What are hemorrhoids?

Hemorrhoids, also called “piles,” are swollen and inflamed veins around the anus or in the lower rectum. They can swell inside the rectum to form internal hemorrhoids, or they can do so near the opening, forming external hemorrhoids. Some people suffer from both types. The treatment will depend on which type you have and what your symptoms are. Hemorrhoids are not dangerous or life threatening. Symptoms usually go away within a few days, and some people with hemorrhoids never have symptoms.

Hemorrhoids can affect both men and women, and about 75 percent of adults will have had hemorrhoids at some point in their lives. The condition is most common among adults 45-65, and among pregnant women—often resulting from straining too much during a bowel movement, they are very common during pregnancy. Hemorrhoids are diagnosed and treated by the GI Division of Premier Medical Group.

What causes hemorrhoids?

Back to top

Several factors may cause this swelling, including chronic constipation or diarrhea, straining during bowel movements, sitting on the toilet for long periods of time, and a lack of fiber in the diet.

Weakening of connective tissue in the rectum and anus that occurs with age is a major cause of hemorrhoids. Pregnancy can cause hemorrhoids by increasing pressure in the abdomen, which may enlarge the veins in the lower rectum and anus. For most women, hemorrhoids caused by pregnancy disappear after child birth.

What are the symptoms of hemorrhoids?

Back to top

The most common symptom of internal hemorrhoids is bright red blood on stool, on toilet paper, or in the toilet bowl after a bowel movement. This is the result of the swollen veins being scratched or broken by straining or rubbing.

The most common symptom of external hemorrhoids is a blood clot, called thrombosis which could cause bleeding, painful swelling, or a hard lump around the anus. When the blood clot dissolves, extra skin is left behind. This skin can become irritated or itch and excessive rubbing or cleaning to relive the symptoms just makes the irritations worse.

How are hemorrhoids diagnosed?

Back to top

A thorough evaluation and proper diagnosis by a doctor is important any time a person notices bleeding from the rectum or blood in the stool. Bleeding may be a symptom of other digestive diseases, including colorectal cancer, fissures, abscesses, warts, and polyps.

The doctor will visually and physically examines the anus and rectum to determine whether hemorrhoids are present. A digital rectal exam with a gloved, lubricated finger and an anoscope—a hollow, lighted tube—may be performed to view the rectum.

The doctor may order additional exams to rule out other causes of bleeding, especially in people age 40 or older. These include:

  • Colonoscopy: A flexible, lighted tube called a colonoscope is inserted through the anus, the rectum, and the upper part of the large intestine, termed the colon. The colonoscope transmits images of the inside of the rectum and the entire colon;
  • Sigmoidoscopy: This procedure is similar to colonoscopy, but it uses a shorter tube called a sigmoidoscope and transmits images of the rectum and the sigmoid colon, the lower portion of the colon that empties into the rectum.

What are the different types of hemorrhoids?

Back to top

The two types of hemorrhoids are internal and external:

Internal hemorrhoids

The most common symptom of internal hemorrhoids is bright red streaks of blood on toilet paper or bright red blood in the toilet bowl after you have a normal bowel movement. There may also be blood on the surface of the stool. They can be tiny or they can grow to be so large they bulge out of the anus. Internal hemorrhoids can be somewhat painful if they bulge out and are squeezed by the anal muscles and really painful if the blood supply is cut off. You may also see mucus on the toilet paper or stool;

External hemorrhoids

Veins can swell inside the anal canal to form internal hemorrhoids, or they can swell near the opening of the anus to form external hemorrhoids. The most common symptom of external hemorrhoids is when they get irritated and clot, forming a hard painful lump (thromboses).

How are hemorrhoids treated?

Back to top

There are a number of treatments available:

Rubber band ligation

A special rubber band is placed around the base of the hemorrhoid, which cuts off circulation, causing the hemorrhoid to shrink. This procedure should be performed only by a doctor.


A chemical solution is injected into the blood vessel to shrink the hemorrhoid.

Infrared coagulation (IRC)

Heat is used to shrink the hemorrhoid tissue.


Large external hemorrhoids or internal hemorrhoids that do not respond to other treatments can be surgically removed.

At-home Treatments

Simple diet and lifestyle changes often reduce the swelling of hemorrhoids and relieve hemorrhoid symptoms. Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining. The American Dietetic Association recommends 25 grams of fiber per day for women and 38 grams of fiber for men. Other simple solutions include:

  • Drinking six to eight 8-ounce glasses of water or other nonalcoholic fluids each day
  • Sitting in a tub of warm water for 10 minutes several times a day
  • Exercising to prevent constipation
  • Not straining during bowel movements
  • Using over-the-counter creams and suppositories to temporarily relieve pain and itching. Such treatments should only be used for a short time because long-term use can damage the skin
  • Taking bulk stool softener or a fiber supplement such as Metamucil or Citrucel