While no one likes to discuss what goes on with your rear end, if you are experiencing something out of the ordinary it’s important to know when to seek medical attention. One very common, but often embarrassing such disorder is hemorrhoids.
Hemorrhoids are essentially swollen veins that occur in your rectum or anus, and the type depends on where they are. Internal hemorrhoids occur inside your rectum and typically don’t hurt, but may bleed without pain. Prolapsed hemorrhoids can stretch until they bulge outside your anus. They may return into the rectum on their own or they may need to be pushed. External hemorrhoids occur outside the anus and can be itchy or painful, as well as sometimes cracking and bleeding.
When the veins around your anus stretch from pressure they may bulge or swell, causing hemorrhoids. Increased pressure in the lower rectum can be from:
- Straining during bowel movements;
- Sitting for long periods of time on the toilet;
- Chronic diarrhea or constipation;
- Anal intercourse; and
- Low-fiber diet.
We are also more prone to hemorrhoids as we age because the tissues that support the rectal and anal veins can weaken and stretch.
The majority of people with hemorrhoids do not develop symptoms – only about 5% have symptoms related to their hemorrhoids. You may experience symptoms from internal hemorrhoids, external, or both.
For internal hemorrhoids, painless rectal bleeding or prolapse of the anal tissue (i.e. internal hemorrhoidal tissue coming outside of the anus) is the common symptom. It usually progresses slowly over time and is intermittent. Internal hemorrhoids are classified by how much they prolapse:
- Grade 1: No prolapse;
- Grade 2: Prolapse that goes back in on its own;
- Grade 3: Prolapse that must be pushed back in by the patient; and
- Grade 4: Prolapse that cannot be pushed back in by the patient (typically very painful).
If you have bleeding with internal hemorrhoids, it’s usually bright red and can be quite brisk. You’ll usually find it after wiping, dripping into the toilet bowl, or streaked onto a bowel movement. Not everyone has significant bleeding, though, and prolapse may be your only symptom. Prolapsing tissue may cause significant anal irritation and itching. You may also experience mucus discharge, difficulty cleaning yourself after a bowel movement, and a sensation of a “stuck” bowel movement at the anus.
External hemorrhoids typically present as a bluish-colored painful lump just outside the anus, usually spontaneously and possibly after an unusual amount of straining. Sometimes a blood clot will develop between the skin overlying the outside of the anus and the underlying tissues, causing a rapid increase in pressure and often pain, which is usually constant and may be severe. Occasionally the high pressure in the external hemorrhoidal area causes a breakdown of the overlying skin and the clotted blood starts to leak out. You may also experience intermittent swelling, pressure, and discomfort.
Sometimes people complain of anal skin tags, which are painless, soft tissue felt on the outside of the anus. They can be left over from a previous external hemorrhoid. Basically, the blood clot stretches the overlying skin, which remains stretched out after the blood clot is absorbed, and it leaves a skin tag. These tags may interfere with your ability to clean your anus after a bowel movement or you may dislike their appearance, but they’re harmless.
While almost everyone gets hemorrhoids from time to time, there are some factors that may increase your chances of having them. For instance, people whose parents had hemorrhoids may have a higher risk. Pregnant women often get them due to the strain of carrying the baby and giving birth. If you are very overweight, or you stand or lift too much, it can make your hemorrhoids worse.
Preventing & treating hemorrhoids
The absolute best way to prevent hemorrhoids is to keep your stools soft for easy passage. One way to do this is eating high-fiber foods (fruits, vegetables, and whole grains) and considering fiber supplements if you don’t get the full recommended amount a day (25 grams for women and 38 grams for men). Be sure to drink plenty of fluids to keep stools soft and prevent constipation while you’re increasing your fiber intake. Don’t strain while on the toilet – it creates greater pressure in the lower rectum veins – and go as soon as you feel the urge. Stay active and avoid long periods of sitting.
For treatment, if you have only mild pain, swelling, and inflammation of your hemorrhoids, you can usually use home remedies, like the ones below:
- Eat high-fiber foods;
- Soak regularly in a warm bath or sitz bath;
- Keep the anal area clean;
- Don’t use dry toilet paper;
- Apply cold for inflammation; and
- Take oral pain relievers (Advil, Motrin, Tylenol, etc.).
Your healthcare provider may recommend an over-the-counter (OTC) medication for mild discomfort. They may include ointments, creams, foams, suppositories, or pads. Don’t use an OTC steroid (i.e. hydrocortisone) for longer than a week without your doctor’s direction because it can thin your skin. Some available OTC products are
Unfortunately, some patients will require measures beyond lifestyle changes and medications. If your internal hemorrhoidal symptoms are severe, you may require a minimally invasive procedure, such as rubber band ligation, sclerotherapy, or coagulation. An external hemorrhoid that has a painful blood clot may require surgical removal of the clot. Lastly, if other procedures are unsuccessful or you have very large hemorrhoids, you may need hemorrhoid removal or stapling.