Last updated: March 23, 2021
If you have ever experienced itching, bleeding, or pain during bowel movements, you may have hemorrhoids. Hemorrhoids are common in both men and women. While they affect about 1 in 20 Americans, more than half of adults older than 50 years old experience this condition. This article will cover the types of hemorrhoids, what causes them, and how to treat them.
Types of hemorrhoids
Everyone has the pillow-like clusters of vein in the lower rectum, anus, and externally. Did you know that hemorrhoids are merely varicose veins? Those vessels, also known as piles, become swollen and distended, thus becoming what we know as hemorrhoids.
- Internal hemorrhoids form in the lining of the anus and lower rectum.
- External hemorrhoids form under the skin around the anus.
- Mixed hemorrhoids are both types
Some may not even notice they have hemorrhoids, while for others, the symptoms of hemorrhoids are quite obvious. Many hemorrhoids present without pain or itching. However, here are some of the typical signs and symptoms.
- Skin irritation
- Pain during bowel movements
- Lumps in or around the anus
- Anal fissures
- Leakage of stool or mucus
- Prolapse: Internal hemorrhoids that fall through anal opening
- Blood clot in vein of external hemorrhoids
- Skin tags: extra skin left behind when blood clot in hemorrhoid dissolves
By knowing the cause, you may be able to prevent these irritations. Some things may cause hemorrhoids to occur or worsen, such as:
- Straining during bowel movements
- Sitting on the toilet for prolonged periods of time
- Chronic constipation
- Low-fiber diet
- Greater than age 50
- Lift heavy objects
The angle matters when you are trying to have a bowel movement — squatting decreases straining and excessive time in the restroom. A stool that puts you into the squatting position will minimize the likelihood of getting hemorrhoids.
Your healthcare provider may inspect your anus. If evaluating internal hemorrhoids, they may perform a digital rectal exam to check for tenderness, blood, lumps, or masses.
There are rare times when symptoms are severe and they need to rule out other things like anal fissures, polyps, or tumors. If necessary, they may refer you for a procedure to diagnose the hemorrhoids. For both cases, they can be performed outpatient and without anesthesia.
- Anoscopy: This is a thin tube with a camera attached, known as a scope, that examines the lining of the anus and lower rectum.
- Rigid proctosigmoidoscopy: This scope evaluates the tissues lining the rectum and lower colon.
Treating hemorrhoids includes dietary adjustments, over-the-counter (OTC) creams and suppositories, and in the worst case scenario, surgery. There are many options other than medications to alleviate the pain, burning, and itching symptoms. Comfort measures include:
- Soaking the area in plain warm water for up to 15 minutes a few times each day. You can fill your clean bathtub up just a few inches and relax.
- You can place a Sitz bath over the toilet and use it with warm water. It can be purchased online or through pharmacies.
- Use moist toilettes or baby wipes instead of toilet paper. Dry paper can aggravate the problem.
- Ice packs and cold compresses may help with the swelling.
Keep stools soft by staying hydrated and eating high-fiber foods like whole grains, vegetables, and fruit. Fiber gummies or psyllium husk will help, too. Start slowly and increase dietary fiber to about 25 grams daily. Both fiber and fluid soften the stool and make it easier to pass.
Beyond a fiber supplement, you may consider adding other supplements to prevent hemorrhoids from becoming a problem.
- Probiotics maintain a healthy balance of good bacteria in your body. Good bacteria in the gut may ward off constipation.
- Magnesium draws water into the intestines and the increase helps to soften stool and move it along. However, for intermittent constipation, the dose is different from the daily supplement’s dose.
These drugs do not require a prescription, but can bring welcome relief from troublesome hemorrhoids. You can take analgesics such as ibuprofen and acetaminophen with any creams, toners, or suppositories. With any of the below topical agents, make sure to wash hands before applying.
- Hemorrhoid cream: The cream works by shrinking the hemorrhoid and creating a protective barrier over the area.
- Suppository: While some may struggle with the thought of inserting a suppository in their rectum, this medication treats significant itching. Phenylephrine is in many cold medications. Suppositories that contain phenylephrine shrink the blood vessels of your hemorrhoids, just like it does in the nose.
- Chilled witch hazel pads: Witch hazel water is an astringent and anti-inflammatory that helps calm sensitive skin.
Removing the hemorrhoids can be done in many different surgical methods.
- Rubber band ligation: A small elastic band is wrapped around the base of a hemorrhoid to cut off blood flow. This is the most common outpatient procedure done between two and four times performed six to eight weeks apart. There are a number of office procedures that work on the same principle.
- Laser or infrared coagulation
- Laser or infrared coagulation, sclerotherapy, and cryosurgery
- Hemorrhoidectomy: This works best for large protruding hemorrhoids, symptomatic internal or external hemorrhoids. An incision is made around the hemorrhoid tissue and removes the blood vessels. It will cure 95% of cases and has low complication rates, however it is very painful. The procedure requires general anesthesia but patients can go home the same day.
- Staples: While this is a viable alternative to a traditional hemorrhoidectomy, it anchors bleeding or prolapsed internal hemorrhoids in their normal position by a stapling device.
The brighter red the stool, the closer the bleed is to the exit! For those having bright red bleeding, it’s usually due to hemorrhoids. However, stool that is black and looks like coffee grounds is typically higher up in the GI tract. Notify the primary care provider because coffee ground stools are a worrisome side effect.
The Bottom Line
For some, hemorrhoids are a mild nuisance, while for others hemorrhoids can cause significant distress. There are many factors that put you at an increased risk for hemorrhoids. Luckily, there are a number of ways to treat them and prevent them from reoccurring.