Hemorrhoids are swollen
veins in the
anal canal. This common problem can be painful, but
it's usually not serious.
Veins can swell inside the anal canal to
form internal hemorrhoids. Or they can swell near the opening of the anus to
form external hemorrhoids. You can have both types at the same time. The
symptoms and treatment depend on which type you have.
Too much pressure on the
veins in the pelvic and rectal area causes hemorrhoids.
tissue inside the anus fills with blood to help control bowel movements. If you
strain or sit on the toilet a long time to move stool, the increased pressure causes the veins in this tissue to
swell and stretch. This can cause hemorrhoids.
constipation also may lead to straining and can increase pressure on veins in
the anal canal.
Pregnant women can get hemorrhoids during the
last 6 months of pregnancy. This is because of increased pressure on the blood
vessels in the pelvic area. Straining to push the baby out during labor can
make hemorrhoids worse.
Being overweight can also lead to
What are the symptoms?
The most common symptoms of
both internal and external hemorrhoids include:
Bleeding during bowel movements. You might
see streaks of bright red blood on toilet paper after you strain to have a
Rectal pain. It may be
painful to clean the anal area.
With internal hemorrhoids, you may see bright red streaks of blood on toilet
paper or bright red blood in the toilet bowl after you have a normal bowel
movement. You may see blood on the surface of the stool.
hemorrhoids often are small, swollen veins in the wall of the anal canal. But
they can be large, sagging veins that bulge out of the anus all the time. They
can be painful if they bulge out and are squeezed by the anal muscles. They may
be very painful if the blood supply to the hemorrhoid is cut off. If
hemorrhoids bulge out, you also may see mucus on the toilet paper or
External hemorrhoids can get irritated and clot under the skin, causing a hard
painful lump. This is called a thrombosed, or clotted, hemorrhoid.
How are hemorrhoids diagnosed?
Your doctor can
tell if you have hemorrhoids by asking about your past health and doing a
You may not need many tests at first, especially
if you are younger than 50 and your doctor thinks that your rectal bleeding is
caused by hemorrhoids. Your doctor may just
examine your rectum with a gloved finger. Or your doctor may use a short,
lighted scope to look inside the rectum.
Rectal bleeding can be a
sign of a more serious problem, such as colon, rectal, or anal cancer. So if
the first exam does not show a clear cause of your problems, your doctor may
use a lighted scope (sigmoidoscope) to look at the lower
third of your colon. Or your doctor may use another kind of scope (colonoscope) to
look at the entire colon to check for other causes of bleeding.
How are they treated?
For most external
hemorrhoids, home treatment is all you need. This includes slowly adding
fiber to your meals, drinking more water, and using
over-the-counter ointments for a limited time to stop itching. You also may use
stool softeners. The same home treatment can be used for most internal
If your internal hemorrhoids are severe, you may
need other treatment. The doctor may tie off the hemorrhoids with rubber bands
or scar the tissue around the hemorrhoids. These treatments reduce the blood
supply to the hemorrhoids so that they shrink or go away.
to remove hemorrhoids may be done if other treatments don't work.
Healthy habits can help you prevent hemorrhoids or keep them from getting
worse. Eat foods that have lots of fiber, such as fruits, vegetables, and whole
grains. Also, drink plenty of water, and get plenty of exercise.
usually caused by increased pressure on the veins in the pelvic and rectal
area. As pressure increases, blood pools in veins and causes them to swell.
Eventually, the swollen veins stretch the surrounding tissue, and hemorrhoids
Bowel habits that can cause increased pressure and lead
to hemorrhoids include:
Rushing to complete a bowel movement. Hurrying
can lead to excessive straining and can increase pressure on rectal
Persistent diarrhea or constipation, which may cause
straining and increase pressure on veins in the anal canal.
Other things that can lead to the development of
Being overweight. Excess weight, especially in
the abdomen and pelvis, may increase pressure on pelvic
Pregnancy and labor. Hormonal changes during pregnancy
increase blood flow to the pelvis and relax supportive tissues while the
growing fetus causes increased pressure on blood vessels. During labor,
hemorrhoids may develop because of the intense pressure on the anal area while
pushing to deliver the baby.
Medical conditions. For example,
long-term heart and liver disease may cause blood to pool in the abdomen and
pelvic area, enlarging the veins.
Bleeding during bowel movements, itching,
and rectal pain are the most common
Rectal pain occurs mainly
with external hemorrhoids. Blood may pool under the skin, forming a hard,
painful lump. This is called a
thrombosed, or clotted, hemorrhoid. You might also
notice streaks of blood on the toilet paper after straining to pass a stool.
The most common symptom of
internal hemorrhoids is rectal bleeding. You may find bright red streaks of
blood on the toilet paper or bright red blood in the toilet bowl after having a
normal bowel movement. Blood also may be visible on the surface of the
Other symptoms of internal hemorrhoids may include:
Itching. This is a frequent complaint,
because internal hemorrhoids often seep mucus, which can irritate the anal skin
and cause itching.
Skin irritation. Large hemorrhoids that bulge
from the anus may secrete mucus, causing mild
Discomfort. You may still feel the urge to pass stool
right after having a bowel movement. This uncomfortable feeling is caused by
the bulging of the hemorrhoid in the end portion of the large intestine (anal
canal). In general, the larger the hemorrhoid, the greater the
Pain. Most internal hemorrhoids are not painful. But
large hemorrhoids that bulge from the anus may become painful if they swell and
are squeezed by the muscles that control the anus. Severe pain may be a sign
that the blood supply to the hemorrhoid is being cut off (strangulated
hemorrhoid). Emergency treatment is needed.
Rectal bleeding and pain and recent changes in bowel
habits are also symptoms of colon, rectal, or anal cancer. People who have
these symptoms, especially those age 50 or older or those with a family history
of colon cancer, need to talk to their doctors.
Other conditions with symptoms similar to hemorrhoids include:
Hemorrhoids form when increased pressure on the pelvic
veins causes veins in the anal canal to swell and gradually stretch out of
shape. Pressure increases can be caused by rushing to complete a bowel
movement, persistent diarrhea or constipation, or other factors including being
overweight or pregnant.
Persistent pressure also weakens tissues
that support the veins in the anal canal. If those tissues become so weak that
they can no longer hold the veins in place, the swollen veins and tissues bulge
into the anal canal (internal hemorrhoids) or under the skin surrounding the
anal opening (external hemorrhoids).
For some people, hemorrhoids
may cause a little discomfort for a limited time. Other people have recurrent
bouts of discomfort when hemorrhoids flare up. Some people struggle with
hemorrhoid pain, discomfort, and itching much of their lives. The degree and
duration of discomfort depend on where the hemorrhoids are.
Hemorrhoids frequently develop during pregnancy because of extra pressure on
veins (from the enlarged uterus).
During labor, hemorrhoids may
start or get worse because of the intense straining and pressure on the anal
area while pushing to deliver the baby. For more information, see the topic
Because external hemorrhoids
may not cause any symptoms, you may not be aware that you have
When a vein within an external hemorrhoid gets irritated, blood may clot under the skin, forming a hard, bluish lump. This is
known as a thrombosed, or clotted, hemorrhoid. Thrombosed hemorrhoids can be
Small internal hemorrhoids
may not grow larger if bowel habits or other factors change to lower pressure
on the veins in the bowel.
Large internal hemorrhoids may bulge
from the anus. After bowel movements, you may have to push them back through
the anus. At worst, large internal hemorrhoids stick out all the time.
In rare cases, hemorrhoids may bulge through the anus and swell. Muscles
that control the opening and closing of the anus may cut off a hemorrhoid's
blood supply (strangulated hemorrhoid). This may cause the hemorrhoid tissues
to die. If this happens, you will feel severe rectal pain and may see blood and
pus at the anus. You will need urgent surgery to prevent further complications,
such as death of the affected tissue and infection.
What Increases Your Risk
Bowel habits, physical
stresses, and other conditions can raise the risk of developing
hemorrhoids or make existing hemorrhoids worse. Some
of these factors can be prevented.
Things that increase your risk
Constipation or diarrhea that does not go away. These
conditions may lead to straining with bowel movements.
A family history of hemorrhoids. You may inherit the tendency
to get them.
Being age 50 or older. Half of people who are older
than 50 seek treatment for hemorrhoids.
Pregnancy and labor and
delivery. As the fetus grows during the last 6 months of pregnancy, blood
volume and pressure on pelvic blood vessels increase. The strain of labor also
can cause hemorrhoids to start or get worse.
Liver disease, heart
disease, or both. These conditions may cause blood to back up in the pelvis and
Things that may make hemorrhoids worse
Hemorrhoids may be made worse by:
Prolonged sitting or standing. This may cause
blood to pool in the anal area and increase pressure on the
Frequent heavy lifting or holding your breath when lifting
heavy objects. This can cause a sudden increase of pressure in blood
When To Call a Doctor
Common symptoms of
hemorrhoids may be a sign of other serious health
problems. Colon or rectal cancer and other conditions have many of the same
symptoms as hemorrhoids. Call your doctor if you have symptoms like these:
Stools are black or tarry.
A lump or bulge that is not tender and does not go away develops at the anal opening.
If you have hemorrhoids, call your doctor
Moderate rectal pain lasts longer than 1 week
after home treatment.
Pain or swelling is
Tissue from inside the body bulges from the anus and does
not return to normal after 3 to 7 days of home treatment.
inside the anus becomes bigger or more painful.
If rectal bleeding becomes heavy or changes color (such as
from bright red to dark red), or if stools change size, shape, or color (from brown to maroon
or black), be sure to see your doctor.
Watchful waiting is a wait-and-see approach. And in most cases, bleeding caused by hemorrhoids should
stop after 2 to 3 days. Continue home treatment to prevent bleeding from
starting again. Call your doctor if bleeding:
Occurs for more than 1 week without
Occurs when there is no
reason to expect it.
If you are older than age 50 or have a family history of
colon cancer, it is a good idea to tell your doctor any time
you have new rectal bleeding, notice blood on your stools, have changes in
bowel habits, or have anal pain. These symptoms may be signs of colon cancer or
other conditions. Your doctor may recommend screening tests to see
if you have a more serious problem. See Exams and Tests.
Who to see
The following professionals can evaluate and treat
A doctor can evaluate
hemorrhoids to rule out other, more serious problems.
A number of conditions that affect the anus and colon (large intestine) can
cause bleeding, mucus drainage, itching, and discomfort. Most people who have
these symptoms think they have hemorrhoids, but often they do not.
If hemorrhoids are present, the doctor will evaluate their
location and size and develop a treatment plan based on the hemorrhoids'
degree of severity.
The diagnosis of hemorrhoids is based on a
medical history and
physical exam. A
digital rectal exam and an
anoscopy may be the only tests needed at first. Your
doctor will decide which tests to use. If hemorrhoids are the obvious cause of
rectal bleeding, you are younger than age 50, and you do not have risk factors
for colon cancer, you may not need more tests.
To make sure
nothing else (like colon cancer) is causing your symptoms, you may need other
tests, such as:
Flexible sigmoidoscopy. This test
allows a doctor to look inside the
rectum, and lower part of the large intestine (colon)
for abnormal growths or other signs of disease.
These tests are not used routinely to diagnose
hemorrhoids can be treated with simple changes to diet
and bowel habits. Most do not require surgery or other treatment unless the
hemorrhoids are very large and painful.
goal of nonsurgical procedures used to treat hemorrhoids, called fixative
procedures, is to reduce the blood supply to the hemorrhoid so it shrinks or
goes away. The scar tissue left in its place helps support the anal tissue and
helps prevent new hemorrhoids.
procedures include tying off the hemorrhoids with a rubber band (rubber band
ligation) or using heat, lasers, or electric current to create scar tissue
(coagulation therapy). Fixative procedures can only be done on internal hemorrhoids.
Surgical removal of hemorrhoids
(hemorrhoidectomy) can be used for large internal hemorrhoids, when several
small hemorrhoids are present, or when other treatments have not controlled
bleeding. Sometimes a combination of treatments (for example, a fixative
procedure and a hemorrhoidectomy) is the most effective way to treat
hemorrhoids. External hemorrhoids can only be removed surgically, if needed. If a blood clot develops in the external hemorrhoid, the clot may need to be removed to relieve pain.
Hemorrhoidectomy versus fixative procedures for internal hemorrhoids
Fixative procedures are usually tried before
surgery if hemorrhoids are small and stick out of the anus during a bowel
movement but return to their normal position afterward (second-degree hemorrhoid).
Hemorrhoidectomy may provide
better long-term results than fixative procedures. But surgery is more
expensive, requires a longer recovery time, is usually more painful, and has a
greater risk of complications.
Fixative procedures are the
preferred treatment for people older than age 70 and for people in poor
You can help prevent the irritating and
painful symptoms of
Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
Drink plenty of fluids, enough so that your urine is light yellow or clear like water.
Get some exercise every day. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.
Take a fiber supplement, such as Citrucel or Metamucil, every day if needed. Start with a small dose and very slowly increase the dose over a month or more.
Practice healthy bowel habits
Go to the bathroom as soon as you have the
Avoid straining to pass stools. Relax and give yourself time
to let things happen naturally.
Avoid holding your breath while
Avoid reading while sitting on the toilet. Get off
the toilet as soon as you have finished.
Modify your daily activities
Avoid prolonged sitting or standing. Take
frequent short walks.
If possible, avoid lifting heavy objects
frequently. If you must lift heavy objects, always exhale as you lift the
object. Don't hold your breath when you lift.
If you are pregnant,
sleeping on your side will lower pressure on the blood vessels in your pelvis.
This can help keep hemorrhoids from becoming bigger.
Home treatment, which mainly involves
establishing healthy bowel habits, may keep your
hemorrhoids from getting worse.
You can use the following suggestions to keep
hemorrhoids from getting worse or to relieve your symptoms.
Avoid making hemorrhoids worse
Blot the anus gently with white toilet paper
moistened with water or a cleansing agent (such as Balneol) after bowel
movements. Baby wipes or other premoistened towels (such as Tucks) are also
useful for this purpose.
Avoid rubbing the anal area. You can rinse
off in the shower or on a bidet instead of wiping yourself with toilet paper.
After cleansing, gently pat the anal area dry with a soft, absorbent towel or
Use soaps that contain no perfumes or dyes.
Relieve pain and itching
Take nonprescription pain relievers. Acetaminophen (Tylenol) can help with pain. Aspirin and other nonsteroidal
anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) and naproxen (Aleve) can help with pain and
Apply ice several times a day for 10 minutes
at a time. Follow this by placing a warm compress on the anal area for another
10 to 20 minutes.
Take a sitz bath. Fill your bathtub with just
enough warm water to cover the anal area. Do this several times a day,
especially after you have had a bowel movement. Soak for about 15 minutes at a
time. Be careful! If the water is too warm, it can burn you.
Use nonprescription medicines as recommended by your
doctor or pharmacist. See Medications for information on nonprescription ointments, creams, and suppositories.
Other comfort measures
You may need a day or more of bed rest to
take pressure off inflamed, irritated veins. If you are pregnant,
you may find it helpful to lie on your side. If you are not pregnant, sleeping
on your stomach with a pillow under your hips will help reduce swelling of
Try not to sit or stand for a long time when
hemorrhoids are irritated. If you must sit for a long time, sit on a pillow.
Avoid lifting heavy objects.
Wear cotton underwear to prevent
moisture buildup, which can irritate hemorrhoids. Wear loose clothing to allow
freedom of movement and to reduce pressure on the anal area.
Medicines can help relieve symptoms of
hemorrhoids. You might try one or more of the
following nonprescription remedies.
Ointments that protect the skin, such as zinc
oxide or petroleum jelly, are the best nonprescription remedies for
hemorrhoids. Ointments can prevent further injury and reduce itching by forming
a barrier over hemorrhoids.
Use suppositories, such as those made by
Preparation H or Tucks (formerly Anusol), for 7 to 10 days to relieve irritation
and to lubricate the anal canal during bowel movements. Some of these products
contain substances that can harm anal tissues if they are used for too
Apply an ointment that contains 1% hydrocortisone, a type of
steroid medicine that may relieve inflammation and itching. Your doctor may prescribe 2.5% hydrocortisone. But these products should not
be used for more than 2 weeks, because they can thin the skin.
Apply products that contain medicine to numb an area (local
anesthetic). These products often have the suffix "-caine" in the name or the
ingredients. Although these products help some people, especially those who
have painful external hemorrhoids, some people become allergic to them. Ask
your doctor before using these products.
nonprescription pain relievers.
Acetaminophen (Tylenol) can help with pain. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen (Motrin) and naproxen (Aleve) can help with pain and swelling.
hemorrhoids do not require surgery. It is usually
considered only for severe hemorrhoids.
Surgery may be done if
other treatments (including home treatment) have failed. Surgery is also
considered when symptoms become so bothersome that your lifestyle is affected
or when hemorrhoids create a medical emergency, such as uncontrolled bleeding
or blood and pus at the anus along with severe rectal pain.
External hemorrhoids usually
are not removed with surgery (hemorrhoidectomy) except if they are very large
and uncomfortable or if you are having surgery on the anal area for another
reason, such as internal hemorrhoids or a tear (anal fissure). If a blood clot develops in the external hemorrhoid, the clot may need to be removed to relieve pain.
Surgical removal of
hemorrhoids (hemorrhoidectomy) is a last resort for treating small internal
Hemorrhoidectomy is considered the most successful
way to treat large internal hemorrhoids, especially those that are still a
problem after treatments that cut off blood flow to hemorrhoids (fixative
procedures) have been tried.
Sometimes, increased pressure on external
hemorrhoids causes them to get irritated and to clot. This
causes a lump (thrombosed, or clotted, hemorrhoid) to form. You may suffer from
severe pain at the site of a clotted hemorrhoid.
A procedure to
relieve the pain can be done in a doctor's office or
outpatient clinic. The doctor applies local anesthesia and then
makes a small
incision where the lump has occurred to remove the
clot and reduce pressure and pain. The procedure works best if it is done soon after the clot has formed.
If the pain is
tolerable, you may choose to wait to see a doctor. The pain
usually goes away in a few days. After 4 or 5 days, the pain from cutting and
draining the hemorrhoid is usually worse than the pain from the clot.
Many people who have
hemorrhoids find relief from symptoms through home treatment. If medical treatment is
needed, fixative procedures are the most widely used nonsurgical treatments.
Other treatment choices
Fixative procedures include:
Rubber band ligation, a procedure in which the
hemorrhoid is tied off at its base with rubber bands, cutting off the blood
flow so that the hemorrhoid shrinks and dies and, in about a week, falls
Not all doctors have the
experience or the equipment to do all types of fixative procedures. This
may help you decide which procedure to choose. Ask your doctor which procedure
he or she does the most and how satisfied people have been with the outcomes of
The American College of Gastroenterology is an organization of digestive disease specialists. The website contains information about common gastrointestinal problems.
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The American Gastroenterological Association is a
society of doctors who specialize in the digestive system
(gastroenterologists). This Web site can help you find a gastroenterologist in
your area. They also have patient information on many gastrointestinal diseases
American Society of Colon and Rectal
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The American Society of Colon and Rectal Surgeons is the leading
professional society representing more than 1,000 board-certified colon and
rectal surgeons and other surgeons dedicated to treating people with diseases
and disorders affecting the colon, rectum, and anus.
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