Hemorrhoids are swollen veins that develop in the rectal area. They can cause symptoms like itching, bleeding, and discomfort. Many people develop hemorrhoids at some point, but mild cases often clear up on their own. More severe hemorrhoids may require medical treatment to reduce symptoms and complications. Let’s explore some key questions about hemorrhoids:
What causes hemorrhoids?
Hemorrhoids develop when the veins around the anus or lower rectum become swollen and inflamed. This happens due to increased pressure in those veins. Common causes include:
- Straining during bowel movements
- Sitting for long periods of time on the toilet
- Chronic diarrhea or constipation
- Obesity
- Pregnancy
- Aging
Activities like heavy lifting, chronic coughing, and genetics may also play a role in some cases. The increased pressure causes the veins to swell, stretch out, and sometimes bulge.
What are the symptoms of hemorrhoids?
Symptoms can vary depending on the type and severity of hemorrhoids. Common signs include:
- Itching or irritation – Hemorrhoids can feel itchy. This is often worse after a bowel movement.
- Pain – Internal hemorrhoids usually cause mild discomfort, but external hemorrhoids can be quite painful, especially during bowel movements.
- Bleeding – Seeing blood on toilet paper or in the toilet bowl after a bowel movement could indicate hemorrhoids. This blood is usually bright red.
- Lump or fullness – External hemorrhoids may protrude from the anus and can be seen or felt. These may go back inside on their own or be pushed back in.
- Leakage – Leakage of stool or mucus can happen with prolapsed internal hemorrhoids (ones that bulge from the anus).
Severe hemorrhoid symptoms like excessive bleeding, pain, or prolapse should be evaluated by a doctor.
What are the types of hemorrhoids?
There are two main classifications of hemorrhoids:
Internal hemorrhoids
These develop within the rectum beneath the lining. You can’t usually see or feel them, and they don’t cause as much pain. But they may bleed during a bowel movement.
External hemorrhoids
These form under the skin around the anus. They tend to be more uncomfortable. Straining may push an external hemorrhoid so it protrudes outside (called a prolapsed hemorrhoid).
Hemorrhoids are also classified by severity:
- Grade 1: No prolapse, only visible during examination
- Grade 2: Prolapse during bowel movement but goes back inside on its own
- Grade 3: Prolapse but needs to be pushed back in manually
- Grade 4: Persistently prolapsed and can’t be pushed back in
How are hemorrhoids diagnosed?
A doctor can often diagnose hemorrhoids based on a physical exam of the anus and rectum. They may perform tests like:
- Visual inspection – Looking at the area to check for signs of hemorrhoids
- Digital exam – Inserting a gloved, lubricated finger into the anus to feel for abnormalities
- Proctoscopy – Using a short tube instrument with a light to view the anal canal and lower rectum
- Colonoscopy or sigmoidoscopy – Scoping tests to examine the entire colon or its lower portion
These exams help rule out other conditions with similar symptoms, like fissures, fistulas, warts, or polyps. Your doctor may also ask about your symptoms and medical history.
How are hemorrhoids treated?
Treatment options depend on the type and severity of hemorrhoids. Mild cases often go away on their own or with at-home care. More advanced hemorrhoids require medical procedures.
Home treatments
You may be able to treat small hemorrhoids with the following:
- Over-the-counter topical ointments, creams, or suppositories – These contain ingredients like hydrocortisone to reduce inflammation and analgesics to relieve pain.
- Sitz baths – Soaking in warm water for 10-15 minutes 2-3 times daily may help relieve irritation.
- Ice packs – Applying ice periodically can constrict blood vessels, reduce swelling, and numb pain.
- Oral pain relievers – Ibuprofen, acetaminophen, etc. can help with discomfort.
- Stool softeners – These make bowel movements easier to pass to reduce straining.
- Added fiber – Eating more fiber-rich fruits, vegetables, and whole grains or taking a supplement can reduce constipation.
Medical procedures
If home care doesn’t improve symptoms, a doctor may recommend:
- Rubber band ligation – Putting tight rubber bands around the base of internal hemorrhoids to cut off their blood supply. The hemorrhoid then shrinks and falls off within a week.
- Sclerotherapy – Injecting a chemical solution into the hemorrhoid to shrink it.
- Coagulation therapies – Using infrared light, heat, or cold (cryotherapy) to coagulate and shrink small hemorrhoids.
- Hemorrhoidectomy – Surgically removing severe external or internal hemorrhoids.
How can hemorrhoids be prevented?
Preventing constipation and straining with bowel movements may help avoid hemorrhoids or keep them from worsening. Tips include:
- Eating more fiber and staying hydrated
- Not delaying when feeling the urge to have a bowel movement
- Avoiding prolonged sitting on the toilet
- Exercising regularly
- Losing weight if overweight
Pregnant women may be unable to completely prevent hemorrhoids but can take steps to reduce constipation and take pressure off the area.
Are hemorrhoids serious?
Mild hemorrhoids often clear up on their own or by using simple home treatments. But some hemorrhoids can become serious if left untreated, causing complications like:
- Anemia – Chronic blood loss from hemorrhoid bleeding can lead to low iron levels and anemia.
- Strangulated hemorrhoid – If the blood supply to a prolapsed hemorrhoid gets cut off, it can become strangulated and cause severe pain.
- Blood clots – External hemorrhoids may develop blood clots, causing a painful thrombosed hemorrhoid.
- Infection – Hemorrhoids could get infected, most often with streptococcus bacteria.
- Stool leakage – Severely prolapsed internal hemorrhoids may allow stool to leak from the anus, leading to hygiene problems and skin irritation.
Severe hemorrhoid symptoms that don’t improve with home care or recurrence of large hemorrhoids likely requires evaluation by a colorectal surgeon. Procedures like rubber band ligation or hemorrhoidectomy can reduce complications.
How long do hemorrhoids last?
The duration of hemorrhoids varies:
- Grade 1 and 2 hemorrhoids may disappear within a few days without treatment.
- Treated grade 1 and 2 hemorrhoids typically resolve within 1-2 weeks.
- Untreated larger hemorrhoids can last for weeks or months before shrinking.
- After treatment procedures like sclerotherapy or rubber band ligation, large internal hemorrhoids may shrink over 6-8 weeks.
- External thrombosed hemorrhoids usually resolve within 7-10 days, but may leave a skin tag behind.
- Hemorrhoids that develop during pregnancy often go away after giving birth.
- Recurrence is common after hemorrhoids go away, especially without proper prevention.
Despite treatment, hemorrhoids tend to reoccur in around half of people within 10 years. Lifestyle changes and prevention techniques can reduce the likelihood of recurrence.
When should I see a doctor about hemorrhoids?
You should see a doctor for hemorrhoids if:
- Symptoms don’t improve after 1 week of home treatments
- You experience severe pain or excessive rectal bleeding
- Hemorrhoids are recurrent and increasing in size
- Hemorrhoids prolapse but don’t go back inside on their own
- You develop a possible complication like infection, anemia, or strangulation
- Hemorrhoid symptoms interfere with daily activities
A doctor can properly diagnose the hemorrhoids, rule out other conditions, and provide appropriate treatment options. Seek immediate medical care if you have sudden severe anal pain or rectal bleeding.
How can I ease hemorrhoid pain at home?
To help relieve hemorrhoid pain at home:
- Apply a cold compress or ice pack to the area for up to 20 minutes to reduce inflammation.
- Take over-the-counter pain relievers like acetaminophen, ibuprofen, or naproxen.
- Try a numbing cream with lidocaine to temporarily numb pain.
- Sit in a warm sitz bath for 10-15 minutes a few times daily.
- Use a hemorrhoid cream with hydrocortisone to decrease swelling.
- Apply witch hazel pads or a topical cream with witch hazel to soothe itching.
- Rest lying on your side or stomach to take pressure off the area.
- Avoid straining during bowel movements and sit on a pillow.
Prevention tips like avoiding constipation, not sitting on the toilet too long, and losing weight may also provide relief in the long-term. See a doctor if symptoms persist or worsen.
Are there any natural remedies for hemorrhoids?
Some natural remedies may temporarily help relieve hemorrhoid symptoms, but there is limited research on their effectiveness and safety. Natural remedies to try include:
- Psyllium husk – A natural fiber supplement that can soften stools.
- Aloe vera – Gel from the aloe plant may soothe irritated skin when applied topically.
- Witch hazel – An astringent that may reduce swelling and bleeding when applied directly.
- Tea tree oil – May relieve itching when mixed with a carrier oil and applied to the area.
- Chamomile, mint, or yarrow tea – Can be applied in the form of cooled tea bags or infused water.
- Sitz baths – Immersing the rectal area in warm water may relieve pain and itching.
There is little evidence that dietary supplements, juices, or special diets can treat hemorrhoids. See a doctor if natural remedies don’t relieve symptoms within a week.
Conclusion
Hemorrhoids are a common problem that usually resolve on their own or with simple at-home treatments. But recurrent or severe hemorrhoids may require medical procedures. See a doctor if hemorrhoids don’t improve after a week of home treatments, bleed frequently, cause significant pain, or have complications. Proper prevention and treatment can help manage bothersome hemorrhoids.