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Hemorrhoids

Hemorrhoids are swollen cushions of tissue in the anus or lower part of the rectum. They contain many arteries and veins.

Alternative Names

Rectal lump; Piles; Lump in the rectum

Causes

Hemorrhoids are very common. They result from increased pressure on the anus. This can occur during pregnancy, childbirth, and due to constipation. The pressure causes the normal anal cushions to swell. This tissue can bleed, often during bowel movements.

Hemorrhoids may be caused by:

  • Straining during bowel movements
  • Constipation
  • Sitting for long periods of time, especially on the toilet
  • Certain diseases, such as liver cirrhosis

Hemorrhoids may be inside or outside the body.

  • Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. When they are large they may fall outside (prolapse). The most common problem with internal hemorrhoids is bleeding during bowel movements.
  • External hemorrhoids occur outside the anus. They can result in difficulty cleaning the area after a bowel movement. If a blood clot forms in an external hemorrhoid, it can be very painful (thrombosed external hemorrhoid).

Symptoms

Hemorrhoids are usually not painful, but if a blood clot forms, they can be very painful.

Common symptoms include:

  • Painless bright red blood from the rectum
  • Anal itching
  • Anal ache or pain, especially while sitting
  • Pain during bowel movements
  • One or more hard tender lumps near the anus

Exams and Tests

Most of the time, a doctor can often diagnose hemorrhoids simply looking at the rectal area. External hemorrhoids can often be detected this way.

Tests that may help diagnose the problem include:

Treatment

Treatments for hemorrhoids include:

  • Over-the-counter corticosteroid (for example, cortisone) creams to help reduce pain and swelling
  • Hemorrhoid creams with lidocaine to help reduce pain
  • Stool softeners help reduce straining and constipation

Things you can do to reduce itching include:

  • Apply witch hazel to the area with a cotton swab.
  • Wear cotton underwear.
  • Avoid toilet tissue with perfumes or colors. Use baby wipes instead.
  • Try not to scratch the area.

Sitz baths can help you to feel better. Sit in warm water for 10 to 15 minutes.

If your hemorrhoids do not get better with home treatments, you may need some type of office treatment, such as heat treatment, to shrink the hemorrhoids. This is called infrared coagulation. This may help avoid surgery. Another type of office treatment that may help is rubber band ligation.

If these treatments are not enough, some type of surgery may be necessary, such as removal of the hemorrhoids (hemorrhoidectomy ). These procedures are generally used for patients with severe bleeding or prolapse who have not responded to other therapy.

Possible Complications

The blood in the hemorrhoid may form clots . This can cause tissue around it to die. Surgery is often needed to remove hemorrhoids with clots.

Rarely, severe bleeding may also occur. Iron deficiency anemia can result from long-term blood loss.

When to Contact a Medical Professional

Call for your health care provider if:

  • Hemorrhoid symptoms do not improve with home treatment.
  • You have rectal bleeding. Your provider may want to check for other, more serious causes of the bleeding.

Get medical help right away if:

  • You lose a lot of blood
  • You are bleeding and feel dizzy, lightheaded, or faint

Prevention

Constipation, straining during bowel movements, and sitting on the toilet too long raise your risk for hemorrhoids. To prevent constipation and hemorrhoids, you should:

  • Drink at least eight glasses of water a day.
  • Eat a high-fiber diet of fruits, vegetables, and whole grains.
  • Consider using fiber supplements.
  • Use stool softeners to prevent straining.

References

Sneider EB, Maykel JA. Diagnosis and management of symptomatic hemorrhoids. Surg Clin North Am. 2010 Feb;90(1):17-32, Table of Contents.

Nelson H. Anus. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 53.

Updated: 4/23/2013

Joshua Kunin, MD, Consulting Colorectal Surgeon, Zichron Yaakov, Israel. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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