Information about Internal & External Hemorrhoids
Hemorrhoids—clusters of swollen veins in and around the anus and rectum—are a common condition. More than half of all Americans develop hemorrhoids by age 50, and men and women are at equal risk. In fact, the condition is so ubiquitous that hemorrhoid sufferers have their own patron saint, St. Fiacre.
Hemorrhoids are thought to result from increased pressure on the veins in the anus or rectum, for example, by straining to move the bowels. Hemorrhoids usually can be managed with lifestyle and self-care measures, but surgical removal is required in some cases.
There are two types of hemorrhoids: internal and external. Internal hemorrhoids are located in the lower portion of the rectum and cannot be seen from outside the rectum. External hemorrhoids are visible beneath the skin around the anus.
Causes of hemorrhoids
A number of factors increase the risk of hemorrhoids or can make them worse. For example, they are more common with age, peaking at around age 65. Hemorrhoids are also associated with obesity, pregnancy and childbirth, liver disease, prostate enlargement, chronic cough, and diarrhea—all of which can increase pressure on veins in the anus and rectum.
Contrary to popular belief, heavy lifting, long periods of sitting, and chronic constipation do not lead to hemorrhoids, although these factors can irritate existing hemorrhoids. Excessive rubbing or cleaning of the anal area also can irritate an existing condition.
Symptoms of hemorrhoids
The most common symptom of internal hemorrhoids is bleeding during a bowel movement. Such bleeding ranges in severity from blood on the toilet paper or on the outside of stools to blood in the toilet bowl. Because the membranes inside the rectum lack pain-sensitive nerves, internal hemorrhoids typically cause no pain or discomfort. However, you may experience a sensation of fullness in the rectum after a bowel movement. Internal hemorrhoids may also prolapse—meaning that the hemorrhoid protrudes outside of the anus. Prolapse can occur after straining during a bowel movement.
Unlike internal hemorrhoids, external hemorrhoids frequently cause irritation and pain, usually lasting no more than 10 days. Acute pain and inflammation can occur when a blood clot in an external hemorrhoid forms a hard lump near the anus. Mucus draining from an external hemorrhoid can cause mild itching. See your doctor if you suspect that you have hemorrhoids and if the condition causes pain or frequent rectal bleeding.
Diagnosis of hemorrhoids
Doctors diagnose hemorrhoids by first asking about any changes in your bowel patterns and about any symptoms of pain, bleeding, or itching. The doctor may then perform an external inspection of the anus, a digital rectal exam (placing a gloved finger into the rectum to feel for hemorrhoids), and an anoscopy (an examination of the anus and lower rectum using a device called an anoscope, a short, rigid, hollow tube with a light source). Sigmoidoscopy (to view the rectum and lower colon) or colonoscopy (to view the entire colon) may be performed to see if the bleeding is originating from a source other than the hemorrhoids.
Treatment of hemorrhoids
If you have mild symptoms, lifestyle and self-care measures are frequently effective. To treat constipation that can exacerbate symptoms, you should increase your fiber and fluid intake to make stools bulkier, softer, and easier to pass. Also, you should not ignore the urge to have a bowel movement and should try not to strain when passing stool. Regular physical activity also may be helpful.
To avoid irritation of hemorrhoids, do not rub your anus too much with toilet paper after a bowel movement. Instead, try wiping gently with wet toilet paper or moist towelettes. Also, avoid sitting on the toilet for long periods.
Although research has not shown that over-the-counter suppositories, ointments, or hydrocortisone creams are effective in the treatment of hemorrhoids, many people report that they are beneficial. You may also get relief from pads containing witch hazel or a numbing agent.
To reduce irritation, try to keep the anal area clean. Avoid using soap, because it can be an irritant. Soaking in a warm bath or using a sitz water bath (a plastic basin of warm water that fits over the toilet) three to four times a day for 10 minutes at a time may be helpful. Afterwards, dry the anal area with a hair dryer to reduce moisture that can cause irritation. Applying cold compresses or ice packs to the anal area up to four times a day can reduce swelling.
If these conservative measures do not provide sufficient symptom relief, there are additional treatments for hemorrhoids. Rubber band ligation is the most common treatment for hemorrhoids. A small rubber band is placed at the base of the hemorrhoid to cut off its blood supply. After about a week, the hemorrhoid withers and falls off. This technique works about three quarters of the time.
Sometimes, a chemical solution is injected into the hemorrhoid to shrink it—a procedure called sclerotherapy.
Other options for internal hemorrhoids use freezing, electrical or laser heat, or infrared light to destroy hemorrhoids. In addition, a procedure called hemorrhoid stapling uses a device to staple and cut out internal hemorrhoids (it is not as effective for external ones). Most internal hemorrhoids can be treated effectively with one or more of these techniques.
A small percentage of people with internal hemorrhoids are not helped by the above therapies and need surgery to remove the hemorrhoids. This procedure, called a hemorrhoidectomy, requires a one- to two-day hospital stay and is the best way to ensure permanent removal of internal hemorrhoids.
For external hemorrhoids, oral pain relievers such as acetaminophen (Tylenol) or aspirin can provide some relief. However, if a hemorrhoid forms into a hard lump due to a blood clot and severe pain lasts longer than seven to 10 days, surgical removal of the clotted hemorrhoid often provides relief from symptoms.