Carl R. Darnall Army Medical Center - Health Library

Hemorrhoids

(Piles)

Definition

Hemorrhoids are swollen veins. They are found in and around the anus and lower rectum. The veins get stretched out when they're under pressure.

The types are:

  • External—Grow 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.
  • Internal—Grow inside the anus. They are painless, but can bleed a lot during bowel movements. They may also pop out or prolapse from the anal canal. If this happens and they can't be pushed back, it can cause severe pain. The internal type is graded based on prolapse severity.
  • Mixed

Hemorrhoids
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Causes ^

The exact cause of hemorrhoids is unknown. The most common may be linked to:

  • Chronic constipation—causes straining during bowel movements
  • A buildup of pressure or fluid inside the belly—maybe caused by pregnancy or other health conditions

Risk Factors ^

Hemorrhoids are more common in older adults. Your chances are also higher for:

  • Having any of the problems listed above
  • Chronic diarrhea
  • Sitting on the toilet for long periods of time
  • Obesity
  • Having people in your family who have hemorrhoids
  • Chronic coughing
  • Long term use of enemas or laxatives
  • Having liver disease

Symptoms ^

Not everyone will have symptoms. They may range from mild to severe. The most common are:

  • Bleeding, 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 can be a sign of other health conditions, some serious. If you are bleeding, call your doctor so you can find the cause.

Diagnosis ^

You will be asked about your symptoms and health history. Your answers and a physical exam may point to hemorrhoids. The doctor will take examine the anal area carefully. An anoscope can be used to see internal structures.

Treatment ^

How hemorrhoids are treated depend on the problems. It mainly starts with easing symptoms. Sometimes they go away on their own or with basic care. Your doctor may try one or more of these:

Initial Treatments

Self-care may be enough. This involves:

  • 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 ease pain and swelling
  • Medicines—using creams and suppositories
  • High-fiber diet —eating more fresh fruit, raw or cooked vegetables, and whole grains
  • Fluids—drinking plenty of fluids will help soften stools

Procedures

If self-care doesn't work, your doctor may advise:

  • Rubber band ligation—A rubber band is placed around the base of the hemorrhoid. The band cuts off blow flow. After a few days the it will wither away.
  • Sclerotherapy—A chemical mix is injected near the vein. The chemicals will cause scar and shrink the vein.
  • Coagulation therapy—Electricity, laser, or infrared light is used to shrink the tissue.
  • Hemorrhoidectomy—Surgical removal is done if none of the other methods work.

Prevention ^

To help lower your chances of hemorrhoids:

  • Empty bowels as soon as possible after you feel the urge.
  • Don't strain while having a bowel movement.
  • Don't sit on the toilet for long periods of time, including reading.
  • Slowly increase your fiber intake to 30-35 grams a day. Eat fruits, vegetables, beans, and whole grains. Consider using supplements if you need to.
  • Drink 6-8 glasses of water or fluids without caffeine a day.
RESOURCES:

American Gastroenterological Association
https://www.gastro.org

American Society of Colon and Rectal Surgeons
https://www.fascrs.org

CANADIAN RESOURCES:

Canadian Association of Gastroenterology
https://www.cag-acg.org

The College of Family Physicians of Canada
https://www.cfpc.ca

REFERENCES:

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(7):1018-1023.

Hemorrhoids. American Society of Colon and Rectal Surgeons website. Available at: https://www.fascrs.org/patients/disease-condition/hemorrhoids. Accessed August 24, 2018.

Hemorrhoids. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116475/Hemorrhoids. Updated February 20, 2018. Accessed August 24, 2018.

Hemorrhoids. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/hemorrhoids. Updated July 2018. Accessed August 24, 2018.

Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006;(4):CD005393.

Last reviewed June 2018 by EBSCO Medical Review Board Marcin Chwistek, MD  Last Updated: 8/24/2018