What Are Hemorrhoids Symptoms Causes Diagnosis Treatment And Prevention
Lindsey KonkelRobert Jasmer, MDJ. Falcetti/iStock
Everyone has hemorrhoidal tissue in this area thats made up of blood vessels, connective tissue, and some muscle. These cushions dont always become enlarged or distended, but as we age, this phenomenon becomes more common causing what we call hemorrhoids, also known as piles.
Hemorrhoids can be caused in a number of ways, most commonly by straining to make a bowel movement. Lifting heavy objects, along with other activities that may cause straining, can also lead to hemorrhoids. Experiencing increased pressure during pregnancy and being overweight are other contributing factors.
Hemorrhoids may be painful and particularly bothersome if they are recurrent, but they’re not dangerous or life-threatening, and symptoms usually go away within a few days. There are plenty of effective ways to treat them, as well as options for the less common types of hemorrhoids that may be more problematic.
What Do Hemorrhoids Look Like When They Fall Out
Some bulges of the inflamed prolapsed hemorrhoids may be a dark red color, and some areas may have blood.
While prolapsed hemorrhoids do occasionally happen, you can nudge them back inside the rectum with your fingers.
If the prolapsed hemorrhoids do not retreat inside the rectal area, either on their own or with gentle pushing, then they will have likely progressed to a more aggressive grade.
If this is the case, consult your doctor on appropriate treatments for your prolapsed hemorrhoids.
Patients With Compounding Conditions
Pregnant patients often develop hemorrhoids as intra-abdominal pressure increases, particularly during the third trimester.36 Also, acute episodes of pain and bleeding are common in pregnant women with preexisting hemorrhoids.
Immunosuppressed patients and those on anticoagulant therapy are more prone to serious complications such as sepsis and profuse bleeding. Thus, conservative management should be used in these patients as well. Injection sclerotherapy may be beneficial, as it has been shown to decrease bleeding. Of note, patients on immunosuppressive agents should stop taking them and start taking an antibiotic, and patients on anticoagulant or antiplatelet medications should be instructed to stop them one week before any intervention.
Crohns disease. Some patients with Crohns disease may have hemorrhoids, though this is rare. Eglinton et al,37 in a series of 715 patients with Crohns disease, reported that 190 had symptomatic perianal disease. Of these, only 3 had hemorrhoids. Treatment is always conservative and directed at the Crohns disease rather than the hemorrhoids.
Patients with portal hypertension are prone to have anorectal varices that may resemble hemorrhoids. Anorectal varices can be treated with vascular ligation, whereas sclerotherapy is the preferred method for hemorrhoids in this group, in whom coagulopathy is common.
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Essential Orgs For Hemorrhoid Information
This site provides a comprehensive review of what hemorrhoids are, what causes them, and how to treat them. In cases when pain is severe and hemorrhoids aren’t healing with at-home treatment, in-office treatment by a healthcare provider is necessary. This can involve surgical and nonsurgical options.
The Mayo Clinic offers trusted guidance on symptoms, causes, diagnosis, and treatment of hemorrhoids. You can also find answers to specific questions about home remedies and hemorrhoid treatment during pregnancy.
Causes And Risk Factors Of Hemorrhoids
Several conditions and habits are thought to cause hemorrhoids:
- Chronic constipation or diarrhea
- Straining too hard during bowel movements
- Sitting on the toilet for a long time
Straining, constipation, and prolonged sitting can all affect the blood flow in the area, causing blood to not move at its expected rate within the vessels, leading to hemorrhoids.
Factors that raise your risk of developing hemorrhoids:
- Lack of fiber in the diet.
- Obesity: Being overweight can put pressure on the hemorrhoidal tissue.
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What Causes Internal And External Hemorrhoids And Simple Ways To Treat Them
Hemorrhoids are usually caused by increased pressure due to pregnancy, being overweight, or straining during bowel movements. By midlife, hemorrhoids often become an ongoing complaint. By age 50, about half the population has experienced one or more of the classic symptoms, which include rectal pain, itching, bleeding, and possibly prolapse . Although hemorrhoids are rarely dangerous, they can be a recurrent and painful intrusion. Fortunately, there’s a lot we can do about hemorrhoids.
Medical Management Of Hemorrhoids
- Indications: all patients with hemorrhoids
- Interventions to reduce anorectal pressure and straining
- Lifestyle modifications
- High fiber diet
- Increased fluid intake
- Avoidance of excessive straining
- Limiting the amount of time spent on the toilet
Conservative management is often the only intervention required for grade IâIIinternal hemorrhoids and external hemorrhoids.
Long-term use of topical medications for hemorrhoids can lead to sensitization and localized reactions and should be avoided.
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What Are Hemorrhoids Made Of
White bread and bagels. Milk, cheese, and other dairy. Meat. Processed foods such as frozen meals and fast food. Watch the amount of salt you eat. It can lead to your body hanging on to water.
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White bread and bagels. Milk, cheese, and other dairy. Meat. Processed foods such as frozen meals and fast food. Watch the amount of salt you eat. It can lead to your body hanging on to water.
Wondering if hemorrhoids can burst or how long they take to go away? Get the answers to some common questions here.
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Symptoms And Signs Of Hemorrhoids
Hemorrhoids are often asymptomatic, or they may simply protrude. Pruritus ani Pruritus Ani The perianal skin tends to itch, which can result from numerous causes . This condition is also known as pruritus ani. Occasionally, the irritation is… read more is not commonly caused by hemorrhoids unless they are significantly prolapsed.
Internal hemorrhoids typically manifest with bleeding after defecation blood is noted on toilet tissue and sometimes in the toilet bowl. Internal hemorrhoids may be uncomfortable but are not as painful as thrombosed external hemorrhoids. Internal hemorrhoids sometimes cause mucus discharge and a sensation of incomplete evacuation.
Strangulated hemorrhoids occur when protrusion and constriction occlude the blood supply. They cause pain that is occasionally followed by necrosis and ulceration.
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What Causes Haemorrhoids
Many cases are thought to be caused by too much straining on the toilet, due to prolonged constipation this is often due to a lack of fibre in a person’s diet. Chronic diarrhoea can also make you more vulnerable to getting haemorrhoids.
Other factors that might increase your risk of developing haemorrhoids include:
- being overweight or obese
- age as you get older, your body’s supporting tissues get weaker, increasing your risk of haemorrhoids
- being pregnant which can place increased pressure on your pelvic blood vessels, causing them to enlarge
- having a family history of haemorrhoids
- regularly lifting heavy objects
- a persistent cough or repeated vomiting
- sitting down for long periods of time
When To See A Doctor
Blood in the stool is never normal and should always be discussed with a physician, even when it is thought to be from a hemorrhoid.
Blood in the stool is most often the result of hemorrhoids bright red blood is characteristic. Stools that have darker red blood or that appear tarry might be related to another condition, particularly one associated with an area higher up in the digestive tract. In the event of these symptoms, it might be necessary to have testing to rule out other conditions.
Hemorrhoids Doctor Discussion Guide
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When To Seek Medical Advice
See your GP if you have persistent or severe symptoms of haemorrhoids. You should always get any rectal bleeding checked out, so your doctor can rule out more potentially serious causes.
The symptoms of haemorrhoids often clear up on their own or with simple treatments that can be bought from a pharmacy without a prescription . However, speak to your GP if your symptoms don’t get better or if you experience pain or bleeding.
Your GP can often diagnose haemorrhoids using a simple internal examination of your back passage, although they may need to refer you to a colorectal specialist for diagnosis and treatment.
Some people with haemorrhoids are reluctant to see their GP. However, theres no need to be embarrassed, because GPs are very used to diagnosing and treating haemorrhoids.
Read more about diagnosing haemorrhoids.
Over The Counter Medications For Hemorrhoids
- Brand names listed as examples do not imply better quality over other brands. Generic equivalents may also exist.
- Use only as directed on the package, unless your healthcare provider instructs you to do otherwise.
- OTCs may interact with other medications or be potentially harmful if you have certain medical conditions. Talk to your pharmacist about options that are right for you.
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Pearls And Other Issues
When internal hemorrhoids prolapse, they can become incarcerated and strangulated. Patients present with acute pain and may have urinary retention. Urgent treatment with excision hemorrhoidectomy is the treatment of choice.
Rectal varices can be seen in patients with portal hypertension but note that this is a distinct entity to hemorrhoids.
It is preferable to manage hemorrhoids in pregnancy medically and only perform operative therapy in severe cases such as a strangulated internal hemorrhoid.
One should exercise caution when considering operative management for hemorrhoids in patients with Crohn disease because of the subsequent prolonged wound healing and ulceration.
Procedures For Hemorrhoids Treatment
Some hemorrhoids can’t be managed with conservative treatments alone, either because symptoms persist or because an internal hemorrhoid has prolapsed. Fortunately, a number of minimally invasive hemorrhoid treatments are available that are less painful than traditional hemorrhoid removal and allow a quicker recovery. These procedures are generally performed in a surgeon’s office or as outpatient surgery in a hospital.
Band it. The most commonly used hemorrhoid treatment in the United States is rubber band ligation, in which a small elastic band is placed around the base of a hemorrhoid . The band causes the hemorrhoid to shrink and the surrounding tissue to scar as it heals, holding the hemorrhoid in place. It takes two to four procedures, done six to eight weeks apart, to completely eliminate the hemorrhoid. Complications, which are rare, include mild pain or tightness , bleeding, and infection. Other office procedures include laser or infrared coagulation, sclerotherapy, and cryosurgery. They all work on the same principle as rubber band ligation but are not quite as effective in preventing recurrence. Side effects and recurrence vary with the procedure, so consult your physician about what’s best for your situation.
Image: LuisPortugal/Getty Images
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Preventing And Treating Haemorrhoids
Haemorrhoid symptoms often settle down after a few days, without needing treatment. Haemorrhoids that occur during pregnancy often get better after giving birth.
- gradually increasing the amount of fibre in your diet good sources of fibre include fruit, vegetables, wholegrain rice, wholewheat pasta and bread, pulses and beans, seeds, nuts and oats
- drinking plenty of fluid particularly water, but avoiding or cutting down on caffeine and alcohol
- not delaying going to the toilet ignoring the urge to empty your bowels can make your stools harder and drier, which can lead to straining when you do go to the toilet
- avoiding medication that causes constipation such as painkillers that contain codeine
- exercising regularly can help prevent constipation, reduce your blood pressure and help you lose weight
These measures can also reduce the risk of haemorrhoids returning, or even developing in the first place.
Medication that you apply directly to your back passage or tablets bought from a pharmacy or prescribed by your GP may ease your symptoms and make it easier for you to pass stools.
There are various treatment options for more severe haemorrhoids. One of these options is banding, which is a non-surgical procedure where a very tight elastic band is put around the base of the haemorrhoid to cut off its blood supply. The haemorrhoid should fall off after about a week.
Read more about treating haemorrhoids and surgery for haemorrhoids.
Beans Lentils And Nuts
You’ll get a lot of bang for your bite with the legume family. Just 1/2 cup of beans — such as kidney, navy, lima, or black beans — will cover about a third of your daily goal. It will have between 7 and 10 grams of fiber , depending on which variety you choose.
About 20 almonds or pecans have around 3 grams of fiber. A 1/2 cup of edamame does, too, and it only has about half the calories.
Instead of using just meat in chili and soups, add or substitute beans. You can also use beans and nuts in salads. Try Indian and Middle Eastern recipes, which often call for beans, lentils, and peas.
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How Are They Treated
For most external hemorrhoids, home treatment is all you need. This includes slowly adding fibre to your meals, drinking more water, and using over-the-counter ointments for a limited time to stop itching. You also may use stool softeners. The same home treatment can be used for most internal hemorrhoids.
If your internal hemorrhoids are severe, you may need other treatment. The doctor may tie off the hemorrhoids with rubber bands or scar the tissue around the hemorrhoids. These treatments reduce the blood supply to the hemorrhoids so that they shrink or go away.
Surgery to remove hemorrhoids may be done if other treatments don’t work.
Healthy habits can help you prevent hemorrhoids or keep them from getting worse. Eat foods that have lots of fibre, such as fruits, vegetables, and whole grains. Also, drink plenty of water, and get plenty of exercise.
Modify Your Daily Activities
- Avoid prolonged sitting or standing. Take frequent short walks.
- If possible, avoid lifting heavy objects frequently. If you must lift heavy objects, always exhale as you lift the object. Don’t hold your breath when you lift.
- If you are pregnant, sleeping on your side will lower pressure on the blood vessels in your pelvis. This can help keep hemorrhoids from becoming bigger.
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Operative Treatment Of Hemorrhoids
Fewer than 10% of all patients evaluated with symptomatic hemorrhoids will require surgical management. Most patients respond to non-operative treatment and do not require a surgical procedure. Hemorrhoidectomy, or surgical removal of the hemorrhoidal tissue, may be considered if a patient presents with symptomatic large external hemorrhoids, combined internal and external hemorrhoids, and/or grade 3-4 prolapse. Hemorrhoidectomy is highly effective in achieving relief of symptoms and it is uncommon to have any significant recurrence. However, it also causes much more pain and disability than office procedures and has somewhat more complications.
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How Are Hemorrhoids Diagnosed
This check is known as a digital rectal exam. During this exam, your doctor inserts a gloved and lubricated finger into your rectum.
Depending on your risk factors for gastrointestinal disease, your doctor may order an additional test like an anoscopy, sigmoidoscopy, or colonoscopy.
In these tests, a small fiber-optic camera fits into a small tube thats inserted into your rectum. With this test, your doctor gets a clear view of the inside of your rectum so that they can examine the hemorrhoid up close.
You can find a primary care doctor, gastroenterologist, or other specialist near you through the Healthline FindCare tool.
You can have hemorrhoids treated at home or at a doctors office.
Can The Abscess Or Fistula Recur
If adequately treated and properly healed, both are unlikely to return. However, despite proper and indicated open or minimally invasive treatment, both abscesses and fistulas can potentially recur. Should similar symptoms arise, suggesting recurrence, it is recommended that you find a colon and rectal surgeon to manage your condition.
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Hemorrhoids: Signs Symptoms And Complications
For most people, the signs and symptoms of hemorrhoidsitchiness, swelling, discomfortwill be mild and respond to home remedies. In a minority of cases, however, hemorrhoid signs and symptoms will be severe enough that they require treatment from a physician. Rarely, hemorrhoids that cause significant blood loss or a blood clot can be life-threatening. It’s important to note that one of the chief calling cards of hemorrhoids, blood in or on the stool or on toilet paper, should never be considered normal. While the cause could indeed be hemorrhoids, a more serious condition could be afoot.
Hemorrhoids can come with external and/or internal symptoms, depending on how they form.
External Hemorrhoids
If the hemorrhoid becomes inflamed and engorged with blood it may look bluish-purple and be painful, not only during a bowel movement but even when walking or sitting.
The symptoms of external hemorrhoids can include:
- Tenderness when wiping
Internal Hemorrhoids
Hemorrhoids on the inside of the rectum, called internal hemorrhoids, might not cause symptoms and might only be discovered or diagnosed when they cause bleeding.
The symptoms of internal hemorrhoids can include:
- Bleeding during bowel movements
- Pain in the case of prolapse