What Are Hemorrhoids?

Hemorrhoids are enlarged and swollen veins around the outside of the anus or in the lower rectum, the last part of the bowel that leads to the anus.

Hemorrhoids may be painful and particularly bothersome if they are recurrent, but they're rarely serious, and symptoms usually go away on their own. Several treatment options exist for more problematic hemorrhoids.

Here’s what to know about the types, symptoms, and treatments for hemorrhoids and how to prevent them from forming.

Internal

Prolapsed

External

• Swelling around the anus
• Itching or irritation in the anal region
• Discomfort or pain
• Bleeding

Thrombosed

• Swelling
• Severe pain
• A discolored, hard lump near the anus
• Inflammation

• Consuming a low-fiber diet
• Pushing hard to have a bowel movement
• Pregnancy
• Engaging in anal intercourse
• Being overweight or obese
• Chronic constipation or diarrhea
• Straining when weight lifting or lifting heavy objects
• Sitting on the toilet for long periods of time

• A family history of hemorrhoids
• Rectal surgery
• Spinal injury
• A sedentary lifestyle
• Inflammatory bowel disease (IBD)
• Aging

Fortunately, most hemorrhoids can be treated at home or with simple medical procedures in a doctor’s office. More severe hemorrhoids may need a surgical procedure.

Medications

Sitz Baths

Sitz baths involve sitting in shallow, warm water to clean the genital and anal areas, increase blood flow to the area, and relax the pelvic muscles. You can take a sitz bath in your bathtub or use a sitz bath bowl that fits over the toilet.

To ease hemorrhoids, use a sitz bath for 10 to 15 minutes, two to three times a day.

Surgery

Options include:

• Sclerotherapy In this procedure, a doctor injects a small amount of medication into the hemorrhoid to help shrink it. Though painless, it is often less effective than other methods of removal.

• Rubber Band Ligation In this procedure, a doctor places one or more small rubber bands around the base of a hemorrhoid. This helps to cut off the blood supply to the hemorrhoid and causes it to fall off within a few days. The procedure can be uncomfortable and cause bleeding within two to four days. More major complications are rare.

• Coagulation In this procedure, a doctor uses infrared light, lasers, electrical currents, or heat to cause small, bleeding hemorrhoids to harden and shrivel. It is generally not painful and has few side effects.

• Transanal Hemorrhoidal Dearterialization (THD) During this procedure, a surgeon ties off hemorrhoids and pulls them back into the anus. They secure them with stitches. 
• Hemorrhoidectomy A hemorrhoidectomy removes either a prolapsed internal hemorrhoid or large external hemorrhoids. 
• Hemorrhoid Stapling This procedure uses a stapling instrument to remove hemorrhoids or to pull them back into the anus and keep them secure.

Keeping your stool soft and having regular bowel movements is one of the best ways to prevent hemorrhoids. The following tips may help you prevent constipation.

Fiber-filled foods include fruits such as berries, avocados, and pears (especially when you eat the skin), and vegetables like broccoli, artichokes, and Brussels sprouts. Whole grains, such as brown rice, quinoa, and oatmeal, are also an important source. Eating legumes — including lentils, beans, and green peas — as well as nuts and seeds, will also help you meet your dietary fiber needs.

If you experience chronic constipation and suspect that it may be contributing to your hemorrhoids, avoid eating too many foods that contain little or no fiber, such as cheese and fast and processed foods.

• Try to use the bathroom at the same time each day — such as first thing in the morning or after breakfast — to train the bowels to move regularly.
• Avoiding straining or holding your breath during bowel movements. Straining can put excess pressure on veins and lead directly to hemorrhoid development. Stress reduction techniques such as deep breathing can be helpful to avoid straining.
• Go to the bathroom as soon as you feel the urge. Letting the urge subside can make your stool harder to pass.

Avoiding sitting on the toilet for too long. Sitting on the toilet for too long can stress veins in the anus. Avoid using your phone or reading while on the toilet since that will likely keep you there longer. Using a toilet stool that elevates the feet and legs relaxes the pelvic floor muscles and makes passing stool easier.

How long hemorrhoids last depends on their severity and type.

• Anemia Bleeding from chronic hemorrhoids can cause anemia, or a deficiency in red blood cells. Red blood cells carry oxygen throughout the body, so having anemia can make you feel tired, weak, or short of breath.
• Strangulated Hemorrhoid In rare situations, swelling may cut off the oxygen supply to a hemorrhoid that has prolapsed, causing a strangulated hemorrhoid. This can be extremely painful and incapacitating, and surgery may be needed to treat it.
• Blood Clots Thrombosed hemorrhoids can be very painful, though they are not generally dangerous. In some cases, a doctor may need to drain them.

• Ongoing bleeding
• Incontinence
• Infection
• Problems urinating

Conditions that may have similar symptoms to hemorrhoids include:

• Anal fissures: These are small tears in the lining of the anus that can cause pain and bleeding.
• Rectal prolapse: With rectal prolapse, part of the rectum slips outside the anus; this can look like external hemorrhoids.
• Ulcerative colitis: Ulcerative colitis is a type of inflammatory bowel disease (IBD) that can cause rectal bleeding.
• Anal fistulas or abscesses: These may cause swelling, pain, or discharge near the anus.

Colorectal polyps or colorectal cancer can also cause rectal bleeding in some cases.

The Takeaway

• Hemorrhoids are swollen, enlarged veins around the anus and rectum.
• Signs and symptoms of hemorrhoids include blood on toilet paper or in stool after a bowel movement, itching or pain in the anal area, pain during bowel movements, and hard, painful lumps around the anus.
• Causes include chronic diarrhea and constipation, straining too hard, and sitting on the toilet for too long. Risk factors include being overweight, a lack of fiber in the diet, aging, and pregnancy.
• Hemorrhoids can usually be treated at home, and they tend to go away in a week or so. For persistent or more complicated types of hemorrhoids, a surgical procedure may be necessary.