What are hemorrhoids?

Hemorrhoids (or piles) are swollen veins in the lower rectum and anus. The anus is the opening at the end of the rectum through which a bowel movement passes. Veins around the anus tend to expand under pressure. Hemorrhoids are one of the most common problems of the lower digestive tract.

There are two types of hemorrhoids: One set of veins is about an inch inside the rectum (internal). The other is under the skin surrounding the anus (external).

Internal hemorrhoids are painless but they sometimes cause a lot of bleeding. The internal veins can stretch and even fall down (prolapse) through the anus to outside the body. The veins may then become irritated and painful.

External hemorrhoids can be seen or felt easily around the anal opening. When the swollen veins are scratched or broken by straining or rubbing, they bleed.

How do they occur?

Some people inherit a tendency to have hemorrhoids. Hemorrhoids can also result from too much pressure on the veins in the rectum. Factors that contribute to pressure on these rectal veins include:

• Straining from constipation during bowel movements
• Holding back or delaying emptying of the bowels
• Sitting for a long time on the toilet, which causes strain on the anal area
• Pregnancy and the strain of childbirth
• Obesity
• Coughing and sneezing for long periods

Flare-ups of hemorrhoids may occur during periods of stress or as a result of overuse of alcohol. Flare-ups can range from mild to severe.

What are the symptoms?

Symptoms of hemorrhoids include the following:

• Itching, mild burning, and bleeding from the anus
• Swelling and pain during bowel movements
• Painful lumps around the anus varying in size from a pea to a walnut (in severe cases of external hemorrhoids).

How are they diagnosed?

Your health care provider will examine your rectum and anus. Your provider will also examine your rectum using a hollow, lighted viewing instrument called a proctoscope.

Your provider will investigate your symptoms thoroughly. Usually rectal bleeding is from hemorrhoids. However, your provider will want to make sure you do not have a more serious cause of rectal bleeding, such as a colon polyp or colon cancer.

How is it treated?

The following treatments usually help to relieve most cases of hemorrhoids.

• High-fiber diet

Eat more high-fiber foods, which will help prevent constipation. Good sources of fiber include fresh fruit; raw or cooked vegetables, especially asparagus, cabbage, carrots, corn, and broccoli; and whole-grain cereals with bran.

• Fluids

Drink plenty of fluids, especially water. Drink six to eight 8-ounce glasses of fluid (not alcohol) a day. Fluid helps to soften bowel movements so they are easier to pass.

• Sitz baths and cold packs

Sitting in lukewarm water two or three times a day for 15 minutes cleans the anal area and may relieve the discomfort of hemorrhoids. Also, you might try putting cold packs on the anus to relieve pain.

• Rest

Raise your bottom when you are resting.

• Medications

If your hemorrhoids cause only mild discomfort, your health care provider may suggest a cream for the painful area. The cream may contain witch hazel, zinc oxide, or petroleum jelly. Your provider may also prescribe suppositories, injections, and other medicines.

- Procedures and surgeries

A number of nonsurgical procedures can be used to remove or reduce the size of hemorrhoids. If you have protruding internal hemorrhoids, your health care provider can perform a procedure called hemorrhoid banding. Your provider will put a tight band around the enlarged vein, cut the hemorrhoid open, and remove the blood clot. In a few days, the vein will heal and the hemorrhoid will painlessly wither and fall off. This method is effective in most cases. Other methods include destroying the hemorrhoid with freezing, electrical or laser heat, or infrared light, or shrinking the hemorrhoid with a chemical injected around the vein.

For more severe cases of hemorrhoids, you may consider surgery called hemorrhoidectomy. For this procedure you are first given an anesthetic to prevent you from feeling pain. Then your provider cuts the inflamed parts of the hemorrhoids and removes them.

How long will the effects last?

Usually hemorrhoids do not pose a danger to your health. In most cases symptoms of hemorrhoids go away naturally within a few days.

Painful symptoms should improve within 2 weeks.

How can I take care of myself?

Always tell your health care provider when you have rectal bleeding. Although bleeding may result from hemorrhoids, more serious illnesses such as colon cancer can also cause bleeding.

Follow these guidelines to help prevent hemorrhoids and to relieve their discomfort:

• Do not strain during bowel movements, which forces hemorrhoids to swell.
• Follow your high-fiber diet and drink plenty of water. If necessary, take a stool softener. Softer stools make it easier to empty the bowels and lessen pressure on the veins.
• Don't overuse laxatives. Diarrhea can be as irritating to the anus as constipation.
• Ask your health care provider what nonprescription product you should buy to relieve pain and itching. Also, ask about any side effects of any medications prescribed for you.
• Exercise regularly to avoid becoming constipated.
• Avoid a lot of wiping after a bowel movement if you have hemorrhoids. Wiping with soft, moist toilet paper (or a commercial moist pad or baby wipe) may relieve discomfort. If necessary, shower instead of wiping, then dry the anus gently.
• Avoid lifting heavy objects if you have hemorrhoids.