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Hemorrhoids

(Piles)

Definition

Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. The blood vessels are stretched under pressure. Hemorrhoids are grouped as either internal or external.

  • Internal hemorrhoids develop inside the anus. They are painless and sometimes bleed a lot during bowel movements. They may also stick out during bowel movements. If they pop out from the anal opening and cannot be pushed back, they can cause severe pain.
  • External hemorrhoids develop under the skin around the anus. They can easily be felt or seen as a lump. They also bleed when broken by straining, rubbing, or scratching.

Hemorrhoids

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Causes    TOP

The exact cause of hemorrhoids is unknown. Excess pressure on the veins in the rectum is a major factor. If the pressure continues, the veins enlarge and stick out.

Risk Factors    TOP

Hemorrhoids are more common in older adults. Factors that increase your risk of getting hemorrhoids include:

  • Straining when trying to pass a stool
  • Chronic constipation or diarrhea
  • Sitting on the toilet for long periods of time
  • Pressure on the veins from pregnancy and childbirth
  • Obesity
  • Family members with hemorrhoids
  • Chronic cough
  • Liver disease
  • Chronic use of enemas or laxatives

Symptoms    TOP

Not everyone will have symptoms. For those that do have symptoms, most will go away within several days.

Common symptoms include:

  • Bleeding from the anus which may be seen:
    • On the stool
    • On the toilet paper
    • In the toilet bowl
  • Anal itching and burning
  • Swelling and pain during bowel movements
  • Sensitive lumps of various sizes around the anus

Bleeding from the rectum or blood in the stool can be a symptom of other conditions including rectal or colon cancer. It is important to see a doctor if you have any rectal bleeding so they can rule out other causes.

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. Your anus and rectum will be examined to look for swollen blood vessels. A rectal exam will be done.

An endoscope may be needed to see deeper areas of the rectum and colon.

Treatment    TOP

Initial Treatments

Treatment will first focus on relieving symptoms. Steps that may help include:

  • Sitz baths—sitting in plain, warm water 2-3 times a day for about 10 minutes each time
  • Ice packs—putting cold packs on the anus for short periods of time to relieve pain and swelling
  • Medication—applying hemorrhoidal creams or suppositories to the affected area
  • High-fiber diet —eating more fresh fruit, raw or cooked vegetables, and whole grains
  • Fluids—drinking plenty of non-alcoholic fluids will help soften stools

Nonsurgical Procedures

The hemorrhoid may need to be shrunk or destroyed if the steps above do not give you relief. These procedures, which are generally performed in a doctor’s office, include:

  • Rubber band ligation —a rubber band is placed around the base of the hemorrhoid. The band cuts off blow flow to the tissue. After a few days the hemorrhoid will wither away.
  • Sclerotherapy—a chemical mix is injected near the blood vessel. The chemicals will cause scarring and shrinkage of the vein.
  • Coagulation therapy—electricity, laser, or infrared light is used to shrink the tissue.

Surgery    TOP

If nonsurgical options fail to give you relief, surgery may be needed.

Hemorrhoidectomy is the removal of hemorrhoidal tissue.

Prevention    TOP

The best way to prevent hemorrhoids is to keep stools soft so they pass easily. The following can help:

  • Eat a high fiber diet.
  • Exercise regularly.
  • Empty bowels as soon as possible after the urge occurs.
  • Avoid the overuse of laxatives.

RESOURCES:

American Society of Colon and Rectal Surgeons
http://www.fascrs.org
National Digestive Diseases Information Clearinghouse
http://digestive.niddk.nih.gov

CANADIAN RESOURCES

The Canadian Association of Gastroenterology
http://www.cag-acg.org
The College of Family Physicians of Canada
http://www.cfpc.ca

References:

Alonso-Coello P, Guyatt G, Heels-Ansdell D, et al. Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev. 2005;(4):CD004649.
Altomare DF, Rinaldi M, La Torre F, et al. Red hot chili pepper and hemorrhoids: the explosion of a myth: results of a prospective, randomized, placebo-controlled, crossover trial. Dis Colon Rectum. 2006;49:1018-1023.
Hemorrhoids. American Society of Colon and Rectal Surgeons website. Available at: https://www.fascrs.org/patients/disease-condition/hemorrhoids. Accessed June 20, 2016.
Hemorrhoids. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116475/Hemorrhoids. Updated July 10, 2016. Accessed September 28, 2016.
Hemorrhoids. National Digestive Diseases Information Clearinghouse website. Available at:
...(Click grey area to select URL)
Updated November 2013. Accessed June 20, 2016.
Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006;(4):CD005393.
Last reviewed January 2018 by Marcin Chwistek, MD
Last Updated: 2/8/2018

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