What are
hemorrhoids?
The term hemorrhoids refers
to a condition in which the
veins around the anus or lower
rectum are swollen and inflamed.
Hemorrhoids may result from
straining to move stool. Other
contributing factors include
pregnancy, aging, chronic
constipation or diarrhea, and
anal intercourse.
Hemorrhoids are either inside
the anus—internal—or under the
skin around the anus—external.
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What are the
symptoms of hemorrhoids?
Many anorectal problems,
including fissures, fistulae,
abscesses, or irritation and
itching, also called pruritus
ani, have similar symptoms and
are incorrectly referred to as
hemorrhoids.
Hemorrhoids usually are not
dangerous or life threatening.
In most cases, hemorrhoidal
symptoms will go away within a
few days.
Although many people have
hemorrhoids, not all experience
symptoms. The most common
symptom of internal hemorrhoids
is bright red blood covering the
stool, on toilet paper, or in
the toilet bowl. However, an
internal hemorrhoid may protrude
through the anus outside the
body, becoming irritated and
painful. This is known as a
protruding hemorrhoid.
Symptoms of external
hemorrhoids may include painful
swelling or a hard lump around
the anus that results when a
blood clot forms. This condition
is known as a thrombosed
external hemorrhoid.
In addition, excessive
straining, rubbing, or cleaning
around the anus may cause
irritation with bleeding and/or
itching, which may produce a
vicious cycle of symptoms.
Draining mucus may also cause
itching.
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How common
are hemorrhoids?
Hemorrhoids are common in
both men and women. About half
of the population has
hemorrhoids by age 50.
Hemorrhoids are also common
among pregnant women. The
pressure of the fetus on the
abdomen, as well as hormonal
changes, cause the hemorrhoidal
vessels to enlarge. These
vessels are also placed under
severe pressure during
childbirth. For most women,
however, hemorrhoids caused by
pregnancy are a temporary
problem.
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How are
hemorrhoids diagnosed?
A thorough evaluation and
proper diagnosis by the doctor
is important any time bleeding
from the rectum or blood in the
stool occurs. Bleeding may also
be a symptom of other digestive
diseases, including colorectal
cancer.
The doctor will examine the
anus and rectum to look for
swollen blood vessels that
indicate hemorrhoids and will
also perform a digital rectal
exam with a gloved, lubricated
finger to feel for
abnormalities.
Closer evaluation of the
rectum for hemorrhoids requires
an exam with an anoscope, a
hollow, lighted tube useful for
viewing internal hemorrhoids, or
a proctoscope, useful for more
completely examining the entire
rectum.
Illustration reprinted with
permission from the American
Society of Colon and Rectal
Surgeons. Artist: Russell K.
Pearl, M.D.
To rule out other causes of
gastrointestinal bleeding, the
doctor may examine the rectum
and lower colon, or sigmoid,
with sigmoidoscopy or the entire
colon with colonoscopy.
Sigmoidoscopy and colonoscopy
are diagnostic procedures that
also involve the use of lighted,
flexible tubes inserted through
the rectum.
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What is the
treatment?
Medical treatment of
hemorrhoids is aimed initially
at relieving symptoms. Measures
to reduce symptoms include
- tub baths several times
a day in plain, warm water
for about 10 minutes
- application of a
hemorrhoidal cream or
suppository to the affected
area for a limited time
Preventing the recurrence of
hemorrhoids will require
relieving the pressure and
straining of constipation.
Doctors will often recommend
increasing fiber and fluids in
the diet. Eating the right
amount of fiber and drinking six
to eight glasses of fluid—not
alcohol—result in softer,
bulkier stools. A softer stool
makes emptying the bowels easier
and lessens the pressure on
hemorrhoids caused by straining.
Eliminating straining also helps
prevent the hemorrhoids from
protruding.
Good sources of fiber are
fruits, vegetables, and whole
grains. In addition, doctors may
suggest a bulk stool softener or
a fiber supplement such as
psyllium (Metamucil) or
methylcellulose (Citrucel).
In some cases, hemorrhoids
must be treated endoscopically
or surgically. These methods are
used to shrink and destroy the
hemorrhoidal tissue. The doctor
will perform the procedure
during an office or hospital
visit.
A number of methods may be
used to remove or reduce the
size of internal hemorrhoids.
These techniques include
- Rubber band
ligation. A rubber
band is placed around the
base of the hemorrhoid
inside the rectum. The band
cuts off circulation, and
the hemorrhoid withers away
within a few days.
- Sclerotherapy.
A chemical solution is
injected around the blood
vessel to shrink the
hemorrhoid.
- Infrared
coagulation. A
special device is used to
burn hemorrhoidal tissue.
- Hemorrhoidectomy.
Occasionally, extensive or
severe internal or external
hemorrhoids may require
removal by surgery known as
hemorrhoidectomy.
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How are
hemorrhoids prevented?
The best way to prevent
hemorrhoids is to keep stools
soft so they pass easily, thus
decreasing pressure and
straining, and to empty bowels
as soon as possible after the
urge occurs. Exercise, including
walking, and increased fiber in
the diet help reduce
constipation and straining by
producing stools that are softer
and easier to pass.
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National Digestive Diseases
Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389
TTY: 1–866–569–1162
Fax: 703–738–4929
Email:
nddic@info.niddk.nih.gov
Internet:
www.digestive.niddk.nih.gov
The National Digestive
Diseases Information
Clearinghouse (NDDIC) is a
service of the National
Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK).
The NIDDK is part of the
National Institutes of Health of
the U.S. Department of Health
and Human Services. Established
in 1980, the Clearinghouse
provides information about
digestive diseases to people
with digestive disorders and to
their families, health care
professionals, and the public.
The NDDIC answers inquiries,
develops and distributes
publications, and works closely
with professional and patient
organizations and Government
agencies to coordinate resources
about digestive diseases. |
(National
Institute of Diabetes and Digestive and
Kidney Diseases) 
(Patient
Education Institute)