Hemorrhoids

What is a hemorrhoid?

Hemorrhoids, also known as piles, are inflamed veins in the anus and lower rectum. Hemorrhoids may be found under the skin surrounding the anus (external hemorrhoids) or inside the rectum (internal hemorrhoids).

Hemorrhoids can be the result of factors such as:

  • Anal intercourse
  • Chronic diarrhea or constipation
  • Increased pressure on veins during pregnancy
  • Low-fiber diet
  • Obesity
  • Prolonged time on the toilet
  • Straining during bowel movements

Hemorrhoids are a common condition that affect an estimated 10.4 million Americans each year, with fifty percent of those having a case of hemorrhoids before the age of fifty.

What are the symptoms of hemorrhoids?

Symptoms of hemorrhoids may include:

  • A lump near the anus
  • Bleeding not associated with pain during bowel movements
  • Feces leakage
  • Itching or irritation in the anal area
  • Pain or discomfort
  • Swelling around the anus

Symptoms of hemorrhoids depend on the location. Internal hemorrhoids lie within the rectum and are usually non-symptomatic. However, when straining to pass a stool, the surface of an internal hemorrhoid tears, causing bleeding. Straining may also cause an internal hemorrhoid to prolapse or push through the anus.

External hemorrhoids may itch, bleed or form a clot (thrombus), resulting in severe swelling, inflammation and pain.

Diagnosing hemorrhoids

While your physician may be able to see external hemorrhoids just by looking, internal hemorrhoids may be diagnosed using procedures such as:

  • Physical examination: A digital rectum exam in which your physician inserts a lubricated, gloved finger into the rectum to feel for growths or abnormalities.
  • Visual examination: Internal hemorrhoids are often too soft to be felt during the digital rectum exam. Visual exam procedures such as an anoscope, proctoscope or flexible sigmoidoscopy (link to flexible sigmoidoscopy page) may be performed.

What are the treatment options for hemorrhoids?

Medications

For hemorrhoids that only cause mild discomfort, your physician may recommend over-the-counter creams, ointments, pads or suppositories. These medications may aid in the relief of the pain and itching associated with hemorrhoids.

Minimally invasive procedures

For reoccurring or persistent hemorrhoids, a minimally invasive procedure to treat hemorrhoids may be recommended. These procedures can be done in an outpatient setting or in your physician’s office and include:

  • Coagulation techniques that cause internal hemorrhoids to harden and shrivel
  • Hemorrhoidal banding
  • Sclerotherapy, an injection of a chemical to shrink hemorrhoids

Surgery

When all other treatment modalities have failed or if the hemorrhoids are too large, your physician may suggest surgical treatment options. Surgical procedures include hemorrhoid removal (hemorrhoidectomy) or hemorrhoid stapling (stapled hemorrhoidectomy or stapled hemorrhoidopexy), a procedure which blocks blood flow to the hemorrhoidal tissue.

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