What Are Hemorrhoids?

Internal hemorrhoids, also called piles, are a common condition. They happen when veins inside the rectum and anus become swollen due to increased pressure.

Many hemorrhoids can be treated with over-the-counter (OTC) remedies. In more severe cases, surgery may be required. This is especially the case if a blood clot has formed, or the hemorrhoids have become chronic or long-term.

This article looks at hemorrhoids, their symptoms, causes, and diagnosis. It also looks at some of the ways hemorrhoids can be treated.

Hemorrhoid Symptoms

The term "hemorrhoid" refers to enlarged veins inside and outside the anus. They can occur at the point where the anal canal connects to the anus or within the rectum itself.

Hemorrhoidal veins are normal veins that everyone has. Hemorrhoids form when these veins become swollen due to excess pressure. 

Sometimes hemorrhoids are mixed, or both internal and external. In some cases, hemorrhoids that were inside the rectum can protrude out of the anus and become externally visible. These are called prolapsed hemorrhoids. They are still considered internal hemorrhoids.

Hemorrhoids are sometimes described as varicose veins, but the two conditions are different. Varicose veins can develop in the rectum or anus due to certain conditions like portal hypertension. They are evaluated independently of hemorrhoids.

Hemorrhoids that have become swollen or inflamed may not cause symptoms. When symptoms are present, they can range from mild to severe. Symptoms can also depend on whether the hemorrhoids are internal, external, or mixed. Common symptoms of hemorrhoids include:

• Internal: Painless rectal bleeding. The blood is bright red and may drip into the toilet bowl or be present on toilet paper when wiping.
• External: A feeling of fullness or discomfort in the rectum
  
• External: Pain in the rectum. If a blood clot has formed, the pain may be sharp, sudden, and severe.
• External: Anal pain and discomfort that becomes more noticeable if hemorrhoids have prolapsed
• Both: The sensation of needing to defecate even when the bowel is empty
• Both: Itching and/or mucous discharge from the anus
• Both: Other anorectal conditions such as anal fissures (less common)

It is important to note that internal hemorrhoids usually can't be felt. External ones often can be. Painless bleeding is usually an indicator of internal hemorrhoids.

Hemorrhoids are not a dangerous condition. They rarely lead to serious health complications. Other more serious conditions, including cancer, can cause similar symptoms, however. This is why it's important to have your symptoms evaluated by a healthcare provider if they are persistent and do not respond to treatment at home.

Many people don't seek care because they are embarrassed. It's important to remember, though, that hemorrhoids are extremely common. In most cases, they can be easily treated.

Causes

Hemorrhoids seem to affect men and women equally. They typically occur during middle age, though younger people can develop them as well. Hemorrhoids affect people worldwide, but the exact incidence isn't known.

Many people never mention hemorrhoids to their healthcare provider. This may be because they're embarrassed or are able to manage the condition without additional medical intervention. Some people may not even know they have hemorrhoids because they never have symptoms.

People get hemorrhoids for a variety of reasons. Multiple factors can contribute. Experts think these factors may make you more likely to develop hemorrhoids:

• A family history of hemorrhoids
• Straining to have bowel movements
• Staying on the toilet for long periods of time
• Inflammatory bowel disease (IBD)
• Obesity
• Constipation
• Diarrhea
• Laxative or enema overuse
• Prolonged sitting, such as in an office setting

Several risk factors related to other body systems can also predispose you to getting hemorrhoids. Some of these are temporary, such as pregnancy. Hemorrhoids that develop due to these causes often resolve with the condition.

Other conditions that can lead to hemorrhoids include:

• Chronic coughing
• Pelvic floor dysfunction
• Connective tissue disorders

Diagnosis

Your healthcare provider will usually be able to diagnose hemorrhoids based on your history of symptoms and a physical exam. During this process, they may also want to rule out more serious conditions that can have similar symptoms.

External hemorrhoids can be diagnosed upon visual inspection. Internal hemorrhoids are diagnosed with tests that look at the lining of your anus and rectum, such as:

• Exam with an anoscope or proctoscope
• Flexible sigmoidoscopy
• Colonoscopy

The tests can confirm a diagnosis of hemorrhoids and exclude other diagnoses such as cancer or inflammatory bowel disease. It's also possible for a person to have hemorrhoids and other conditions at the same time.

Your healthcare provider may also order blood tests or stool sample tests to look for blood, infection, and/or inflammation.

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Once your hemorrhoids are diagnosed, your healthcare provider may assign a grade based on how prolapsed they are. For internal hemorrhoids, the grading system has four stages:

• Grade I: No prolapse.
• Grade II: Prolapse only when bearing down. These reduce on their own.
• Grade III: Prolapse when bearing down. These can be manually reduced.
• Grade IV: Prolapsed, do not reduce on their own, and cannot be reduced manually.

Hemorrhoids that are grade IV may cause complications. They can become strangulated, which happens when the blood supply is cut off. They may also form blood clots. This is called thrombosis. Grade IV hemorrhoids can also become ulcerated and form sores.

Conditions With Similar Symptoms

Several conditions can cause symptoms similar to hemorrhoids. Some are benign, but others may be quite serious. Your healthcare provider may want to rule out these other conditions if you have symptoms such as:

• Discomfort
• Bleeding
• Lumps

Other conditions that can cause similar symptoms include:

• Warts
• Skin tags
• Proctitis
• Anal fissure
• Abscesses
• Rectal prolapse
• Enlarged, dilated veins due to a condition such as increased portal vein blood pressure

Your healthcare provider may also want to rule out cancer as a cause of your symptoms. This is especially true if you are over the age of 45 or you have a family history of colorectal cancers.

Treatment

Hemorrhoids often don't cause problems. Many people don't even realize they have them.

If you have hemorrhoids without symptoms, you don't need treatment. Treatment may be necessary if your hemorrhoids cause pain or recur frequently.

There are many different options for managing hemorrhoids. These range from at-home and over-the-counter (OTC) treatments to surgical procedures. There are also many steps you can take to reduce your risk of developing hemorrhoids and help prevent them from coming back.

At Home and Over-the-Counter

The easiest and most affordable hemorrhoid treatments can be done at home. These include:

• Topical creams, ointments, or wipes such as Tucks
• Warm sitz baths, where you spend 20 minutes in the tub after having a bowel movement
• Using ice packs to help reduce swelling
• Sitting on a cushion to ease pain and discomfort
  

Constipation is associated with hemorrhoids. Stool softeners may be helpful for preventing constipation, but stimulant laxatives and enemas should not be overused. These products can worsen or even lead to hemorrhoids.

Some people also find it helpful to establish a bowel routine. This may include setting a specific time of day for attempting to have a bowel movement.

Lifestyle Adjustments

Lifestyle changes and adjustments can help relieve the symptoms of hemorrhoids and help prevent them from returning after treatment. These tips can even reduce your chances of developing hemorrhoids in the first place. For example:

• Avoid prolonged sitting when possible.
• Have a bowel movement as soon as you feel the urge rather than holding it.
• Don't spend prolonged periods of time on the toilet and avoid straining.
• Avoid heavy lifting or other activities that strain the abdominal muscles.
• Maintain proper anal and perianal hygiene.

Certain factors such as heredity can't be changed. There are other risk factors, however, that you can change by proactively developing healthier habits, such as exercising regularly, drinking plenty of water, and eating a healthy diet that includes fiber.

Getting more exercise and spending time on your feet can help keep manage hemorrhoids. Note, however, that not all exercise is beneficial. Extreme exercise with a lot of straining or forceful exhalation and weightlifting can even worsen hemorrhoids.

If you are overweight or obese, changing your diet and activity level to promote healthy weight loss also helps with the management of hemorrhoids. Be sure to drink plenty of water, too. Dehydration can cause constipation.

If your hemorrhoids are related to chronic or frequent diarrhea, it's important to find out what's causing your bowel changes. You may have a food allergy or a condition such as Crohn's disease. Getting the right treatment for your condition will help treat the hemorrhoids as well.

Procedures

More severe cases of hemorrhoids or those that keep coming back after treatment at home may need to be treated surgically. Several procedures can be used to surgically treat hemorrhoids. Your healthcare provider will help you decide which option is best.

• Rubber band ligation: Also called "banding," this procedure cuts off the blood supply to the tissue. After about a week, the tissue withers and the hemorrhoid falls off. Some medical professionals can perform this procedure in the office, while others prefer to do it in an operating room. Banding involves minimal recovery. Patients can usually go home and resume normal activity the same day.
• Cautery: These procedures involve the use of infrared radiation technology, cryotherapy, electrocautery, or lasers. They are sometimes used to treat hemorrhoids that have not responded to home remedies and banding procedures.
• Sclerotherapy: During this procedure, a healthcare provider injects chemicals into the tissue to make the vein shrink. This is a quick procedure that can be done in your healthcare provider's office. Unfortunately, it isn't always a permanent fix.
• Hemorrhoidectomy: This is the complete surgical removal of the hemorrhoid. Recovery from this procedure can be very painful and there are potential complications. In some cases this can include damage to the muscles that control the bowel.

Several other surgical techniques can be used to treat hemorrhoids. If your healthcare provider thinks your hemorrhoids need surgical treatment, they will work with you to review the available treatment options and pick the one that is best for your case.

Summary

Hemorrhoids are swollen veins in the rectum and anus. They can cause pain and bleeding or no symptoms at all.

Risk factors for developing hemorrhoids include family history, obesity, a history of straining to have bowel movements, or having certain conditions like inflammatory bowel disease.

Lifestyle changes can help treat and prevent hemorrhoids. Switch to a healthy diet with lots of fiber, increase your exercise levels, and avoid sitting for long periods of time.

A Word From Verywell

Hemorrhoids are a common condition affecting people of all ages. Most cases can be treated at home with over-the-counter remedies, but severe cases may require surgery. If you believe you may have hemorrhoids, it is best to speak with your healthcare provider. Even if you do not have hemorrhoids, you may have another medical condition with similar symptoms.