Hemorrhoids (also called piles) are distended varicose veins in the anus. All veins are lined with valves that permit blood to flow in only one direction (back to the heart). Excess pressure on these valves can cause them to weaken and fail, allowing blood to flow in the wrong direction or to stagnate. The vein may engorge with blood, which, in the anus, results in a hemorrhoid.
Although hemorrhoids are often painless, the swollen wall of the vein is fragile and thus is prone to rupture and bleeding. Stagnant blood promotes formation of clots in the vein, which are typically painful and, in severe cases, may require surgery. Hemorrhoids usually affect people between the ages of 20 and 50 and are especially common in those who are constipated, pregnant, or obese, owing to increased pressure within the veins of the lower abdomen.
What Causes Hemorrhoids?
- Straining during bowel movements is a primary cause. (A diet low in fiber can result in constipation, which in turn encourages the tendency to strain during bowel movements.)
- Pregnancy, childbirth, heavy lifting and obesity increase the risk of hemorrhoids.
- Prolonged standing or sitting may be causes.
- Loss of muscle tone due to old age, an episiotomy, or rectal surgery can promote hemorrhoids.
- Digestive problems such as diarrhea and constipation can cause hemorrhoids.
- Excessive consumption of alcohol and caffeine
Symptoms of Hemorrhoids
- Bright red blood on the toilet paper, the stool, or in the toilet bowl after a bowel movement
- Pain, especially during bowel movements
- Anal itching
- Mucus discharge from the anus
- Swelling or a hard lump near the anus area
- A high-fiber diet including fresh fruit, vegetables, and whole-grain breads and cereals is recommended. Consuming Psyllium fiber supplements can also increase your fiber intake.
- Drink plenty of water.
- Don’t strain during bowel movements or stay on the toilet longer than necessary.
- Exercise regularly.
- Do not take laxatives, except bulk-forming laxatives such as Metamucil, Fiberall etc. Other forms of laxatives can cause diarrhea, which can worsen hemorrhoids.
- Patient history and examination of the anus and rectum are necessary. A doctor may detect internal hemorrhoids with a special scope.
- Barium enema x-rays may be ordered.
How to Treat Hemorrhoids
- Wash the anal area gently but thoroughly after each bowel movement, using a soft tissue and warm water. To dry, dab the area with a soft cloth.
- For external hemorrhoids, apply an ice compress.
- Frequent warm baths or sitz baths can relieve mild symptoms of pain and itching.
- Anesthetic ointment and topical corticosteroids (such as hydrocortisone) may ease pain and swelling.
- An injection of a solution that turns the hemorrhoid to scar tissue may be used (sclerotherapy).
- Some hemorrhoids may be tied off using a rubber band (rubber band ligation).
- To help relieve pain use acetaminophen (one brand name: Tylenol), ibuprofen (one brand name: Motrin) or aspirin.
- In severe cases surgical removal (hemorrhoidectomy) may be necessary.
When to Call a Doctor
- Any sign of rectal bleeding should be evaluated by a physician.
- If other symptoms do not improve with home treatment, see a doctor.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media