What Is It?
Hemorrhoids are lumps or masses of tissue in the anus, which contain enlarged blood vessels. Any increase in abdominal pressure may produce hemorrhoids. This may be from:
Internal hemorrhoids. Internal hemorrhoids lie inside the anal canal, where they primarily cause the symptom of intermittent bleeding, usually with bowel movements, and sometimes mucous discharge. They are usually painless. Internal hemorrhoids also may protrude (prolapse) outside the anus, where they appear as small, grape-like masses. Usually the prolapsed hemorrhoid can be pushed back into the anus with a finger tip.
External hemorrhoids. These lie just outside the anal opening, where they primarily cause symptoms of swelling or bothersome protrusions, and sometimes discomfort. Swelling and discomfort may occur only intermittently. External hemorrhoids may also cause difficulties keeping the anal area clean after bowel movements. External hemorrhoids sometimes develop a blood clot inside of them ("thrombosis"), often after a period of diarrhea or constipation. In that case, it produces a sudden firm and painful swelling or lump around the rim of the anus.
Many people have both internal and external hemorrhoids.
Hemorrhoids are a very common health problem. Hemorrhoids are more likely to develop in individuals who eat insufficient dietary fiber and don't get enough exercise, which can lead to repeated episodes of constipation and straining to have bowel movements.
Symptoms of hemorrhoids include:
Like most anal or rectal conditions, physicians diagnose hemorrhoids by inspecting the anal area, feeling inside the anus with a gloved finger, and looking inside the anal canal with a small short scope ("anoscope"). If there is rectal bleeding, it is important that a physician also checks for other more dangerous causes of bleeding, such as colorectal cancer. This evaluation is usually done with a long flexible telescope ("flexible sigmoidoscopy," or "colonoscopy").
Hemorrhoid flare-ups (swelling, irritation and mild discomfort) are usually brief, and most symptoms disappear within a few days.
In pregnant women, hemorrhoid symptoms usually improve dramatically or disappear after childbirth.
Intermittent slight bleeding from hemorrhoids may carry on for months or years.
Painful swelling from thrombosis of an external hemorrhoid usually resolves over a period of days to weeks.
You can often prevent hemorrhoids by preventing 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:
If you are experiencing a flare-up of hemorrhoid swelling and discomfort, try the following:
If you have persistent or severe hemorrhoid symptoms, your doctor may offer one of the following treatment options:
Office treatments can only be used for internal hemorrhoids (it would be too painful to use them on external hemorrhoids).
Treatments in the operating room:
When to Call a Professional
Call your doctor whenever you have bleeding from your rectum, especially if you are over age 40, when there is an increase in the risk of rectal bleeding from colorectal cancer or other serious digestive diseases.
Also, see your doctor if you have severe rectal pain.
Hemorrhoids are not dangerous, and only need to be treated if they cause very bothersome symptoms. If hemorrhoids occur during pregnancy, they will usually regress spontaneously after childbirth. For hemorrhoids related to constipation, the prognosis is also good, provided you make the necessary changes to your diet and lifestyle. For hemorrhoids that cause persistent symptoms despite nonsurgical treatment, the results from office treatment or surgery are usually very good.
American Society of Colon and Rectal Surgeons
85 W. Algonquin Rd., Suite 550
Arlington Heights, IL 60005
National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
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
American College of Gastroenterology (ACG)
P.O. Box 342260
Bethesda, MD 20827-2260
American Gastroenterological Association
4930 Del Ray Ave.
Bethesda, MD 20814