Hemorrhoids, also called piles, are swollen and inflamedveins around your anus or in your lower rectum.
The two types of hemorrhoids are external hemorrhoids, which form under the skin around the anus internal hemorrhoids, which form in the lining of the anus and lower rectum.
The causes of hemorrhoids include
- straining during bowel movements
- sitting on the toilet for long periods of time
- chronic constipation or diarrhea
- a low-fiber diet
- weakening of the supporting tissues in your anus and rectum that happens with aging
- pregnancy
- often lifting heavy objects
The symptoms of hemorrhoids depend on the type you have.
If you have external hemorrhoids, you may have
- anal itching
- one or more hard, tender lumps near your anus
- anal ache or pain, especially when sitting
Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.
If you have internal hemorrhoids, you may have
- bleeding from your rectum––bright red blood on stool, on toilet paper, or in the toilet bowl after a bowel movement
- a hemorrhoid that has fallen through your anal opening, called prolapse
Internal hemorrhoids that are not prolapsed most often are not painful. Prolapsed internal hemorrhoids may cause pain and discomfort.
Some hemorrhoid symptoms are similar to those of other digestive tract problems. For example, bleeding from your rectum may be a sign of bowel diseases such as Crohn’s disease, ulcerative colitis, or cancer of the colon or rectum.
You can most often treat your hemorrhoids at home by the following ways:
- eating foods that are high in fiber
- taking a stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel)
- drinking water or other nonalcoholic liquids each day as recommended by your health care professional
- not straining during bowel movements
- not sitting on the toilet for long periods of time
- taking over-the-counter pain relievers such as acetaminophen , ibuprofen , naproxen , or aspirin
- sitting in a tub of warm water, called a sitz bath, several times a day to help relieve pain
Applying over-the-counter hemorrhoid creams or ointments or using suppositories—a medicine you insert into your rectum—may relieve mild pain, swelling, and itching of external hemorrhoids. Most often, doctors recommend using over-the-counter products for 1 week. You should follow up with your doctor if the products
- cause side effects such dry skin around your anus or a rash
Most prolapsed internal hemorrhoids go away without at-home treatment. However, severely prolapsed or bleeding internal hemorrhoids may need medical treatment.
Medical treatment for hemorrhoids include in office procedures or may include surgery.
Office treatments include the following:
- Rubber band ligation. Rubber band ligation is a procedure that doctors use to treat bleeding or prolapsing internal hemorrhoids. A doctor places a special rubber band around the base of the hemorrhoid. The band cuts off the blood supply. The banded part of the hemorrhoid shrivels and falls off, most often within a week. Scar tissue forms in the remaining part of the hemorrhoid, often shrinking the hemorrhoid. Only a doctor should perform this procedure—you should never try this treatment yourself.
- Sclerotherapy. A doctor injects a solution into an internal hemorrhoid, which causes scar tissue to form. The scar tissue cuts off the blood supply, often shrinking the hemorrhoid.
- Infrared photocoagulation.A doctor uses a tool that directs infrared light at an internal hemorrhoid. Heat created by the infrared light causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.
- Electrocoagulation. A doctor uses a tool that sends an electric current into an internal hemorrhoid. The electric current causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.
Outpatient center or hospital treatments include the following:
- Hemorrhoidectomy. A doctor, most often a surgeon, may perform a hemorrhoidectomy to remove large external hemorrhoids and prolapsing internal hemorrhoids that do not respond to other treatments. Your doctor will give you anesthesia for this treatment.
- Hemorrhoid stapling. A doctor, most often a surgeon, may use a special stapling tool to remove internal hemorrhoid tissue and pull a prolapsing internal hemorrhoid back into the anus. Your doctor will give you anesthesia for this treatment.
Sometimes complications of hemorrhoids also require treatment.
Seek care right away
You should seek medical care right away if you have severe anal pain and bleeding from your rectum, particularly with discomfort or pain in your abdomen, diarrhea, or fever.
Most hemorrhoids can be treated with simple changes to diet and bowel habits. Most do not require surgery or other treatment unless the hemorrhoids are very large and painful.The goal of nonsurgical procedures used to treat hemorrhoids, called fixative procedures, is to reduce the blood supply to the hemorrhoid so it shrinks or goes away. The scar tissue left in its place helps support the anal tissue and helps prevent new hemorrhoids.Fixative procedures include tying off the hemorrhoids with a rubber band (rubber band ligation) or using heat, lasers, or electric current to create scar tissue (coagulation therapy). Fixative procedures can only be done on internal hemorrhoids.Surgical removal of hemorrhoids (hemorrhoidectomy) can be used for large internal hemorrhoids, when several small hemorrhoids are present, or when other treatments have not controlled bleeding. Sometimes a combination of treatments (for example, a fixative procedure and a hemorrhoidectomy) is the most effective way to treat hemorrhoids. External hemorrhoids can only be removed surgically, if needed. If a blood clot develops in the external hemorrhoid, the clot may need to be removed to relieve pain.Hemorrhoidectomy versus fixative procedures for internal hemorrhoids
- Fixative procedures are usually tried before surgery if hemorrhoids are small and stick out of the anus during a bowel movement but return to their normal position afterward (second-degree hemorrhoid).
- Hemorrhoidectomy may provide better long-term results than fixative procedures. But surgery is more expensive, requires a longer recovery time, is usually more painful, and has a greater risk of complications.
- Fixative procedures are the preferred treatment for people older than age 70 and for people in poor health.
Hemorrhoids: Which Treatment Should I Use?
Surgery to remove hemorrhoids is called hemorrhoidectomy. The surgeon makes small cuts around the anus to slice them away.
A patient may get local anesthesia, which numbs the affected area, or general anesthesia, which puts the patient to sleep for the operation.
Hemorrhoidectomy is often an outpatient procedure, and you can usually go home the same day.
Because it’s highly sensitive near the cuts and you might need stitches, the area can be tender and painful afterward.
Recovery most often takes about 2 weeks, but it can take as long as 3 to 6 weeks to feel like you’re back to normal.
Procedure for Prolapse and Hemorrhoids (PPH)
PPH is also called a stapled hemorrhoidectomy. The doctor will use a stapler-like device to reposition the hemorrhoids and cut off their blood supply. Without blood, they’ll eventually shrivel and die.