Division of Gastroenterology & Hepatology
What are hemorrhoids?
Hemorrhoids are cushions consisting of blood vessels and elastic tissue that are present in the anal canal and are commonly also referred to as “piles”. There are two types of hemorrhoids, which are called internal or external hemorrhoids depending upon their location in the anal canal. They are important in preventing stool leakage when you strain or cough. Sometimes, trouble with constipation, excessive straining, and increase in intra-abdominal pressure during pregnancy, obesity and absence of valves in blood vessels that feed them can cause these cushions to swell. This can result in bleeding, pain or anal irritation. Liver disease can also cause swollen vessels called “varices” which should not be mistaken for hemorrhoids. Your doctor should usually be able to tell the difference and may looks for other signs of liver disease, which may be a clue.
What are the symptoms of hemorrhoids?
There are several symptoms that may occur from hemorrhoids. You may notice bright red blood on the toilet paper or in the toilet bowl most commonly from internal hemorrhoids. Sometimes, these veins stretch, and may even fall down (prolapse) through the anus to outside the body (protruding hemorrhoids). When this happens, the vein may become irritated and painful.
When they prolapse or protrude outside, blood clots may form in them, which may make them large and painful, and these are called thrombosed external hemorrhoids. You may notice a tender lump on the edge of the anus. Bleeding starts when the swollen veins are scratched or broken by straining or rubbing. People who have external hemorrhoids may also feel itching at the anus. This might result from draining mucus and irritation caused by too much rubbing or cleaning of the anus, or alternatively by inadequate anal hygiene leading to particles of stool around the anus caught in between the hemorrhoid protrusions. Any stool particles on the perianal skin will cause itching and irritation in this area.
How common are problems with hemorrhoids?
Hemorrhoid problems occur equally in men and women and affect approximately 1 million Americans each year. About 50% of people over the age of 50 will have experienced symptoms related to hemorrhoids at some point in time. Many people have bleeding from hemorrhoids but the bleeding is usually not serious. Women may begin to have problems during pregnancy. The pressure of the fetus in the abdomen, as well as hormonal changes, causes hemorrhoidal veins to enlarge. These veins are also placed under severe pressure during the birth of the baby. For most women, however, such hemorrhoids are a temporary problem and usually get better rapidly after delivery.
What is the Treatment?
Often all that is needed to reduce symptoms is to include more fiber (about 25-30 gms/daily) in your diet to soften the stool. You should also eat more fresh fruits, leafy vegetables, whole grain breads and cereals (especially bran). There are several over the counter fiber supplements that you can use. Drinking six to eight glasses of water each day will also help. Softer stools make it easier to empty the bowels and lessen pressure on the veins.
Good hygiene is also important. Bathe the anus gently after each bowel movement using a soft, moist toilet paper (or a commercial moist pad) and avoid a lot of wiping. If necessary, you can even use a bath or shower as an alternative to wiping. After bathing, dry the anus gently with a soft cloth or towel. You can also try a sitz bath where you soak the perianal region in warm water.
When Do I Need to See My Doctor?
It is a good idea to see your doctor any time you see bleeding from the anus. This is important to make sure you don't have cancer or some other disease of the digestive system. You will need an examination of your anus and rectum and possibly further examination of the bowel. If the doctor finds hemorrhoids, you may be advised to change your diet or to use a fiber supplement that softens the stool, or a stool softener. Your doctor might also recommend ice tubs or warm soaks (sitz baths).
If you know you are having pain from hemorrhoids, you might try putting cold packs on the anus, followed by a tub bath, or sitz bath, three or four times a day. To protect against irritation, cleanse the anus carefully and apply Vaseline to the area. Medicated suppositories or creams are available at the drug store. Any of these home treatments may relieve the symptoms, and no other treatment may be needed. If symptoms persist see your doctor.
In some cases, internal hemorrhoids that have fallen outside of the anus (prolapsed) or that bleed too much need further treatment. Your gastroenterologist may be able to treat bleeding internal hemorrhoids with a simple outpatient procedure where rubber bands can be placed around the hemorrhoids, which will control the bleeding in most cases. If this does not work, you may need an operation by the surgeon though this is typically not necessary.
In summary, hemorrhoid problems are quite common and there are various treatment options including topical applications and simple office-based procedures to treat symptoms.