Hemorrhoids are swollen veins in the lower rectum and anus, the lowest parts of the gastrointestinal tract. They can develop inside the rectum or under the skin around the anus and occur when the veins in this area become distended and swollen, similar to how varicose veins form in the legs. There are many causes of hemorrhoids; they can result from just about anything that disrupts blood flow to and from the area, from straining to have a bowel movement to being pregnant. Hemorrhoids are fairly common, and while there are some complications that can develop, they are generally not dangerous, though they may be uncomfortable and distressing. This in-depth look at hemorrhoids will help you understand causes, symptoms, treatments, and how to prevent them from developing in the first place.

What are hemorrhoids?

Hemorrhoids are swollen, inflamed veins in the lower part of the rectum or anus. There are two types of hemorrhoids: internal and external. Internal hemorrhoids form in the lining of the rectum or anus. Many people may not even know they have internal hemorrhoids unless they prolapse or become symptomatic. External hemorrhoids form under the skin around the anus and can be easily felt with the fingers when wiping after a bowel movement.

Hemorrhoids form when there is too much pressure in the veins in this part of the body. Many things can cause this, including chronic constipation or diarrhea, frequent lifting of heavy objects, and straining during bowel movements. Hemorrhoids are also more likely to occur when the supporting tissues in the rectum and anus are weak, which can happen with aging and pregnancy.

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Risk factors

Anything that can lead to increased pressure in the anus or rectum can cause hemorrhoids. Risk factors include:

  • Frequent straining during bowel movements
  • Sitting for long periods of time
  • Having chronic constipation or diarrhea
  • Having anal intercourse
  • Eating a low-fiber diet
  • Regularly lifting heavy objects

People are more at-risk for hemorrhoids as they age, as the muscles and tissues that support the anus and rectum can stretch and weaken. This can also happen during pregnancy. Hemorrhoids are also more common in people with obesity due to many factors, including diets, prolonged sitting, and decreased activity levels.

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Symptoms of hemorrhoids

Symptoms of hemorrhoids depend on the type. External hemorrhoids form a lump on the anus which can lead to pain when sitting or anal itching. Excessive rubbing, wiping, or straining can make symptoms worse.

Sometimes, blood clots can form in external hemorrhoids, which can cause them to grow larger and more painful. Internal hemorrhoids do not cause visible lumps or pain. They can bleed with bowel movements, producing a small amount of bright red blood. Either type of hemorrhoid can create a feeling of fullness, like the rectum is not completely emptied after a bowel movement.

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Diagnosis of hemorrhoids

Doctors use multiple methods to diagnose hemorrhoids. First, they will likely ask you to provide your medical history and explain your symptoms. They will want to know about your eating habits, toileting habits, current medications, and whether you use laxatives or enemas.

Your doctor is also likely to perform a physical exam, checking your anus for lumps, swelling, irritation, or skin tags and assessing the tone of the muscles in your anus. They may also recommend procedures to detect or investigate the extent of internal hemorrhoids, including an anoscopy or a rigid proctosigmoidoscopy to examine the lining of your rectum and anus. If you have pain in your rectum or notice bright red blood after a bowel movement, it is important to speak to your doctor. While these can be signs of hemorrhoids, they can also be symptoms of other serious health conditions, like anal fissures, diverticulosis, polyps, or colorectal cancer.

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Treatment options

Treatment of hemorrhoids depends on the severity. For both internal hemorrhoids and external hemorrhoids, the first line of treatment is modifying the stool, specifically increasing fiber and fluid intake to reduce constipation. Doctors may also recommend regular exercise and stool softeners and ask that you avoid pushing, straining, and sitting on the toilet for more than five minutes at a time.

If these changes are ineffective, treatments like rubber band ligation, injection sclerotherapy, dilation, and cryotherapy may be used. Rubber band ligation is the most commonly performed intervention as it is the safest and the most cost-effective. Surgery may be required if other treatments are unsuccessful or if hemorrhoids are particularly large. Surgical options include excising or cutting out the hemorrhoid, stapling the hemorrhoid to cut off the blood supply, and trans-anal revascularization when the surgeon ligates the arteries to reduce the size of the hemorrhoids.


Complications of hemorrhoids

Complications from hemorrhoids are rare, but they can happen. If hemorrhoids cause ongoing bleeding, it can lead to anemia, a condition in which there are not enough healthy red blood cells to effectively oxygenate the tissues. Blood clots can sometimes form inside an internal hemorrhoid, or the blood supply can get cut off, both of which can be extremely painful. Another complication is prolapse, which is when a hemorrhoid falls through the anal opening, causing discomfort or pain. The earlier hemorrhoids are treated, the better. Early treatment is often more straightforward than interventions required for advanced hemorrhoids and can prevent complications.

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Preventative measures

The best way to prevent hemorrhoids is to keep your stool soft. Making stool easier to pass can help avoid excess pressure during bowel movements. To do so, drink plenty of fluids; aim for six to eight glasses of water daily. Avoid drinks with sugar, alcohol, and caffeine, as these can have a diuretic effect, leading to increased urine output that can contribute to dehydration.

You should also eat high-fiber foods, like vegetables, fruits, and whole grains, which increase bulk and make stools easier to pass. If you need more fiber in your diet, fiber supplements can help. When increasing your fiber intake through diet or supplements, do so slowly to avoid excess gas and stomach pain. Do not strain or hold your breath when passing stool, as this increases pressure. Exercise can also help prevent constipation, as can avoiding long periods of sitting, especially on the toilet.

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Home remedies

Symptoms of hemorrhoids can be relieved with some home remedies.

To reduce irritation and itching, fill the bathtub with about four inches of warm water and sit in it with your knees bent for about fifteen minutes. After exiting the bath, gently pat the area dry; do not rub. You can also try over-the-counter products like lidocaine creams or witch hazel to relieve itching or shrink the tissue. Be sure to keep the area clean. If you have hemorrhoids, use a baby wipe, witch hazel pad, or cotton cloth soaked in water to clean the anal area after every bowel movement.

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Dietary management

Eating food to support healthy bowel movements and avoid constipation can help treat hemorrhoids or avoid getting them in the first place. The following foods are high in fiber and can help prevent constipation:

  • Whole grains, like oatmeal, bran cereal, brown rice, and whole wheat bread and pasta
  • Legumes, including black beans, kidney beans, chickpeas, and soybeans
  • Fruits, like oranges, pears, berries, and apples with the skin on
  • Nuts, like peanuts, almonds, and pecans

You should also avoid foods that can cause constipation, including:

  • Fast food
  • High-fat meat
  • Dairy products
  • Chips
  • Processed foods
  • Prepared foods

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When to seek medical help

If home remedies and dietary changes are not effective, and you are still having pain or other symptoms of hemorrhoids after a week, call you doctor. They can work with you to determine what treatment options are appropriate to give you relief. If you are experiencing pain with bowel movements, pain that does not go away, or bleeding, contact your doctor right away, as these can be signs of other more serious conditions.

Symptoms of hemorrhoids can mimic other health problems, including polyps or colorectal cancer. Regular health check-ups are essential to ensure you are not experiencing complications of hemorrhoids or symptoms of other health conditions. Hemorrhoids are relatively common, and they are generally not harmful if treated effectively. If you have hemorrhoids and are experiencing pain or discomfort, talk to your doctor about possible approaches to treatment. Eating a high-fiber diet, drinking plenty of water, and getting exercise can all help alleviate the symptoms of hemorrhoids or prevent them from developing in the first place.


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