Hemorrhoids

Swollen veins in the lower part of your bottom (rectum) are called hemorrhoids. Sometimes these swollen veins are inside the rectum, and while they often don't hurt, they can sometimes bleed. Other times, the swollen veins are outside the rectum, which can be painful.

Hemorrhoids, also known as piles, are like varicose veins in your bottom area. They happen when veins around your anus and rectum swell up. Internal hemorrhoids are those inside the rectum, and external hemorrhoids are those under the skin around the anus.

There are ways to relieve hemorrhoids. Many people find that simple things like changing their habits and using home treatments are enough to feel better.

Hemorrhoids, or piles, have different symptoms depending on their location. Internal hemorrhoids are inside the rectum. You usually can't feel them, and they often don't cause any discomfort. However, straining during bowel movements can sometimes cause a little painless bleeding. You might see a small amount of bright red blood on toilet paper or in the toilet bowl. Sometimes, an internal hemorrhoid can push out through the anus, becoming a prolapsed or protruding hemorrhoid. This can cause pain and irritation.

External hemorrhoids are outside the rectum, around the anus. Symptoms of external hemorrhoids include:

• Itching or soreness: The area around the anus might feel itchy or irritated.
• Pain: You may experience pain or discomfort.
• Swelling: The area around your anus might swell up.
• Bleeding: Blood can collect in an external hemorrhoid, forming a blood clot called a thrombus.

A thrombosed hemorrhoid (a blood clot in a hemorrhoid) is very painful and causes swelling, inflammation, and a hard, discolored lump near the anus.

If you have any bleeding during bowel movements, or if your hemorrhoids haven't gotten better after a week of home treatment, it's important to see a doctor. Don't assume rectal bleeding is always caused by hemorrhoids. Other serious conditions, such as colorectal cancer or anal cancer, can also cause rectal bleeding. Changes in your bowel habits, like different stool colors or consistency, could also be signs of something else.

Seek immediate medical attention (emergency care) if you have a lot of rectal bleeding, feel lightheaded, dizzy, or faint. These could be signs of a serious problem.

If you're having blood in your stool, or if your hemorrhoids haven't gotten better after a week of home treatment, see your doctor.

Don't automatically think hemorrhoids are the cause of rectal bleeding, especially if your bowel movements are different. Changes in how often you have a bowel movement, or changes in the color or texture of your stool, could signal a problem beyond just hemorrhoids. Rectal bleeding can be a symptom of other serious conditions like colorectal cancer or anal cancer.

Get immediate medical help if you're bleeding a lot from your rectum, or if you feel lightheaded, dizzy, or faint. Heavy bleeding combined with these symptoms is a serious sign that needs immediate attention.

Swollen or bulging veins around the anus are called hemorrhoids. They happen when the veins in the lower part of your rectum stretch and get bigger. This stretching often happens because of increased pressure in the area. Several factors can cause this pressure:

• Straining during bowel movements: Pushing too hard when you have a bowel movement puts extra pressure on the veins. This can be common if you're constipated. Making sure you're not straining too hard is key.

• Sitting for long periods: Staying seated, especially on the toilet for extended times, can also put consistent pressure on the veins in the rectum. Taking breaks and moving around can help.

• Chronic bowel issues: Problems like diarrhea or chronic constipation can irritate the rectum and lead to increased pressure. Managing these conditions can reduce the risk of hemorrhoids.

• Obesity: Extra weight puts extra pressure on the veins in the entire body, including those in the rectum. Maintaining a healthy weight can help.

• Pregnancy: The weight of a growing baby puts pressure on the veins in the pelvis, which can include the rectal area. This is a common cause during pregnancy.

• Anal intercourse: The friction and pressure involved in anal sex can sometimes lead to hemorrhoids.

• Low-fiber diet: A diet lacking in fiber can lead to constipation, which in turn increases pressure during bowel movements. Eating more fruits, vegetables, and whole grains can help.

• Heavy lifting: Lifting heavy objects puts stress on the muscles and veins in the body, including those in the rectum. Using proper lifting techniques and taking breaks is important.

As people get older, they're more likely to get hemorrhoids. This is because the tissues that hold the veins in the rectum and anus can become weaker and stretch out. A similar thing can happen during pregnancy, as the growing baby puts extra weight and pressure on the area around the anus.

Hemorrhoids are common, but serious complications are uncommon. While most hemorrhoids cause mild discomfort, a few rare issues can arise.

• Anemia: Hemorrhoids sometimes cause slow, ongoing bleeding. If you lose a lot of blood over time, this can lead to anemia. Anemia means your body doesn't have enough healthy red blood cells. Red blood cells carry oxygen to all the parts of your body. Without enough, you might feel tired, weak, or pale.

• Strangulated Hemorrhoid: An internal hemorrhoid can become strangulated. This happens when the blood supply to the hemorrhoid is cut off. This is a serious problem because it can cause intense and sudden pain. You should see a doctor right away if you think you might have a strangulated hemorrhoid.

• Blood Clot (Thrombosed Hemorrhoid): Sometimes, a blood clot forms inside a hemorrhoid. This is called a thrombosed hemorrhoid. While not life-threatening, a thrombosed hemorrhoid can be incredibly painful. The pain is usually sudden and localized to the area of the clot. In some cases, a doctor might need to drain the clot to relieve the pain.

Keeping your bowel movements soft is the best way to prevent hemorrhoids. Hemorrhoids, or swollen veins in the anus and rectum, can be uncomfortable and sometimes bleed. Here's how to help prevent them and ease symptoms:

Eat a High-Fiber Diet: Fruits, vegetables, and whole grains are packed with fiber. Fiber makes your stool softer and larger, which helps it pass through your digestive system more easily. Avoid straining during bowel movements, as this is a major cause of hemorrhoids. Gradually increase your fiber intake to prevent gas or other digestive issues.

Stay Hydrated: Drinking plenty of water and other fluids, like juice or broth, helps to keep your stool soft and easy to pass. Limiting alcohol consumption can also be helpful. Aim for 6 to 8 glasses of fluids daily.

Fiber Supplements (Optional): Many people don't get enough fiber from their food. If you're not able to get enough fiber through diet alone, fiber supplements like psyllium husk (found in products like Metamucil and Konsyl) or methylcellulose (like Citrucel) can be helpful. These supplements can reduce hemorrhoid symptoms and bleeding.

Important Note about Fiber Supplements: If you choose to take fiber supplements, it's crucial to drink plenty of water (at least 8 glasses a day). Fiber supplements can cause constipation if you don't drink enough fluids. This can worsen hemorrhoid symptoms. Always talk to your doctor before starting any new supplement regimen, especially if you have other health conditions.

Doctors can diagnose hemorrhoids in a few ways. External hemorrhoids are often visible during a physical exam. For internal hemorrhoids, a doctor might need to examine the inside of your rectum and anus.

One common method is a digital exam. A doctor inserts a lubricated, gloved finger into your rectum. This helps them feel for any unusual lumps or growths. Sometimes, internal hemorrhoids are too soft to feel this way.

If that's the case, the doctor might use a tool to look inside. Tools like anoscopes, proctoscopes, or sigmoidoscopes allow a doctor to see the lower part of the colon and rectum. These tools are thin, flexible tubes with a light on the end.

Sometimes, a colonoscopy is needed. This is a longer, more thorough exam that lets the doctor see your entire colon. A colonoscopy might be recommended if:

• You have symptoms that could suggest another digestive problem.
• You have risk factors for colon cancer.
• You are middle-aged and haven't had a colonoscopy recently.

Mayo Clinic doctors can help you with hemorrhoid-related concerns. They offer various procedures, including colonoscopies and flexible sigmoidoscopies.

Home Remedies and Medical Treatments for Hemorrhoids

Hemorrhoids, sometimes called piles, are swollen veins in the anus or rectum. Mild hemorrhoids often respond well to home care. Here's how to manage them:

Home Treatments:

• Fiber-Rich Diet: Eating more high-fiber foods like fruits, vegetables, and whole grains makes your stool softer and bulkier, preventing straining during bowel movements. Gradually increase your fiber intake to avoid gas or other digestive issues.
• Topical Treatments: Over-the-counter creams, ointments, suppositories, or pads containing hydrocortisone, witch hazel, or numbing agents can help relieve pain, itching, and swelling. Hydrocortisone can thin the skin if used for too long, so follow your doctor's advice on usage time.
• Warm Baths: Soaking the anal area in warm water (either in a tub or a sitz bath) for 10-15 minutes, a few times a day, can ease discomfort. A sitz bath is a small basin that fits over the toilet.
• Over-the-Counter Pain Relievers: Acetaminophen (like Tylenol), aspirin, or ibuprofen (like Advil or Motrin) can temporarily reduce pain.

When to See a Doctor:

If home treatments don't provide relief within a week, see your doctor. Seek immediate medical attention if you have severe pain, bleeding, or other concerning symptoms.

Mild Hemorrhoids:

For mild hemorrhoids, your doctor might recommend over-the-counter creams, ointments, suppositories, or pads. These often contain ingredients like witch hazel, hydrocortisone, or lidocaine to help with pain and itching.

Blood Clots:

If a painful blood clot forms in an external hemorrhoid, your doctor may remove it. This is best done within 72 hours of the clot forming. The procedure typically involves numbing the area.

Minimally Invasive Procedures:

For bleeding or painful hemorrhoids not responding to other treatments, less-invasive procedures are available:

• Rubber Band Ligation: A small tool is inserted into the anus to place rubber bands around the base of the internal hemorrhoid. This cuts off the blood supply, causing the hemorrhoid to shrink and fall off within a week. This procedure can cause some discomfort and bleeding, which usually subsides within a few days. Possible complications exist.
• Sclerotherapy: A chemical solution is injected into the hemorrhoid tissue to shrink it. This procedure may be less effective than rubber band ligation.
• Coagulation: Using lasers, infrared light, or heat, this technique hardens and shrinks bleeding internal hemorrhoids. It generally causes little discomfort.

Surgical Options (Rare):

Surgery is usually a last resort for hemorrhoids that haven't responded to other treatments or are very large.

• Hemorrhoidectomy: This is the most common surgical procedure and involves removing the extra tissue causing the bleeding. It can be done with local anesthesia, sedation, spinal anesthesia, or general anesthesia. Post-operative discomfort is common, and recovery time can vary. Potential complications include difficulty urinating (especially after spinal anesthesia) leading to urinary tract infections.
• Hemorrhoid Stapling: This procedure, also known as stapled hemorrhoidopexy, blocks blood flow to the hemorrhoidal tissue. It's typically used for internal hemorrhoids. Recovery is generally quicker than with hemorrhoidectomy but carries a higher risk of the hemorrhoids returning or developing rectal prolapse (a part of the rectum pushing through the anus). Possible complications include bleeding, bladder problems, and pain. In rare cases, a life-threatening blood infection (sepsis) can occur.

Important Note: It's crucial to discuss all treatment options with your doctor to determine the best approach for your specific situation.