Hemorrhoids or piles, are swollen veins in your anus and lower rectum. They may result from straining during bowel movements or from the increased pressure on these veins during pregnancy. These may be located inside the rectum (internal piles), or they may develop under the skin around the anus (external piles).
By 50 years of age, about half of adults have had to deal with the itching, discomfort and bleeding that can signal the presence of hemorrhoids.
Fortunately, many effective options are available to treat hemorrhoids. Most people can get relief from symptoms by using home treatments and making lifestyle changes.
Symptoms of hemorrhoids may include but are not limited to:
- Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl
- Itching or irritation in your anal region
- Pain or discomfort
- Swelling around your anus
- A lump near your anus, which may be sensitive or painful
- Leakage of stools
Internal hemorrhoids lie inside the rectum. You usually do not see or feel these, and they usually don’t cause discomfort. Occasionally, straining can push an internal hemorrhoid through the anal opening. This is known as a protruding or prolapsed hemorrhoid and can cause pain and irritation.
External hemorrhoids are under the skin around your anus. When irritated, external hemorrhoids can itch or bleed. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), resulting in severe pain, swelling and inflammation.
The veins around your anus tend to stretch under pressure and may bulge or swell up. Swollen veins (hemorrhoids) can develop from an increase in pressure in the lower rectum. Factors that might cause increased pressure include:
- Straining during bowel movements
- Sitting for long periods of time on the toilet
- Chronic diarrhea or constipation
- Low-fiber diet
Piles are more likely as you get older because the tissues that support the veins in your rectum and anus can weaken and stretch with aging.
- Chronic blood loss may cause anemia. This can result in fatigue and weakness.
- Severe pain and infection
Your doctor may tell you that you have external hemorrhoids simply by looking. Tests and procedures to diagnose internal hemorrhoids may include:
- Examination of your anal canal and rectum for abnormalities. During a digital rectal exam, your doctor inserts a gloved, lubricated finger into your rectum. He or she feels for anything unusual, such as growths. The exam can give your doctor an indication of what further testing might be appropriate.
- Visual inspection of your anal canal and rectum. Because internal hemorrhoids are often too soft to be felt during a rectal examination, your doctor may also examine the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope. These are scopes that allow your doctor to see into your anus and rectum.
Your doctor may want to do a more extensive examination of your entire colon using colonoscopy. This might be recommended if:
- Your signs and symptoms suggest you might have another digestive system disease
- You have risk factors for colorectal cancer
- You’re older than age 50 and haven’t had a recent colonoscopy
Most of the time, treatment for hemorrhoids involves steps that you can take on your own, such as lifestyle modifications. But sometimes medications or surgical procedures are necessary.
If a blood clot has formed within an external hemorrhoid, your doctor can remove the clot with a simple incision, which may provide prompt relief.
For persistent bleeding or painful hemorrhoids, your doctor may recommend another minimally invasive procedure. These treatments can be done in your doctor’s office or other outpatient setting.
- Rubber band ligation. Your doctor places one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation. The hemorrhoid withers and falls off within a week. This procedure — called rubber band ligation — is effective for many people.
Hemorrhoid banding can be uncomfortable and may cause bleeding, which might begin two to four days after the procedure but is rarely severe.
- Injection (sclerotherapy). In this procedure, your doctor injects a chemical solution into the hemorrhoid tissue to shrink it. While the injection causes little or no pain, it may be less effective than rubber band ligation.
If other procedures haven’t been successful or you have large hemorrhoids, your doctor may recommend a surgical procedure. Surgery can be performed on an outpatient basis or you may need to stay in the hospital overnight.
- Hemorrhoid removal. During a hemorrhoidectomy, your surgeon removes excessive tissue that causes bleeding. Various techniques may be used. The surgery may be done with a local anesthetic combined with sedation, a spinal anesthetic or a general anesthetic.
Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. Complications may include temporary difficulty emptying your bladder and urinary tract infections associated with this problem.
Most people experience some pain after the procedure. Medications can relieve your pain. Soaking in a warm bath also may help.
- Hemorrhoid stapling. This procedure, called stapled hemorrhoidectomy or stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. Stapling generally involves less pain than hemorrhoidectomy and allows an earlier return to regular activities.
The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:
- Eat high-fiber foods
- Drink plenty of fluids.
- Consider fiber supplements.
- Don’t strain.
- Go as soon as you feel the urge.
- Avoid long periods of sitting.