What Are Hemorrhoids? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Hemorrhoids are enlarged and swollen veins (also called varicose) around the outside of the anus or in the lower rectum. The rectum is the last part of the bowel and leads to the anus, the opening at the end of the bowel where fecal matter leaves the body.

Everyone has hemorrhoidal tissue in this area that’s made up of blood vessels, connective tissue, and some muscle. These “cushions” don’t always become enlarged or distended, but as we age, this phenomenon becomes more common — causing what we call hemorrhoids, also known as piles.

Hemorrhoids can be caused in a number of ways, most commonly by straining to make a bowel movement. Lifting heavy objects, along with other activities that may cause straining, can also lead to hemorrhoids. Experiencing increased pressure during pregnancy and being overweight are other contributing factors.

Hemorrhoids may be painful and particularly bothersome if they are recurrent, but they're not dangerous or life-threatening, and symptoms usually go away within a few days. There are plenty of effective ways to treat them, as well as options for the less common types of hemorrhoids that may be more problematic.

Types of Hemorrhoids: Internal and External

Hemorrhoids are either internal or external.

Internal Hemorrhoids These hemorrhoids develop inside the rectum (the part of the large bowel leading to the anus) and are not usually visible to the naked eye. Internal hemorrhoids generally don't hurt, but they often bleed painlessly.

In some cases, internal hemorrhoids may protrude through the anus and can be seen, which is known as becoming prolapsed. When this happens, they will usually shrink back inside the rectum on their own or can be pushed back in. (1)

External Hemorrhoids These hemorrhoids develop under the skin around the outside of the anus. These are the most uncomfortable hemorrhoids and can be itchy or painful, and may feel lumpy. When a blood clot forms within an external hemorrhoid, this is known as a thrombosed hemorrhoid, which can result in severe, ongoing pain. (1) Sometimes clots dissolve on their own, but if they don’t, your doctor can remove the clot, a procedure that’s most effective if done within 72 hours of the clot forming. (2)

Seeing blood in your toilet bowl after a bowel movement is no doubt alarming, but it’s one of the main symptoms of hemorrhoids. Other symptoms include:

• Bright red blood on toilet paper or in your stool after a bowel movement
• Itching in the anal area
• Pain in the anal area, especially when sitting
• Pain during bowel movements
• One or more hard, painful lumps around the anus

If you experience any of these hemorrhoid symptoms, avoid excess straining, rubbing, or cleaning around the anus, which can make irritation and itching worse, and can even lead to bleeding. In addition, try to pat the area dry instead of wiping it.

Learn More About the Signs and Symptoms of Hemorrhoids

Several conditions and habits are thought to cause hemorrhoids:

• Chronic constipation or diarrhea
• Straining too hard during bowel movements
• Sitting on the toilet for a long time

Straining, constipation, and prolonged sitting can all affect the blood flow in the area, causing blood to not move at its expected rate (known as pooling) within the vessels, leading to hemorrhoids.

Factors that raise your risk of developing hemorrhoids:

• Lack of fiber in the diet.
• Obesity: Being overweight can put pressure on the hemorrhoidal tissue.
• Aging: As we get older, the connective tissue in the rectum and anus becomes weaker, potentially resulting in bulging hemorrhoids.
• Pregnancy: As the fetus grows and puts pressure on the abdomen, the veins in the rectum and anus may become enlarged. The problem typically goes away after birth.

Hemorrhoids and Pregnancy

Hemorrhoids are common during pregnancy, particularly in the third trimester, when the enlarged uterus puts pressure on the pelvis and the veins near the anus and rectum. The increased level of the hormone progesterone during pregnancy can also contribute to the development of hemorrhoids: Progesterone relaxes the walls of the veins, making them more likely to swell.

Some women get hemorrhoids for the first time when they’re pregnant. But if you’ve had hemorrhoids before, you’re more likely to get them again when you’re pregnant.

Fortunately, hemorrhoids usually aren't harmful to your health or the health of your baby, and they typically go away on their own once you give birth. You can often alleviate symptoms with home care, but check with your doctor first to make sure any treatments are safe to take during your pregnancy.

Learn More About Hemorrhoids and Pregnancy

RELATED: How to Relieve and Prevent Constipation

You can often treat hemorrhoids yourself at home, and symptoms should ease within a week. But if they don't, or if you have rectal bleeding, you should see your doctor, according to the National Institute for Diabetes and Digestive and Kidney Diseases. (4) Bleeding from the rectum could possibly be a sign of digestive tract problems and bowel diseases, such as ulcerative colitis, Crohn’s disease, or anal or colorectal cancer, so it’s important to treat it seriously, especially if you are over 40 years old. (5)

Hemorrhoid Treatment in a Doctor’s Office, With or Without Surgery

Medical procedures may be needed for hemorrhoids that don’t go away with home treatments.

Painful external hemorrhoids can be excised (cut off) during an office visit following a shot of local anesthetic to numb the area.

For internal hemorrhoids, a few office procedures may be considered. In rubber band ligation, the most common hemorrhoid procedure performed in the United States, the doctor places a small rubber band around the base of the hemorrhoid, cutting off the hemorrhoid's blood supply. (6) The hemorrhoid typically shrinks and falls off within about a week, though several quick follow-up visits may be required to completely get rid of the hemorrhoid. (1)

Other procedures include sclerotherapy, in which a chemical injected into the hemorrhoid causes scar tissue to form, shrinking the hemorrhoid; and infrared coagulation, in which an intense beam of infrared light causes the scar tissue to form, cutting off the blood supply and shrinking the hemorrhoid. (4)

If you have a large external hemorrhoid, both internal and external hemorrhoids, or an internal hemorrhoid that’s prolapsed (popped out through the anus), a surgical operation called a hemorrhoidectomy may be necessary, though few patients require this procedure. (1)

During a hemorrhoidectomy, the hemorrhoid and surrounding tissue are removed via a small incision, which is usually closed up with stitches afterward. The procedure is performed in an operating room with either localized or general anesthesia, or a spinal block that numbs the bottom half of the body. The procedure is successful in 95 percent of cases, though patients may experience postoperative pain. (6)

Another option that aims to reduce postoperative pain is a stapled hemorrhoidopexy, in which a device pulls the hemorrhoidal tissue upward and to its normal position, stapling it in place. (The staples fall out over time.) (1)

Learn More About Treatment for Hemorrhoids: Medication, Alternative and Complementary Therapies, Surgery Options, and More

Prevention of Hemorrhoids

Preventing constipation by keeping your stool soft and having regular bowel movements is one of the best ways to help prevent hemorrhoids.

The following tips may help you prevent constipation:

Get plenty of fiber in your diet. A high-fiber diet can make stool softer and bulkier so that it passes easily. According to the Academy of Nutrition and Dietetics, adult men under age 50 should aim for at least 38 grams of fiber a day and adult women under age 50 should aim for 25 grams. For those older than 50, the recommendation is slightly lower: 30 grams for men and 21 grams for women. (8) But be careful to add fiber to your diet slowly to avoid excessive gas or bloating.

Related

6 Easy Ways to Prevent Hemorrhoids

There are a number of easy, healthy ways to incorporate more fiber into your diet. Fiber-filled foods include fruits such as berries, avocados, and pears (especially when you eat the skin). Broccoli, artichokes, and Brussels sprouts are among the vegetables that can up your fiber intake. Whole grains, such as brown rice, quinoa, and oatmeal, are also an important source. Legumes, including lentils, various beans, and green peas, are a great way to get fiber. Nuts and seeds make for a great fiber-filled snack, too.

If you're having trouble getting enough fiber in your regular diet, consider a fiber supplement. (7)

If you experience chronic constipation and suspect that may be contributing to your hemorrhoids, avoid eating too many foods that contain little or no fiber, such as cheese and fast and processed foods.

Drink plenty of water and other fluids. Recommendations for daily water intake vary and depend on the individual, but the Institute of Medicine of the National Academies has set adequate intake levels at 2.7 liters (91 ounces) for men and approximately 3.7 liters (125 ounces) for women. (9) This can come from beverages and food, but caffeinated beverages and alcohol can be dehydrating and should not be counted in reaching this intake goal.

Exercise regularly. Exercise, especially 20 to 30 minutes of moderate aerobic activity a day, can help keep bowel movements regular. (6) And regular exercise may help you lose weight, which may be contributing to the formation of hemorrhoids.

Other tips for preventing hemorrhoids include:

Don't strain or hold your breath during bowel movements. Straining can put excess pressure on veins and lead directly to hemorrhoid development.

Go to the bathroom as soon as you feel the urge. Letting the urge subside can make your stool harder to pass.

Avoid long periods of sitting. Sitting for too long, especially on the toilet, can stress veins in the anus.

Hemorrhoid complications are rare. Complications may include:

Anemia Bleeding from chronic hemorrhoids can cause anemia, or not having enough red blood cells. (10) Red blood cells carry oxygen throughout the body, so having anemia can make you feel tired, weak, or short of breath.

Strangulated Hemorrhoid In rare situations, swelling may cut off the oxygen supply to a hemorrhoid that has prolapsed, causing a strangulated hemorrhoid. This can be extremely painful and incapacitating, and surgery may be needed to treat it. (11)

Gastrointestinal problems such as constipation and diarrhea can lead to or worsen hemorrhoids. The prolonged sitting or straining that may occur when you're dealing with these issues puts pressure on the hemorrhoidal tissue.

Hemorrhoids also often develop during pregnancy. This is similarly due to greater pressure in the area but can also be due to an increase in blood volume and as a result of hormonal changes that increase the likelihood of swelling. Constipation during pregnancy is a common cause of hemorrhoids.

Hemorrhoids can be uncomfortable, both to have and to talk about. But getting clear, straightforward information can help you deal with them.

Essential Orgs for Hemorrhoid Information

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

In addition to basic info about symptoms, causes, and treatment, the NIDDK website offers recommendations on diet and nutrition — what to eat and what to avoid — as well as links to relevant clinical trials that may be seeking participants.

American Society of Colon and Rectal Surgeons

This site provides a comprehensive review of what hemorrhoids are, what causes them, and how to treat them. In cases when pain is severe and hemorrhoids aren't healing with at-home treatment, in-office treatment by a healthcare provider is necessary. This can involve surgical and nonsurgical options.

Mayo Clinic

The Mayo Clinic offers trusted guidance on symptoms, causes, diagnosis, and treatment of hemorrhoids. You can also find answers to specific questions about home remedies and hemorrhoid treatment during pregnancy.

Favorite Podcast on Hemorrhoids

Each episode of the Cleveland Clinic's Butts and Guts podcast explores a different digestive health issue, including this lively, informative one on hemorrhoids.

Additional reporting by Deborah Shapiro.