Hemorrhoids are swollen veins that develop in the anal canal. Bleeding during bowel movements, itching, and rectal pain are the most common symptoms. Hemorrhoids can be uncomfortable at times, but rarely are they a serious problem.
Most of the time, you can treat them with simple changes to your diet and bowel habits. These changes include eating more fiber and not straining to pass stools. Most hemorrhoids don't need surgery or other treatment unless they are very large and painful or bleed a lot.
Hemorrhoids are swollen veins in or just outside of the anus. If you have hemorrhoids, you might notice a painful lump outside the anus. You might also notice bleeding or itching.
Hemorrhoids are common, and your doctor will usually suggest home treatment.
For some people, hemorrhoids may cause a little discomfort for a limited time. Other people have recurrent bouts of discomfort when hemorrhoids flare up. Some people struggle with hemorrhoid pain, discomfort, and itching much of their lives. The degree and duration of discomfort depend on where the hemorrhoids are.
Hemorrhoids frequently develop during pregnancy because of extra pressure on veins (from the enlarged uterus).
During labor, hemorrhoids may start or get worse because of the intense straining and pressure on the anal area while pushing to deliver the baby.
Because external hemorrhoids may not cause any symptoms, you may not be aware that you have hemorrhoids.
When a vein within an external hemorrhoid gets irritated, blood may clot under the skin, forming a hard, bluish lump. This is known as a thrombosed, or clotted, hemorrhoid. Thrombosed hemorrhoids can be very painful.
Small internal hemorrhoids may not grow larger if bowel habits or other factors change to lower pressure on the veins in the bowel.
Large internal hemorrhoids may bulge from the anus. After bowel movements, you may have to push them back through the anus. At worst, large internal hemorrhoids stick out all the time.
In rare cases, hemorrhoids may bulge through the anus and swell. Muscles that control the opening and closing of the anus may cut off a hemorrhoid's blood supply (strangulated hemorrhoid). This may cause the hemorrhoid tissues to die. If this happens, you will feel severe rectal pain and may see blood and pus at the anus. You will need urgent surgery to prevent further complications, such as death of the affected tissue and infection.
Hemorrhoids may cause:
For most external hemorrhoids, home treatment is all you need. 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 create scar tissue around the hemorrhoids. These treatments reduce the blood supply to the hemorrhoids so they shrink or go away.
Surgery to remove hemorrhoids may be done if other treatments don't work. It may be done to remove large internal or external hemorrhoids that are uncomfortable or painful.
When an external hemorrhoid gets irritated and clots (thrombosed, or clotted, hemorrhoid), a doctor may relieve your pain by removing the contents of the clot. The doctor will use a medicine to numb the anal area (local anesthetic). Then he or she will make a small incision to drain the clot.
This will probably give you immediate and long-lasting relief from the intense pain.
Before you go home, you will be instructed to take daily sitz baths (sit in a shallow tub of warm water for 10 to 15 minutes) and to gently cleanse your anal area with a cleansing agent such as Balneol. Your doctor may give you a cream that contains a local anesthetic to help relieve pain. The wound should heal in about a week.
If your doctor doesn't remove the clot within 3 to 4 days after it forms, the pain will gradually get less over the next few days. The skin covering the clot may break open on its own, causing mild bleeding. With home treatment, pain and bleeding should go away in about a week. But it may take several weeks for the clot to go away.
There are things you can do to help prevent hemorrhoids.
Your doctor can tell if you have hemorrhoids by asking about your past health and doing a physical exam.
You may not need many tests at first if your doctor thinks that your rectal bleeding is caused by hemorrhoids. Your doctor may just examine your rectum with a gloved finger. Or your doctor may use a short, lighted scope to look inside the rectum.
Rectal bleeding can be a sign of a more serious problem, such as colon, rectal, or anal cancer. So if the first exam doesn't show a clear cause of your problems, your doctor may do tests to check for other causes of bleeding. The doctor may use a lighted scope to look at the lower third of your colon. This is called sigmoidoscopy. Or your doctor may use another kind of scope to look at the entire colon. This is called colonoscopy.
Medicines can help relieve symptoms of hemorrhoids. Over-the-counter (OTC) treatments you can try include:
The following professionals can evaluate and treat hemorrhoids:
If medical treatment or surgery is needed, you may be referred to a:
Internal hemorrhoids develop inside the anal canal. External hemorrhoids develop near the anal opening. Both types can occur at the same time.
Hemorrhoids are usually caused by too much pressure on the veins in the pelvic and rectal area. If you sit on the toilet a long time or strain to have a bowel movement, the extra pressure causes the veins in this tissue to swell and stretch. The result is hemorrhoids.
Things that can lead to hemorrhoids include:
Things that make hemorrhoids worse include:
A first-degree internal hemorrhoid bulges into the anal canal during bowel movements.
A second-degree internal hemorrhoid bulges from the anus during bowel movements, then goes back inside by itself.
A third-degree hemorrhoid bulges from the anus during bowel movements and must be pushed back in with a finger. A fourth-degree hemorrhoid protrudes from the anus all the time.
Call 911 anytime you think you may need emergency care. For example, call if:
Call your doctor now or seek immediate medical care if:
Watch closely for changes in your health, and be sure to contact your doctor if:
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