Often described as “varicose veins of the anus and rectum,” hemorrhoids are enlarged, bulging blood vessels in and around the anus and lower rectum. The rectum is the bottom section of your colon (large intestine). The tissues supporting the vessels stretch. As a result, the vessels expand, the walls thin, and bleeding occurs. When the stretching and pressure continue, the weakened vessels protrude. The two types of hemorrhoids, external and internal, refer to their location.
External (outside) hemorrhoids form near the anus and are covered by sensitive skin. They are usually painless unless a blood clot (thrombosis) forms.
Thrombosed external hemorrhoids are blood clots that form in an outer hemorrhoid in the anal skin. If the clots are large, they can cause significant pain. A painful anal mass may appear suddenly and get worse during the first 48 hours. The pain generally lessens over the next few days. You may notice bleeding, if the skin on top opens.
Internal (inside) hemorrhoids form within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptoms. However, an internal hemorrhoid can cause severe pain, if it is completely prolapsed. This means it has slid out of the anal opening and cannot be pushed back inside.
Facts and Stats
- Hemorrhoids are one of the most common known ailments.
- Millions of Americans currently suffer from hemorrhoids.
- The average person suffers for a long time before seeking treatment for hemorrhoids.
- Advances in treatment methods means some types of hemorrhoids can be treated with far less painful methods than before.
The exact cause of hemorrhoids is unknown. A lot of pressure is put on human rectal veins due to our upright posture, which can potentially cause bulging. Other contributing factors include:
- Chronic constipation or diarrhea
- Straining during bowel movements
- Faulty bowel function due to overuse of laxatives or enemas
- Spending long periods of time on the toilet (e.g., reading)
Any of the following may be a sign of hemorrhoids:
- Bleeding during bowel movements
- Protrusion of skin during bowel movements
- Itching in the anal area
- Pain in the anal area
- Sensitive lump(s)
It is important that symptoms are checked by a colon and rectal surgeon first before you try self-treatments. They will perform a thorough examination and recommend treatment. Mild symptoms can be relieved frequently without surgery. With nonsurgical treatment, pain and swelling usually decrease in 2-7 days. The firm lump should recede within 4-6 weeks.
- Eating a high-fiber diet and taking over-the-counter fiber supplements (25-35 grams of fiber/day) to make stools soft, formed and bulky.
- Avoiding excessive straining to reduce the pressure on hemorrhoids and help prevent protrusion.
- Drinking more water to help prevent hard stools and aid in healing.
- Taking warm tub baths (sitz baths) for 10-20 minutes, a few times per day to help the healing process.
If pain from a thrombosed hemorrhoid is severe, your physician may decide to remove the hemorrhoid and/or clot with a small incision. These procedures can be done at your physician’s office or at the hospital under local anesthesia.
Rubber band ligation: This treatment works well on internal hemorrhoids that protrude during bowel movements. A small rubber band is placed over the hemorrhoid, cutting off its blood supply. The hemorrhoid and the band fall off in a few days. The wound usually heals in 1 -2 weeks. Mild discomfort and bleeding may occur. Sometimes this treatment needs to be repeated for complete treatment of the hemorrhoids.
Injection and coagulation: This method can be used on bleeding hemorrhoids that do not protrude. Both methods are fairly painless and cause the hemorrhoids to shrivel up.
Hemorrhoid stapling: A special device is used to apply staples and remove tissue from internal hemorrhoids. While the stapling method can shrink internal tissue, it cannot be used for external hemorrhoids. This procedure is generally more painful than rubber band ligation but less painful than hemorroidectomy.
Hemorrhoidectomy: This is the most complete surgical method for removing extra tissue that causes bleeding and protrusion. It is done under anesthesia using either sutures or staples. Depending on the case, hospitalization and a period of rest may be required. Contrary to popular belief, laser methods do not offer any benefit compared to standard operative techniques. Laser surgery is expensive and no less painful.
Hemorrhoidectomy is considered when:
- Clots repeatedly form in external hemorrhoids
- Ligation is not effective in treating internal hemorrhoids
- Protruding hemorrhoid cannot be reduced
- There is chronic bleeding
Do hemorrhoids lead to cancer?
Hemorrhoids do not increase the risk of colorectal cancer nor cause it. However, more serious conditions can cause similar symptoms. Even when a hemorrhoid has healed completely, your colon and rectal surgeon may request other tests. A colonoscopy may be done to rule out other causes of rectal bleeding. Every person age 50 and older should undergo a colonoscopy to screen for colorectal cancer.