Definition

Hemorrhoids are swollen veins. They are found in and around the anus and lower rectum. External hemorrhoids grow under the skin around the anus. Internal ones grow inside the anus.

Hemorrhoids
Nucleus factsheet image

Copyright © Nucleus Medical Media, Inc.

Causes

The exact cause not known. It may be due to:

  • Chronic constipation that results in straining during bowel movements
  • A buildup of pressure or fluid inside the belly, such as from pregnancy or health problems

Risk Factors

This problem is more common in older adults. Other things that may raise the risk are:

  • Having any of the problems that cause hemorrhoids
  • Having other family members who have hemorrhoids
  • Sitting on the toilet for long periods of time
  • Chronic coughing
  • Chronic diarrhea
  • Obesity
  • Long term use of enemas or laxatives
  • Liver disease

Symptoms

Some people may not have symptoms. Others may have problems that range from mild to severe. Common ones are:

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

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam may be done. It will focus on the anal area. An anoscope may be used to see internal structures. This is often enough to make the diagnosis.

Treatment

The goal of treatment is to ease symptoms and promote healing.

Initial Treatments

Initial treatments may be:

  • Supportive care, such as warm baths or cold packs
  • Lifestyle changes, such as a high fiber diet and drinking plenty of fluids
  • Medicines to ease pain, such as:
    • Ointments, creams, and suppositories applied to the skin
    • Over the counter pain relievers taken by mouth

Procedures

Procedures may be done when other methods are not helpful. Options are:

  • Rubber band ligation —places a rubber band around the base of the hemorrhoid to cut off blood flow to it until it withers away
  • Sclerotherapy—injects a chemical mix near the vein to scar and shrink the vein
  • Coagulation therapy—uses electricity, laser, or infrared light to shrink the tissue
  • Hemorrhoidectomy —uses surgery to remove the hemorrhoid

Prevention

To lower the risk of this problem:

  • Do not strain or read while having a bowel movement.
  • Treat constipation.
  • Drink plenty of fluids during the day.
  • Eat a high fiber diet.
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:

Hemorrhoids. American Society of Colon and Rectal Surgeons website. Available at: https://www.fascrs.org/patients/disease-condition/hemorrhoids. Accessed October 22, 2020.

Hemorrhoids. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/hemorrhoids. Accessed October 22, 2020.

Hemorrhoids. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/hemorrhoids. Accessed October 22, 2020.

Jacobs D. Clinical practice. Hemorrhoids. N Engl J Med. 2014 Sep 4;371(10):944-951.

Last reviewed September 2020 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD  Last Updated: 10/22/2020