Hemorrhoids

Hemorrhoids

WHAT ARE HEMORRHOIDS?

Hemorrhoids are clusters of blood vessels that lie underneath the lining of the anorectal canal. They function as cushions that can swell and regress, aiding in the passage of stool. Hemorrhoid tissue exists within the anorectal canal (internal hemorrhoids), but also at the anal opening (external hemorrhoids). When hemorrhoids become inflamed, enlarged or start to bleed, evaluation and treatment should be sought.  

WHAT ARE THE SYMPTOMS OF INFLAMED HEMORRHOIDS?

Symptoms of inflamed hemorrhoids include:

• Bleeding during bowel movements
• Itching or irritation in the anal area
• Pain or discomfort
• Swelling around the anus
• A painful, purple lump at the anal opening

WHAT CAUSES INFLAMED HEMORRHOIDS?

Hemorrhoids can be caused by:

• Chronic diarrhea or constipation
• Low-fiber diet
• Straining during bowel movements
• Sitting for long periods of time on the toilet
• Obesity
• Pregnancy
• Anal intercourse

WHAT IS THE CAUSE OF HEMORRHOIDS?

Everyone has hemorrhoids. When people say they have hemorrhoids, they usually mean they are experiencing pain and bleeding when their hemorrhoids become inflamed. Although inflamed hemorrhoids are most common between the ages of 45 and 65, the condition can occur at any age.

HOW ARE HEMORRHOIDS DIAGNOSED?

Hemorrhoids can be diagnosed upon examination by a physician. An external inspection and internal rectal examination will be performed. The rectal examination may be done using an anoscope (a short scope to look into the rectum).

Although external hemorrhoids can often be visualized by the doctor, a rectal exam may also be in order. Depending on the results of the exam, a colonoscopy may be ordered as well. This enables the provider to examine the entire colon.

HOW ARE HEMORRHOIDS TREATED?

External hemorrhoids can be visualized at the anal opening and may present as a painful purple lump or itchy, swollen tissue. Conservative management might be recommended. This includes treatment with topical ointments that help reduce swelling, sitz baths, stool softeners, laxatives, and possibly oral pain relievers such as acetaminophen or aspirin. Your doctor may also recommend that you eat a high-fiber diet and drink at least 6 to 8 glasses of water a day to avoid becoming constipated. In addition, it is recommended to keep the anal area clean, avoid dry toilet paper and apply cold compresses to relieve swelling.

A thrombosed external hemorrhoid (TEH) results when there is an acute rupture of small blood vessels into the perianal skin. Depending on the timing of the TEH, an excision and drainage of the hemorrhoid may be recommended. This procedure can be performed in the clinic, emergency room, or in the operating room.

Internal hemorrhoids may be treated differently. Depending on the symptoms and size of the hemorrhoids, the physician will decide whether conservative (non-surgical) management is appropriate. This might include diet changes (increased fiber and water intake), topical medications, stool softeners, and/or laxatives. Inflamed hemorrhoids may also be treated with coagulation (infrared, laser or bipolar), causing them to harden and shrivel.

WHAT ARE THE COMPLICATIONS OF HEMORRHOIDS?

Complications from hemorrhoids are rare, but they could cause anemia if there is substantial blood loss.

WHO IS AT RISK FOR DEVELOPING HEMORRHOIDS?

People most at risk of developing inflamed hemorrhoids include those living with alcoholism, chronic diarrhea or chronic constipation. Those who lack physical activity are also at risk. Others at  risk include those who are obese and and those who practice anal intercourse.

NEXT STEPS

• Don’t dismiss rectal bleeding. Rectal bleeding can be caused by conditions other than hemorrhoids. It It is important to have a thorough evaluation to look for other causes of anorectal bleeding.  
• Seek medical intervention. Being proactive is important, and it starts with a medical evaluation. To request an evaluation at Loma Linda University Health, contact this department or schedule the appointment through MyChart.