Hemorrhoids are lumps or masses of tissue in the anus, which contain enlarged blood vessels. Hemorrhoids may be inside the anal canal (internal hemorrhoids), where they primarily cause the symptom of intermittent bleeding, usually with bowel movements. They may also lie just outside the anal canal (external hemorrhoids), where they primarily cause symptoms of swelling and sometimes discomfort. Swelling and discomfort may occur intermittently, when the hemorrhoids become especially irritated.

Many patients have both internal and external hemorrhoids. In most cases, the increase in abdominal pressure that triggers hemorrhoids is related to one or more of the following:

• Repeated straining to have a bowel movement, especially in people who suffer from frequent constipation
• The pressure of the fetus in pregnant women
• Repeated episodes of diarrhea
• Obesity
• Cirrhosis of the liver, in rare cases

Internal hemorrhoids, which develop inside the passageway of the anus, are usually painless. Internal hemorrhoids also may protrude (prolapse) outside the anus, where they appear as small, grape-like masses. These can be painful.

External hemorrhoids, which develop around the external opening of the anus, may be painful, because the skin around them is very sensitive. Sometimes they are just bothersome protrusions, which make hygiene difficult. External hemorrhoids sometimes develop a clot inside of them, often after a period of diarrhea or constipation. In that case, it produces a firm and painful swelling or lump around the rim of the anus.

Hemorrhoids are a very common health problem, affecting at least 4% of people in the United States at any one time. You are more likely to develop hemorrhoids if you eat a low-fiber diet and don't get enough exercise, which can lead to repeated episodes of constipation and straining to have bowel movements.

Symptoms of hemorrhoids include:

• Bright red blood on the toilet paper after having a bowel movement, especially if the stool was very hard or very large. Blood also may streak the surface of the stool, or color the water inside the toilet bowl



• For a prolapsed hemorrhoid, a soft, grape-like mass protruding from the anus that may be itchy or painful or may leak a fluid or mucus. In some cases, you can gently press the prolapsed hemorrhoid back into the anus with your fingertips.



• For an external hemorrhoid, a painful bulge or firm lump around the rim of the anus. The lump may have a blue or purple tint.

Unless there is rectal bleeding, most people with hemorrhoids can diagnose and treat the problem themselves. If you have rectal bleeding, it is important for you to see a physician, so he or she can check for more dangerous causes of bleeding.

Painful hemorrhoid flare-ups can be a persistent problem, especially if you suffer from repeated episodes of constipation. Flare-ups are usually brief, and most symptoms disappear within a few days.

In pregnant women, hemorrhoids are often a temporary problem that either improves dramatically or disappears after childbirth.

You often can prevent hemorrhoids by preventing episodes of constipation. Some of the following diet and lifestyle changes may help you to soften your stool, establish a regular schedule for bowel movements and avoid the straining that can lead to hemorrhoids:

• Add more fiber to your diet � Set a goal of 25 to 30 grams of fiber daily, from such high fiber foods as beans, broccoli, carrots, bran, whole grains and fresh fruits. To avoid bloating and gas, add these foods gradually over a period of several days.



• Drink adequate amounts of fluid � For most healthy adults, this is the equivalent of 6 to 8 glasses of water daily.



• Begin a program of regular exercise � As little as 20 minutes of brisk walking daily can stimulate your bowel to move regularly.



• Train your digestive tract to have regular bowel movements � Schedule a time to sit on the toilet at approximately the same time each day. The best time to do this is usually right after a meal. Do not sit on the toilet for long periods (it tends to make hemorrhoids push out and swell up).



• Respond immediately to the urge to have a bowel movement � Do not postpone until the time is more convenient.

If dietary changes are not enough to prevent hard, dry stools, your doctor may suggest that you take a fiber powder supplement containing psyllium (Metamucil) or methylcellulose (Citrucel).

If you have been diagnosed with hemorrhoids in the past, and you are experiencing a flare-up of pain or itching, try the following strategy:

• Because persistent constipation can aggravate your hemorrhoids and prevent them from improving, take preventive measures to avoid constipation.



• Take warm sitz baths, especially when the hemorrhoids are uncomfortable. Sit in a tub or pan of plain warm water, 3 or 4 times a day, for 15-20 minutes each time. (Large pharmacies and medical supply stores also sell convenient plastic sitz bath devices that fit into a toilet). The water will keep the area clean, and the warmth will reduce inflammation and discomfort. Be certain to dry the rectal area thoroughly after each sitz bath. If you work, you can still take a sitz bath in the morning, upon returning from work, and again at bedtime.



• Apply a cold compress or icepack to the anal area, or try a cool cotton pad soaked in witch hazel.



• Apply petroleum jelly or aloe vera gel to the anal area, or use an over-the-counter hemorrhoid preparation containing lidocaine or hydrocortisone.



• After every bowel movement, clean the anal area with a witch hazel pad, a soothing baby wipe or a cotton cloth soaked in warm water. Be thorough but gentle. Aggressive rubbing and scrubbing, especially with soaps or other skin cleansers, can irritate the skin and make your hemorrhoids worse.

If you have more severe hemorrhoid symptoms, or if your hemorrhoids are prolapsed or filled with a blood clot, your doctor may recommend one of the following treatment options:

• Rubber band ligation � A rubber band is slipped around the base of the hemorrhoid to cut off its circulation. Once it has been deprived of its vital blood supply, the banded hemorrhoid withers and falls off.



• Sclerotherapy � An irritating chemical solution is injected directly into the hemorrhoid or the area around it. This solution causes a local reaction that interferes with blood flow inside the hemorrhoid, making the hemorrhoid shrink.



• Coagulation therapies � These treatments use electricity, a laser or infrared light to destroy hemorrhoids by burning.



• Hemorrhoidectomy � Although this surgical removal of hemorrhoids is painful, it is effective.

Call your doctor whenever you have bleeding from your rectum. Even if you have been treated for bleeding hemorrhoids in the past, it is always safer for your doctor to determine the best course of action. This is especially true if you are over age 40, when there is an increase in the risk of rectal bleeding from colorectal cancer and other serious digestive diseases.

Also, call your doctor if you have severe pain or itching from hemorrhoids, especially if this interferes with your ability to perform your job comfortably.

If hemorrhoids are related to pregnancy, the prognosis is very good, since most women experience relief after childbirth. For hemorrhoids related to constipation, the prognosis is also good, provided you make the necessary changes to your diet and lifestyle.

American Society of Colon and Rectal Surgeons
85 W. Algonquin Rd., Suite 550
Arlington Heights, IL 60005
Phone: 847-290-9184
Fax: 847-290-9203
Email: ascrs@fascrs.org
http://www.fascrs.org

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
Phone: 1-800-891-5389
Email: nddic@info.niddk.nih.gov
http://www.niddk.nih.gov/health/digest/digest.htm

National Institute of Diabetes & Digestive & Kidney Disorders
Office of Communications and Public Liaison
Building 31, Room 9A04
31 Center Drive, MSC 2560
Bethesda, MD 20892-2560
Phone: 301-496-4000
E-Mail: niddk_inquiries@nih.gov
http://www.niddk.nih.gov/

American College of Gastroenterology (ACG)
P.O. Box 342260
Bethesda, MD 20827-2260
Phone: 301-263-9000
http://www.acg.gi.org/

American Gastroenterological Association
4930 Del Ray Ave.
Bethesda, MD 20814
Phone: 301-654-2055
Fax: 301-654-5920
http://www.gastro.org/