Hemorrhoids, also known as piles, are a familiar disorder, and usually not a serious one. It’s thought that 75 percent of Americans will have them at some time in their lives. The word comes from hemo (blood) plus rrhoos (flowing or discharging), and indeed the first symptom of hemorrhoids is usually a spot or streak of bright red blood on toilet paper or in the stool after a bowel movement.
The tissue of the anus and rectum is a cushion of blood vessels, connective tissue, and muscle. A hemorrhoid is an inflammation or enlargement of the veins in this tissue, caused by excess pressure in the anal or abdominal area.
Most people can tell if they have external hemorrhoids. These develop from veins around the edge of the anus, and are often felt as hard, itchy, tender lumps that are likely to be painful at times. If the veins rupture, bleeding also occurs.
The majority of hemorrhoids, however, are internal, developing an inch or more above the anus. Usually they cannot be seen or felt, and so often go undetected until they bleed. In some cases, an internal hemorrhoid can also prolapse—it falls through the anal opening and forms a protruding mass that may be painful and itchy. A prolapsed hemorrhoid can slip back into the rectum or can be moved back in with gentle pressure from a finger. But persistent or permanently prolapsed hemorrhoids need medical attention.
Symptoms of Hemorrhoids
- External hemorrhoid symptoms include a painful hard bump on the edge of or just outside the anus. External hemorrhoids may be accompanied by anal itching, bleeding and pain upon defecation.
- Internal hemorrhoid symptoms include bright red blood on toilet paper, in stool, or in the toilet after a bowel movement (often the first and only symptom). There may also be a discharge of mucus from the anus.
- Prolapsed hemorrhoids are often painful and symptoms include moist swelling of skin protruding outside the anal opening.
What Causes Hemorrhoids?
It used to be said that constipation was the chief cause, however, doctors are not so sure. A study published in the American Journal of Gastroenterology found that constipation and hemorrhoids were not linked; instead, diarrhea seemed to be a more likely cause.
Still, excess pressure in the anal area can promote hemorrhoids. That’s why habitually intense or straining while moving your bowels can promote or aggravate hemorrhoids. So can pregnancy, because the uterus puts additional pressure on the lower abdomen (though the hemorrhoids often disappear in the weeks following delivery). Other possible contributors to hemorrhoids include eating a low-fiber diet, being overweight and being sedentary. It’s also thought that genetics plays an important role.
Lifting heavy objects can cause hemorrhoids, as it increases the pressure on the internal rectal veins. In some cases, anal sex can cause hemorrhoids.
What If You Do Nothing?
Hemorrhoids are more of a nuisance than anything else and are rarely a serious risk to health. With proper care, pain or bleeding from an external hemorrhoid resolves itself very quickly in most cases. If you can withstand the pain and itching, the hemorrhoids may eventually diminish so living with them becomes tolerable.
But when you do notice the bleeding for the first time, you should get a doctor’s opinion. Probably it’s only a hemorrhoid, but in a very small number of cases, rectal bleeding may be the first sign of serious gastrointestinal disease, including cancer.
Home Remedies for Hemorrhoids
If a doctor has confirmed that you do have hemorrhoids, there may be no need for medical treatment. The following measures can ease the discomfort of hemorrhoids if you have them.
- Don’t strain or hold your breath on the toilet. When possible, choose a time for defecating when you aren’t rushed, and when the internal action of peristalsis can be helpful for you—perhaps after breakfast or soon after drinking a glass of water. Avoiding constipation also helps ease straining during a bowel movement.
- Practice good hygiene. Keep the anal area clean, but avoid using rough toilet paper. Gently wipe with wet paper or premoistened wipes.
- Try frequent warm baths. For painful hemorrhoids, try warm-water sitz baths two or three times daily, in a squatting position. (For convenience you can buy a plastic sitz-bath seat that fits over the toilet rim.)
- Apply zinc oxide paste or powder or petroleum jelly to ease defecation and soothe itching. Nonprescription cortisone cream (0.5 percent strength) or witch hazel (which has an astringent effect) may also help. Be careful of relying on certain over-the-counter hemorrhoid remedies such as Preparation H—these can be damaging to anal tissue, especially with prolonged use.
- Try cold compresses or ice packs several times a day. These can help reduce both inflammation and discomfort.
- Wear cotton underwear and loose clothing. This helps avoid irritation.
- Be careful of what you eat. Some people find that certain foods and beverages aggravate hemorrhoids. Prime offenders may include nuts, red pepper, mustard, regular and decaffeinated coffee, and alcohol. You can try eliminating foods that seem to be making matters worse.
Many people rely on over-the-counter preparations to relieve inflammation and pain from external hemorrhoids. The most useful ingredients in many of these products are likely to be zinc oxide or petroleum jelly—both of which cost less if bought on their own. And generic products are just as good as brand names (and cheaper).
You can also get some pain relief from products ending in “caine,” which are local anesthetics. These ingredients can irritate the skin, so pick a product specifically for hemorrhoids.
Products that claim to shrink tissue, such as Preparation H or Anusol, must carry certain cautions (people with heart disease and diabetes should not use them, for example), and they must also advise hemorrhoid sufferers to seek medical help if the condition worsens or fails to improve. Such products can also be damaging to anal tissue, especially with prolonged use.
Limit use of any over-the-counter product to seven days, and do not use any of these products on bleeding hemorrhoids. If symptoms persist, call your doctor.
Though hemorrhoids may not be avoidable in all cases, you can do many things to prevent them from developing.
- Eat a high-fiber diet. This helps to prevent constipation. Fruits, whole grains, and vegetables form the base of a well-balanced diet, and this helps produce soft but formed, regular bowel movements. The increased fecal bulk is easily eliminated without straining the hemorrhoidal veins. To prevent painful gas, cramping, bloating, or diarrhea, increase your fiber intake gradually.
- Drink plenty of water. Drinking 8 to 10 glasses a day will help ease bowel movements.
- Don’t self-prescribe laxatives. Laxatives frequently cause diarrhea, which can be as rough on the hemorrhoids as the straining associated with constipation.
- Avoid sitting or standing for long periods. If your job is sedentary and you must sit for long periods, stand up now and then and take a short walk. If you have to stand for long stretches of time, you may stress your rectal veins. Sit or lie down for brief periods whenever possible.
- Reduce your weight. Excess pounds increase pressure and cause hemorrhoids.
- Exercise regularly. Daily exercise improves circulation, prevents constipation, helps prevent hemorrhoids from developing, and aids in the shrinkage of existing hemorrhoids.
- Be careful lifting. Abdominal strain can increase pressure on the rectal-anal veins. Whenever lifting heavy objects, inhale first, bend your knees and pull up with your arms, straightening your legs simultaneously. Get someone to help with extremely heavy objects.
Beyond Home Remedies: When To Call Your Doctor
Any of the following symptoms means you should consult a doctor: severe pain, throbbing, rectal bleeding that continues in excess of a week or is not associated with bowel movements, or blood that is dark rather than bright red. Throbbing pain and the formation of a lump near the anus may mean that an external hemorrhoid has “thrombosed” (formed a blood clot). Constant pain or persistent blood loss may mean that you have some condition other than a hemorrhoid, such as an anal fissure, fistula, or abscess. These maladies require their own forms of treatment.
What Your Doctor Will Do
A detailed history will be taken followed by an examination of the anus and rectum. A physical exam will reveal any external hemorrhoids. Using a gloved finger, a proctoscope, or an anoscope, the physician may detect internal hemorrhoids in the rectum. If no hemorrhoids are found, further tests may be recommended to find the cause of bleeding.
If hemorrhoids are found but home remedies don’t bring relief, your doctor can prescribe suppositories, injections, and other therapies to soothe and reduce the swelling and pain. If these are ineffective, surgery may be recommended.
Medical Treatments for Hemorrhoids
When hemorrhoids are persistent and distressful despite self-care measures, your doctor may recommend removing them. There are several ways to do this, including ligation (tying them off with a rubber band); injection of a chemical solution that shrinks the vein; laser surgery; and in severe cases surgical removal in a hospital.
Surgery is the most invasive treatment, and you should consider it only if your primary physician advises it for external and/or internal hemorrhoids that bleed continually or are repeatedly swollen and painful. It’s always wise to seek a second opinion before deciding to have surgery.
Don’t let your first stop be a surgeon’s office or a clinic that advertises quick-fix laser treatment (“In and out the same day!”). All of the above methods involve varying degrees of discomfort during recovery, and there may be complications to the procedures. Moreover, none of them guarantees that hemorrhoids won’t recur (in fact, recurrence is frequent).
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media