Hemorrhoids: Symptoms, Home Care and When to Be Seen

What it involves

MedlinePlus defines hemorrhoids as swollen veins in the anus or lower part of the rectum. The NIDDK adds that they are also called piles, and that external hemorrhoids form under the skin around the anus while internal hemorrhoids form in the lining of the anus and lower rectum. Hemorrhoids are very common.

Who this is for

• Adults with anal itching, a tender lump, or pain when sitting or passing stool
• Patients who have seen bright red blood after a bowel movement
• Patients with constipation or straining that keeps bringing the problem back
• Patients whose symptoms have not improved with home treatment

What to expect

• Questions about your symptoms, bowel habits, diet, and any bleeding
• A physical exam that usually includes a look at the area around the anus
• A plain explanation of whether hemorrhoids fit your symptoms or other causes need to be ruled out
• A plan for home care and follow-up, and a referral if a procedure or further testing is needed

Internal and external hemorrhoids

MedlinePlus says internal hemorrhoids occur just inside the anus, at the beginning of the rectum, and when they are large they may fall outside the body. Their most common problem is bleeding during bowel movements. External hemorrhoids occur outside the anus and can make it hard to clean the area after a bowel movement. If a blood clot forms in an external hemorrhoid it can be very painful, which MedlinePlus calls a thrombosed external hemorrhoid.

What causes them

MedlinePlus says hemorrhoids result from increased pressure on the anus, which makes the normal anal veins and tissue swell. Pressure comes from pregnancy or childbirth, constipation, straining during bowel movements, and sitting for long periods, especially on the toilet. The NIDDK adds a low-fiber diet and aging. The constipation evaluation explains the most common trigger and what a provider asks about it.

Common symptoms

MedlinePlus says hemorrhoids are most often not painful, but it lists these common symptoms:

• Painless bright red blood from the rectum
• Anal itching
• An anal ache or pain, especially while sitting
• Pain during bowel movements
• One or more hard or tender lumps near the anus

Rectal bleeding is not always hemorrhoids

MedlinePlus says to contact your provider for rectal bleeding, because the provider may want to check for other, more serious causes. Get medical help right away if you lose a lot of blood, or if you are bleeding and feel dizzy, lightheaded, or faint. Long-term blood loss can also lead to iron deficiency anemia, which the anemia and low iron guide describes. The colorectal cancer screening guide covers the screening side of bowel health.

How they are diagnosed

MedlinePlus says most of the time a provider can diagnose hemorrhoids by simply looking at the rectal area, and external ones are often found that way. The NIDDK says your doctor takes a medical history, checks the area around the anus, performs a digital rectal exam, and may use procedures to look inside the anus and rectum. MedlinePlus lists sigmoidoscopy, anoscopy, and colonoscopy as tests that may help, and any of those would be arranged through a referral.

Home treatment

MedlinePlus lists over-the-counter or prescription corticosteroid creams for pain and swelling, prescription creams with lidocaine, stool softeners, and a high-fiber diet. To reduce itching, it suggests witch hazel on a cotton swab, cotton underwear, unscented and uncolored toilet tissue or baby wipes, and not scratching. Sitz baths, sitting in warm water for 10 to 15 minutes, can help you feel better. The NIDDK says drinking water and other liquids helps the fiber in your diet work better.

If home care is not enough

MedlinePlus says hemorrhoids that do not get better with home treatment may need an office treatment to shrink them. If that is not enough, surgery such as removal of the hemorrhoids may be necessary, generally for people with severe bleeding or prolapse who have not responded to other therapy. Those procedures would be done by a specialist through a referral. To lower the chance of a return, MedlinePlus advises plenty of fluids, a high-fiber diet of fruits, vegetables, and whole grains, and stool softeners to prevent straining.

Sources

• MedlinePlus — Hemorrhoids
• NIDDK — Hemorrhoids