Hemorrhoids

What are hemorrhoids?

Hemorrhoids are swollen veins in the anal canal. This common problem can be painful, but is usually not serious. These may form inside or outside of the anal opening and are therefore referred to as internal or external hemorrhoids. (You can have both types at the same time)

Causes
Symptoms
Diagnosis
Treatment
Causes: 

Many people have hemorrhoids at some time. Too much pressure on the veins in the pelvic and rectal area causes hemorrhoids. If you strain or sit on the toilet a long time to move stool, the increased pressure causes the veins lining the anus to swell and stretch. This can cause hemorrhoids. Diarrhea or constipation also may lead to straining and can increase pressure on veins in the anal canal.

Pregnant women can get hemorrhoids during the last 6 months of pregnancy. This is because of increased pressure on the blood vessels in the pelvic area. Straining to push the baby out during labor can make hemorrhoids worse. Being overweight can also lead to hemorrhoids.

Symptoms: 
  • Bleeding during bowel movements. You might see streaks of bright red blood on toilet paper after you strain to have a bowel movement.
  • Itching.
  • Rectal pain.
Diagnosis: 

Your health care provider will look at your anal area, perhaps with digital rectal exam or an anoscope (a hollow, lighted tube for viewing the lower few inches of the rectum).

More procedures may be needed to identify internal hemorrhoids or rule out other ailments that frequently cause anal bleeding, such as anal fissure, colitis, Crohn's disease, and colorectal cancer.

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To see further into the anal canal a sigmoidoscopy may be used, or the entire colon may be viewed with colonoscopy.

Treatment: 

Treatment of hemorrhoids is largely dependent on location and severity, ie. Internal vs. external. Most hemorrhoids can be treated with simple changes to diet and bowel habits or with short courses of topical medications. Most do not require surgery.

The goal of nonsurgical procedures used to treat hemorrhoids, called fixative procedures, is to reduce the blood supply to the hemorrhoid so it shrinks or goes away. The scar tissue left in its place helps support the anal tissue and helps prevent new hemorrhoids. These procedures involve tying off the hemorrhoids with a rubber band (rubber band ligation) or using heat, lasers, or electric current to create scar tissue. Fixative procedures can only be done on internal hemorrhoids.

Surgical removal of hemorrhoids (hemorrhoidectomy) can be used for large internal or external hemorrhoids. Sometimes a combination of treatments is the most effective way to treat hemorrhoids. a blood clot develops in the external hemorrhoid, the clot may need to be removed to relieve pain.