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Hemorrhoids

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(Piles)

Definition

Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. They stretch under pressure and are similar to varicose veins in the legs. Hemorrhoids are either internal or external.
  • Internal hemorrhoids develop inside the anus. They are painless and sometimes bleed a lot during bowel movements. They may also protrude during bowel movements. If they protrude from the anal opening and cannot be pushed back, they can cause severe pain.
  • External hemorrhoids develop under the skin around the anus and can easily be felt or seen as a lump. They bleed when broken by straining, rubbing, or scratching.
Hemorrhoids
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Causes

The exact cause of hemorrhoids is unknown. The major contributing factor appears to be too much pressure on the veins in the rectum. If the pressure continues, the veins become enlarged and protrude.

Risk Factors

Factors that increase your risk of getting hemorrhoids include:
  • Straining when trying to pass a stool
  • Chronic constipation or diarrhea
  • Sitting on the toilet for long periods of time
  • Pressure on the veins from pregnancy and childbirth
  • Increased age
  • Obesity
  • Family members with hemorrhoids
  • Chronic cough
  • Liver disease
  • Chronic use of enemas or laxatives

Symptoms

In most cases, symptoms will go away within several days. Although many people have hemorrhoids, not all experience symptoms.
Common symptoms include:
  • Bleeding from the anus that may appear:
    • On the stool
    • On the toilet paper
    • In the toilet bowl
  • Anal itching and burning
  • Swelling and pain during bowel movements
  • Sensitive lumps of various sizes around the anus

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Your anus and rectum will be examined to look for swollen blood vessels. A digital rectal exam will be done. This is done by inserting a gloved, lubricated finger into the rectum to feel for abnormalities. Sometimes, it is necessary to do the exam with the use of an endoscope that allows the rectal canal and other parts of the colon to be viewed.
Bleeding from the rectum or blood in the stool can be a symptom of other diseases involving gastrointestinal tract or colon/rectal cancer. It is important to see a doctor if you have any rectal bleeding.

Treatment

Initial Treatments

Initial medical treatment of hemorrhoids is aimed at relieving symptoms. Measures to reduce symptoms include:
  • Sitz baths—sitting in plain, warm water 2-3 times a day for about 10 minutes each time
  • Ice packs—putting cold packs on the anus for short durations to relieve pain and swelling
  • Medication—applying hemorrhoidal creams or suppositories to the affected area
  • High-fiber diet—eating more fresh fruit, raw or cooked vegetables, and whole grains has been shown to reduce hemorrhoid symptoms.
  • Fluids—drinking plenty of non-alcoholic fluids will help soften stools

Nonsurgical Procedures

If these treatments do not provide relief, one of several nonsurgical procedures may be used to shrink or destroy the hemorrhoidal tissue. These procedures, which are generally performed in a doctor’s office, include:
  • Rubber band ligation—a rubber band is placed around the base of the hemorrhoid to cut off circulation and force the hemorrhoid to wither away within a few days
  • Sclerotherapy—a chemical solution is injected near the blood vessel to cause scarring and shrinkage of the hemorrhoid
  • Coagulation therapy—electricity, laser, or infrared light is used to shrink the hemorrhoidal tissue

Surgery

If nonsurgical procedures are not an option or fail to resolve the problem, surgery may be needed.
Hemorrhoidectomy is the permanent removal of hemorrhoids by cutting the hemorrhoidal tissue away. Some of the newest surgical treatments involve using stainless steel staples. While many surgeons favor these treatments, there is some evidence that techniques that are more traditional produce more consistent and long-lasting relief.
If you are diagnosed with hemorrhoids, follow your doctor's instructions.
If you are diagnosed with hemorrhoids, follow your doctor's instructions.

Prevention

The best way to prevent hemorrhoids is to keep stools soft so they pass easily. The following practices can help:
  • Eat a high fiber diet.
  • Exercise regularly.
  • Empty bowels as soon as possible after the urge occurs.
  • Avoid the overuse of laxatives.

RESOURCES

American Society of Colon and Rectal Surgeons http://www.fascrs.org

National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov

CANADIAN RESOURCES

The Canadian Association of Gastroenterology http://www.cag-acg.org

The College of Family Physicians of Canada http://www.cfpc.ca

References

Alonso-Coello P, Guyatt G, Heels-Ansdell D, et al. Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev. 2005;(4):CD004649.

Altomare DF, Rinaldi M, La Torre F, et al. Red hot chili pepper and hemorrhoids: the explosion of a myth: results of a prospective, randomized, placebo-controlled, crossover trial. Dis Colon Rectum. 2006;49:1018-1023.

Hemorrhoids. American Society of Colon and Rectal Surgeons website. Available at: http://www.fascrs.org/patients/conditions/hemorrhoids/. Updated October 2012. Accessed May 30, 2013.

Hemorrhoids. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated March 21, 2013. Accessed May 30, 2013.

Hemorrhoids. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids/index.aspx . Updated April 30, 2012. Accessed May 30, 2013.

Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev . 2006;(4):CD005393.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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