What are they?

Hemorrhoids are blood vessels and their surrounding tissue in and around the anus and lower rectum that have become swollen, due to stretching and bulging of the vessel walls under pressure.  Nearly everyone has this condition at some point or at least in some minor form.  But enlarged or protruding hemorrhoids can cause uncomfortable symptoms.  They are a problem equally in men and women, and are especially prevalent in the 45-to-65-year-old age group.

Hemorrhoids are either internal (inside the anorectal area) or external (visible around the opening and outside of the anus).  While they may be uncomfortable and inconvenient, they are usually not dangerous or life threatening.

 

What are causes and risk factors for hemorrhoids?

Hemorrhoids may develop as a result of repeated straining during bowel movements.  This downward force increases blood pressure within blood vessels in the anorectal area and causes them to protrude form their normal position.  Thus, chronic constipation or diarrhea can be a contributing factor.  Heredity and aging are also risks for hemorrhoids.

In addition, hemorrhoids are common in pregnant women, due to the pressure of the fetus on the pelvic floor and due to hormonal changes that cause hemorrhoidal vessels to enlarge.  The process of childbirth also puts stress on these vessels.

 

What are the symptoms of hemorrhoids?

With hemorrhoids, the surface of the bulging blood vessels can become irritated and can leak blood.  Common symptoms of hemorrhoids include:

• bright red blood present on the stool, toilet paper, or in the toilet bowl;

• irritation and pain around the anus;

• a swelling, lump, protrusion or bulge at the anus;

• and itching around the anus.

The degree of severity of a hemorrhoid is based partly on the extent to which it protrudes, or prolapses, from its normal position.  Uncommonly, hemorrhoids may cause blood clots or create an infection that requires immediate treatment

 

How are hemorrhoids diagnosed?

Diagnosing hemorrhoids involves a physical examination of the anus and rectum to look for swollen blood vessels.  Diagnosis may also include:

•  digital rectum examination, in which the physician inserts a gloved, lubricated finger into the rectum to check for abnormalities;

• anoscopy, in which a hollow, lighted tube (endoscope) that is useful for viewing internal hemorrhoids is inserted into the anus;

• proctoscopy, which uses an endoscope to completely examine the rectum;

•  sigmoidoscopy;

• or colonoscopy.

 

How are hemorrhoids treated?

Often hemorrhoids will go away on their own within a few days, as the protruding blood vessel or vessels and surrounding tissue contract and return to (or closer to) normal shape and position.  Initial treatment, though, may include:

• careful hygiene of the area to assure that stays clean;

• sitting in plain, warm water in the tub several times a day;

• ice packs to reduce swelling;

• and application of hemorrhoidal creams or suppositories to reduce swelling and prevent infection.

 

Your physician may also recommend increasing both fiber and fluids to soften stools.  A softer stool lessens pressure during bowel movements and on hemorrhoids, as a result of decreased straining during bowel movements due to softer feces.

 

In some cases, surgery for hemorrhoids is necessary.