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Hemorrhoids

Content provided by the Faculty of the Harvard Medical School

What Is It?

Hemorrhoids are lumps or masses of tissue in the anus, which contain enlarged blood vessels. Any increase in abdominal pressure may produce hemorrhoids. This may be from:

  • Repeated straining to have a bowel movement, especially in people who suffer from frequent constipation.

  • Pregnancy.

  • Repeated episodes of diarrhea.

  • Obesity.

  • Many patients have no apparent explanation for the formation of hemorrhoids, however.

Internal hemorrhoids. Internal hemorrhoids lie inside the anal canal, where they primarily cause the symptom of intermittent bleeding, usually with bowel movements, and sometimes mucous discharge. They are usually painless. Internal hemorrhoids also may protrude (prolapse) outside the anus, where they appear as small, grape-like masses. Usually the prolapsed hemorrhoid can be pushed back into the anus with a finger tip.

External hemorrhoids. These lie just outside the anal opening, where they primarily cause symptoms of swelling or bothersome protrusions, and sometimes discomfort. Swelling and discomfort may occur only intermittently. External hemorrhoids may also cause difficulties keeping the anal area clean after bowel movements. External hemorrhoids sometimes develop a blood clot inside of them ("thrombosis"), often after a period of diarrhea or constipation. In that case, it produces a sudden firm and painful swelling or lump around the rim of the anus.

Many patients have both internal and external hemorrhoids.

hemorrhoids

Hemorrhoids are a very common health problem. Hemorrhoids are more likely to develop in individuals who eat insufficient dietary fiber and don't get enough exercise, which can lead to repeated episodes of constipation and straining to have bowel movements.

Symptoms

Symptoms of hemorrhoids include:

  • Bright red blood on the toilet paper after having a bowel movement, especially if the stool was very hard or very large. Blood also may streak the surface of the stool, or color the water in the toilet bowl.

  • For a prolapsed hemorrhoid, a soft, grape-like mass protruding from the anus that may discharge mucous.

  • For external hemorrhoids, bothersome protrusions and difficulties keeping the anal area clean.

  • External hemorrhoids may also cause intermittent swelling, irritation, and mild discomfort, especially after a period of diarrhea or constipation.

For thrombosis of an external hemorrhoid, a painful bulge or firm lump suddenly appears at the rim of the anus. The lump may have a blue or purple tint. It may discharge blood.

  • Severe pain is not a typical symptom of hemorrhoids (except for thrombosis of an external hemorrhoid).

Diagnosis

Like most anal or rectal conditions, physicians diagnose hemorrhoids by inspecting the anal area, feeling inside the anus with a gloved finger, and looking inside the anal canal with a small short scope ("anoscope"). If there is rectal bleeding, it is important that a physician also checks for other more dangerous causes of bleeding, such as colorectal cancer. This evaluation is usually done with a long flexible telescope ("flexible sigmoidoscopy," or "colonoscopy").

Expected Duration

Hemorrhoid flare-ups (swelling, irritation and mild discomfort) are usually brief, and most symptoms disappear within a few days.

In pregnant women, hemorrhoid symptoms usually improve dramatically or disappear after childbirth.

Intermittent slight bleeding from hemorrhoids may carry on for months or years.

Painful swelling from thrombosis of an external hemorrhoid usually resolves over a period of days to weeks.

Prevention

You can often prevent hemorrhoids by preventing constipation. Some of the following diet and lifestyle changes may help you to soften your stool, establish a regular schedule for bowel movements, and avoid the straining that can lead to hemorrhoids:

  • Add more fiber to your diet. Set a goal of 25 to 30 grams of fiber daily, from such high fiber foods as beans, broccoli, carrots, bran, whole grains and fresh fruits. Alternatively, many people find that it is more convenient to take a fiber powder such as psyllium ("Metamucil"), or methylcellulose ("Citrucel"), which is available at drug stores without prescription. To avoid bloating and gas, add fiber to your diet gradually over a period of several days.

  • Drink adequate amounts of fluid. For most healthy adults, this is the equivalent of 6 to 8 glasses of water daily.

  • Begin a program of regular exercise. As little as 20 minutes of brisk walking daily can stimulate your bowel to move regularly.

  • Train your digestive tract to have regular bowel movements. Schedule a time to sit on the toilet at approximately the same time each day. The best time to do this is usually right after a meal. Do not sit on the toilet for long periods (it tends to make hemorrhoids swell up and push out).

  • Respond immediately to the urge to have a bowel movement. Do not postpone until the time is more convenient.

Reference: Hemorrhoids section on Better Medicine