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Definition

Hemorrhoids are swollen veins in the anus or lower part of the rectum.

Causes

Hemorrhoids are very common. They result from increased pressure on the anus. This can occur during pregnancy or childbirth, and due to constipation. The pressure causes the normal anal veins and tissue to swell. This tissue can bleed, often during bowel movements.

Hemorrhoids may be caused by:

• Straining during bowel movements
• Constipation
• Sitting for long periods of time, especially on the toilet
• Certain diseases, such as cirrhosis

Hemorrhoids may be inside or outside the body.

• Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. When they are large, they may fall outside (prolapse). The most common problem with internal hemorrhoids is bleeding during bowel movements.
• External hemorrhoids occur outside the anus. They can result in difficulty cleaning the area after a bowel movement. If a blood clot forms in an external hemorrhoid, it can be very painful (thrombosed external hemorrhoid).

Symptoms

Hemorrhoids are most often not painful, but if a blood clot forms, they can be very painful.

Common symptoms include:

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

Exams and Tests

Most of the time, a health care provider can diagnose hemorrhoids by simply looking at the rectal area. External hemorrhoids can often be detected this way.

Tests that may help diagnose the problem include:

• Rectal exam
• Sigmoidoscopy
• Anoscopy

Treatment

Treatments for hemorrhoids include:

• Over-the-counter corticosteroid (for example, hydrocortisone) creams to help reduce pain and swelling
• Hemorrhoid creams with lidocaine or other anesthetic to help reduce pain
• Stool softeners to help reduce straining and constipation

Things you can do to reduce itching include:

• Apply witch hazel to the area with a cotton swab.
• Wear cotton underwear.
• Avoid toilet tissue with perfumes or colors. Use baby wipes instead.
• Try not to scratch the area.

Sitz baths can help you to feel better. Sit in warm water for 10 to 15 minutes.

If your hemorrhoids do not get better with home treatments, you may need some type of office treatment to shrink the hemorrhoids.

If office treatment is not enough, some type of surgery may be necessary, such as removal of the hemorrhoids (hemorrhoidectomy). These procedures are generally used for people with severe bleeding or prolapse who have not responded to other therapy.

Possible Complications

The blood in the hemorrhoid may form clots. This can cause tissue around it to die. Surgery is sometimes needed to remove hemorrhoids with clots.

Rarely, severe bleeding may also occur. Iron deficiency anemia can result from long-term blood loss.

When to Contact a Medical Professional

Contact your provider if:

• Hemorrhoid symptoms do not improve with home treatment.
• You have rectal bleeding. Your provider may want to check for other, more serious causes of the bleeding.

Get medical help right away if:

• You lose a lot of blood
• You are bleeding and feel dizzy, lightheaded, or faint

Prevention

Constipation, straining during bowel movements, and sitting on the toilet too long raise your risk for hemorrhoids. To prevent constipation and hemorrhoids, you should:

• Drink plenty of fluids.
• Eat a high-fiber diet of fruits, vegetables, and whole grains.
• Consider using fiber supplements.
• Use stool softeners to prevent straining.

References

Bass LM, Wershil BK. Anatomy, histology, embryology, and developmental anomalies of the small and large intestine. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 98.

Cameron J. Anorectal. In: Cameron J, ed. Current Surgical Therapy. 14th ed. Philadelphia, PA: Elsevier; 2023:chap 5.

Zainea GG, Pfenninger JL. Office treatment of hemorrhoids. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 87.

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