Hemorrhoid symptoms & treatment

Hemorrhoids affect many people in this country. Most of us have heard about them but some of us may not be entirely sure what they are. At Advocate Health Care, we can offer tips on how to deal with hemorrhoids yourself and suggest when you may want to seek care from one of our expert gastroenterologists.

What is a hemorrhoid?

A hemorrhoid is an inflamed or swollen vein in the skin around the outside of the anus (the opening that allows bowel movements to exit the body) or inside the colon. Hemorrhoids inside the colon are called internal hemorrhoids. Those outside the body are called external hemorrhoids.

External hemorrhoids may be reddish or skin colored. Internal hemorrhoids are formed on mucous membranes that line the inside of the colon, so they are usually reddish.

Sometimes hemorrhoids have blood clots inside them. They may take on a blue, purple, black, grey or dark brown color, depending on your normal skin tone. These are called thrombosed hemorrhoids and they can be very painful.

You usually won’t see an internal hemorrhoid. You may not know you have it unless a health care provider tells you about it after an exam or after a procedure like a colonoscopy. Sometimes you’ll see an internal hemorrhoid if part of it gets pushed out through the anus (prolapsed) during a bowel movement. A prolapsed hemorrhoid usually goes back inside the body when the straining is over. If it doesn’t, you may be able to gently push it back inside.

Any kind of hemorrhoid is likely to be uncomfortable, annoying and sometimes extremely painful.

Hemorrhoid causes and hemorrhoid risk factors

Some of the things that can contribute to hemorrhoids are:

Hemorrhoid symptoms

Internal hemorrhoids often have no symptoms. Or you may notice bright red blood on toilet paper or in the toilet bowl after a bowel movement. Hemorrhoids are a common cause of rectal bleeding, but be sure to check with your doctor about any bleeding because it can also be a symptom of anal fissures, ulcerative colitis, Crohn’s disease or some types of cancer. Hemorrhoids don’t cause any of these other conditions and the treatments for each of them are different.

External hemorrhoids are harder to ignore. You may notice a hard, tender lump and an itchy feeling. Your anus may ache, especially when you’re sitting. There may also be bleeding or swelling. For most people, these hemorrhoid symptoms go away after a few days as long as they avoid straining or too much cleaning or rubbing around the anus.

Complications from hemorrhoids

Complications from hemorrhoids are rare, but can include:

• Thrombosed hemorrhoid: When a blood clot forms inside an internal or external hemorrhoid. May cause extreme pain.
• Skin tags: Skin that remains after a blood clot inside a hemorrhoid is reabsorbed.
• Infection
• Strangulated hemorrhoid: When part of an internal hemorrhoid prolapses (comes out through the anus) and its blood supply is cut off by the muscles of the anus. This can be very painful.
• Anemia: Caused by chronic blood loss.

How to prevent hemorrhoids

You can prevent or treat hemorrhoids with self-care methods like drinking enough water and eating foods that are high in fiber (beans, nuts, seeds, whole grains, fresh fruits and vegetables). At the same time, minimize eating red meats and processed foods as well as alcohol consumption. Don’t smoke.

Avoid straining during bowel movements. Avoid too much heavy lifting. Walking can help your digestion so that your bowel movements are softer and easier to pass. Always use the toilet as soon as you feel the urge.

Home treatments for hemorrhoids

The tips for prevention can also help if you develop hemorrhoids. You can add some of these strategies:

• Sitting in a shallow bath of warm water (sitz bath) several times a day can relieve pain
• Taking a stool softener or a fiber supplement
• Taking over-the-counter nonsteroidal pain relievers to relieve pain
• Using over-the-counter hemorrhoid creams, ointments or suppositories
• Applying ice packs to reduce pain and swelling

Seek medical help if you have severe pain, bleeding or hemorrhoid symptoms that don’t resolve after a week of at-home treatments. There are other causes for rectal pain or bleeding, and the treatments for them are different than the treatments for hemorrhoids.

Hemorrhoid diagnosis

Your health care provider will perform a thorough physical, including asking about your general health history and any hemorrhoid symptoms. They’ll ask about any treatments you’ve already tried and whether you feel they’ve helped.

They’ll check the appearance of any external hemorrhoids. They may do a digital rectal exam by putting on gloves, applying lubrication and inserting a finger into your rectum to feel for tenderness or lumps and check muscle tone.

They may use an anoscope (short plastic tube) or a sigmoidoscope (flexible lighted tube) to observe more of the colon.

Using all these methods and whatever else is needed, they'll verify whether you have hemorrhoids or another condition.

Nonsurgical treatment for hemorrhoids

Your doctor may start by suggesting treatments you can try such as some of the ones listed above. They may also suggest prescription medications that are more effective than remedies available over the counter.

Bleeding and persistent hemorrhoids can be treated with minimally invasive procedures such as:

• Rubber band ligation: Your doctor puts one or two small medical-grade rubber bands around the base of a hemorrhoid to cut off its blood flow. You may need more than one banding treatment to get rid of a hemorrhoid. The treated hemorrhoid shrinks and falls off. 
• Sclerotherapy: A chemical is injected into the hemorrhoid to cut off blood supply and cause the hemorrhoid to shrink. Any pain is minimal.
• Cryotherapy: Your doctor applies a cooled gas or liquid to freeze the external hemorrhoid, which then shrinks and falls off.

Surgical treatment for hemorrhoids

Surgery is usually recommended for large hemorrhoids, bleeding or prolapsed internal hemorrhoids, or those that haven’t responded to other treatment. These are usually outpatient procedures but sometimes require an overnight hospital stay. Procedures include:

• Excisional hemorrhoidectomy: This is surgical removal of hemorrhoids. Your doctor makes incisions around the hemorrhoid and removes it while you’re under general anesthesia. You may have pain after the procedure and may need to take it easy for as long as two weeks, but the surgery has a high rate of lasting success.
• Stapled hemorrhoidopexy: This doesn’t involve an incision. Instead, using a device inserted through a tube into your anus, your doctor removes tissue around the hemorrhoid. The hemorrhoid is lifted, and the tissue is stapled back into place. Blood flow to the hemorrhoid is cut off, and it shrinks within four to six weeks. Stapled hemorrhoidopexy takes about 30 minutes under general anesthesia. It’s usually less painful than hemorrhoidectomy and lets you get back to your regular activities faster.