Hemorrhoids

Overview, Causes, & Risk Factors

Hemorrhoids are swollen blood vessels that are found in and around the anus and lower rectum. They can be internal, which means inside the anus. Or, they may be external, which means they are found outside the anus.

What is going on in the body?

The blood vessels around the anus swell and may bleed or cause other symptoms. The exact cause of hemorrhoids is not always clear.

What are the causes and risks of the condition?

Hemorrhoids are related to dilated blood vessels, but the exact cause is not always clear. Some types of hemorrhoids run in families. Other factors that increase your risk for hemorrhoids include:

  • alcoholism
  • anal intercourse
  • chronic diarrhea
  • cancer of the rectum or colon
  • a diet that lacks fiber
  • frequent coughing and sneezing
  • liver disease, such as cirrhosis
  • loss of muscle tone in the rectum due to aging and rectal surgery
  • obesity
  • jobs that require standing or sitting for long periods of time
  • pregnancy
  • straining due to constipation

    • Symptoms & Signs

    What are the signs and symptoms of the condition?

    You may have hemorrhoids for years without them causing any health problems. If you do have symptoms, they most often include:

  • a lump around the anus
  • mucus-like discharge from the rectum
  • rectal bleeding, which may be seen as red streaks on the toilet paper or blood in the toilet bowl
  • rectal pain and itching

    • Diagnosis & Tests

    How is the condition diagnosed?

    To diagnose hemorrhoids, your doctor will start with a medical history and physical exam. As part of the exam, your doctor will feel for internal hemorrhoids by inserting a lubricated finger into your rectum. This is called a digital exam. Sometimes your doctor may use a hollow, lighted tube called an anoscope to view internal hemorrhoids. To rule out other disorders, he or she may order a sigmoidoscopy or proctoscopy. These tests also use a lighted tube, but look at your bowel, rather than your rectum. Your doctor may also order blood tests.

    Prevention & Expectations

    What can be done to prevent the condition?

    One of the best ways to avoid hemorrhoids is to prevent the pressure and straining that come from constipation. To lessen the impact of your hemorrhoids, take these actions:

  • avoid sitting in one place for long periods of time
  • drink six to eight glasses of fluid each day
  • eat a diet high in fiber
  • exercise regularly
  • limit the time you spend on the toilet
  • maintain a healthy body weight

    • Many times, hemorrhoids are related to liver disease caused by alcohol abuse. It's important to avoid alcohol intake or, if you must drink, to do so only in moderation.

    What are the long-term effects of the condition?

    If hemorrhoids are not effectively treated, you may develop infections as a result. You are at risk for an anorectal abscess or anal fissure. You may also lose the ability to control your bowel movements. If bleeding continues, a low red blood cell count, called anemia, can develop.

    What are the risks to others?

    Hemorrhoids are not contagious and pose no risk to others.

    Treatment & Monitoring

    What are the treatments for the condition?

    Many times, hemorrhoids resolve without any type of treatment. Take these measures to ease your pain, decrease swelling, and regulate your bowel movements:

  • use hemorrhoidal creams, lotions, or suppositories to relieve pain
  • apply ice packs to reduce the swelling
  • take stool softeners or laxatives to prevent constipation
  • sit in a warm tub or sitz bath three to four times a day

    • If hemorrhoids are severe or treatment is not effective, the doctor may recommend hemorrhoid surgery. A variety of procedures can be used to remove hemorrhoids or reduce their size.

    What are the side effects of the treatments?

    Medicines used to treat hemorrhoids may cause allergic reactions. Surgery can cause bleeding, infection, or allergic reaction to anesthesia.

    What happens after treatment for the condition?

    Symptoms may subside for a time if you prevent straining when you have a bowel movement. However, flare-ups of hemorrhoids are common. Hemorrhoid surgery may provide a permanent cure for the problem.

    How is the condition monitored?

    The doctor will check for further problems by doing a digital exam during your regular check-ups. Always report any new or worsening symptoms to your doctor.

    Attribution

    Author:Gail Hendrickson, RN, BS
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:10/31/01
    Reviewer:Adam Brochert, MD
    Date Reviewed:09/26/01

    Sources

    Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998.

    Griffith, H. Winter. Instructions for Patients. Philadelphia:W.B. Saunders Company,1994.

    NIH Publication No. 95-3021, National Digestive Disease Information Clearinghouse, 2 Information Way, Bethesda, MD 20892