hemorrhoid, a painful bulge or firm lump around the rim of the anus. The lump may have a blue or purple tint.

Unless there is rectal bleeding, most people with hemorrhoids can diagnose and treat the problem themselves.

Painful hemorrhoid flare-ups can be a persistent problem, especially if you suffer from repeated episodes of constipation. Flare-ups are usually brief, and most symptoms disappear within a few days.

In pregnant women, hemorrhoids are often a temporary problem that either improves dramatically or disappears after childbirth.

You often can prevent hemorrhoids by preventing episodes of constipation. Some of the following diet and lifestyle changes may help you to soften your stool, establish a regular schedule for bowel movements and avoid the straining that can lead to hemorrhoids:

• Add more fiber to your diet — Set a goal of 25 to 30 grams of fiber daily, from such high fiber foods as beans, broccoli, carrots, bran, whole grains and fresh fruits. To avoid bloating and gas, add these foods gradually over a period of several days.
• Drink adequate amounts of fluid — For most healthy adults, this is the equivalent of six to eight glasses of water daily.
• Begin a program of regular exercise — As little as 20 minutes of brisk walking daily can effectively stimulate your bowel function.
• Train your digestive tract to have regular bowel movements — Schedule a 10-minute period to sit on the toilet at approximately the same time each day. The best time to do this is usually right after a meal.
• Respond immediately to the urge to have a bowel movement — Do not postpone until the time is more convenient.

If dietary changes are not enough to prevent hard, dry stools, your doctor may suggest that you use a stool softener (docusate or mineral oil) or a fiber supplement containing psyllium or methylcellulose.

If you have been diagnosed with hemorrhoids in the past, and you are experiencing a flare-up of pain or itching, n try the following strategy:

• Because persistent constipation can aggravate your hemorrhoids and prevent them from improving, take preventive measures to avoid constipation.
• Try sitz baths. Sit in a tub filled with warm water for 10 to 15 minutes several times a day.
• Apply a cold compress or icepack to the anal area, or try a cool cotton pad soaked in witch hazel.
• Apply petroleum jelly or aloe vera gel to the anal area, or use an over-the-counter hemorrhoid preparation containing lidocaine or hydrocortisone.
• After every bowel movement, clean the anal area with a witch hazel pad, a soothing baby wipe or a cotton cloth soaked in warm water. Be thorough but gentle. Aggressive rubbing and scrubbing, especially with soaps or other skin cleansers, can irritate the skin and further aggravate your hemorrhoids.
• As necessary, modify your daily activities. Lie down periodically to decrease pressure in your anal area, and avoid spending long periods of time on the toilet.

If you have more severe hemorrhoid symptoms, or if your hemorrhoids are prolapsed or thrombosed, your doctor may recommend one of the following treatment options:

• Rubber band ligation — A rubber band is slipped around the base of the hemorrhoid to cut off its circulation. Once it has been deprived of its vital blood supply, the banded hemorrhoid withers and falls off.
• Sclerotherapy — An irritating chemical solution is injected directly into the hemorrhoid or the area around it. This solution causes a local reaction that interferes with blood flow inside the hemorrhoid, making the hemorrhoid shrink.
• Coagulation therapies — These treatments use electricity, a laser or infrared light to destroy hemorrhoids by burning.
• Hemorrhoidectomy — Although this surgical removal of hemorrhoids is very effective, it carries the risk of causing anal scars that may interfere with bowel movements.

Call your doctor whenever you have rectal bleeding. Even if you have been treated for bleeding hemorrhoids in the past, it is always safer for your doctor to determine the best course of action. This is especially true if you are over age 40, when there is an increase in the risk of rectal bleeding from colorectal cancer and other serious digestive diseases.

Also, call your doctor if you have severe pain or itching from hemorrhoids, especially if this interferes with your ability to perform your job comfortably.

If hemorrhoids are related to pregnancy, the prognosis is very good, since most women experience relief after childbirth. For hemorrhoids related to constipation, the prognosis is also good, provided you make the necessary changes to your diet and lifestyle.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.