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What are hemorrhoids?

Hemorrhoids are enlarged veins that develop in the anal canal. Although uncomfortable at times, this common condition rarely poses a serious problem.

Normally, tissue surrounding the inside of the anus, sometimes called "anal cushions," fills with blood to help control bowel movements. Hemorrhoids develop when excessive pressure (defecation) or other factors cause the veins within these cushions to swell and stretch.

Nearly everyone has hemorrhoids at some time. They can develop at any age, but the incidence increases after age 30. About 50% of people older than 50 have had hemorrhoids at some time in life.

What causes hemorrhoids?

Increased pressure on the veins in the pelvic and rectal area causes hemorrhoids. As pressure raises, blood pools in veins and causes them to swell, stretching the surrounding tissue and forming typical hemorrhoids. Increased pressure can come from rushing to complete a bowel movement or from constipation or persistent diarrhea, if either causes too much straining during bowel movements.

Being overweight also can contribute to developing such conditions.

Pregnant women frequently develop hemorrhoids during the last 6 months of pregnancy because of increased pressure on the blood vessels in the pelvic area. Straining to push the baby out during labor can also cause hemorrhoids.

What are the types of hemorrhoids?

Hemorrhoids can develop inside the anal canal (internal hemorrhoids) or near the anal opening (external hemorrhoids). Both types can occur at the same time. The symptoms, progression, and treatment differ depending on where hemorrhoids develop.

Internal hemorrhoids have four degrees of severity. Bleeding may occur with any of these.

• First degree: The hemorrhoid does not protrude from the anus.
• Second degree: The hemorrhoid protrudes from the anus during a bowel movement but returns to the anal canal afterward.
• Third degree: The hemorrhoid protrudes from the anus during a bowel movement, but you can push it inside the anus with your finger.
• Fourth degree: The hemorrhoid is always outside the anus and cannot be pushed into the anal canal.

What are the symptoms?

• External hemorrhoids: External hemorrhoids can cause itching, burning, and irritation. You might notice streaks of bright red blood on toilet paper after straining to have a bowel movement, and it may be difficult to clean the anal area.
• Internal hemorrhoids: Rectal bleeding is the most common symptom of internal hemorrhoids. You may notice bright red streaks of blood on toilet paper or bright red blood in the toilet bowl after having a normal bowel movement. You may see blood on the surface of the stool. Internal hemorrhoids can range from small, swollen veins in the wall of the anal canal to large, sagging veins and tissue that bulge out of the anus all the time. Internal hemorrhoids can be painful if they protrude all the time and are squeezed by the anal muscles or if they are clotted (thrombosed). You also may see mucus on stool or toilet tissue from hemorrhoids that protrude.

How are hemorrhoids diagnosed?

The diagnosis of hemorrhoids is based on a medical history and physical exam, which help a health professional identify the type of hemorrhoid-external or internal-and determine the appropriate treatment.

If a health professional thinks that hemorrhoids are the obvious cause of rectal bleeding in a person younger than age 50, an examination with a gloved finger (digital rectal exam) or a short lighted scope (anoscopy) are the only tests needed for an initial evaluation.

If you are older than 50, or if anoscopy does not provide a clear diagnosis, your health professional may use a flexible sigmoidoscope to look at the lower third of the colon or a colonoscope to examine the entire colon to check for other possible causes of bleeding.

How are hemorrhoids treated?

Home treatment is recommended for external hemorrhoids. Treatment includes sitting in a warm bath several times a day, gradually increasing fiber and water in your diet, and occasional use of stool softeners.

Most internal hemorrhoids can be treated at home with the same measures used for external hemorrhoids. More severe hemorrhoids can be treated with nonsurgical procedures such as tying off hemorrhoids with rubber bands (rubber band ligation); scarring the tissue around (coagulation therapy); injecting them with chemicals (injection sclerotherapy); or surgical removal (hemorrhoidectomy).

You can often prevent hemorrhoids or keep them from becoming worse by maintaining a healthy life. Eat a fiber-rich meals, vegetables, and whole grains; drink plenty of water; and exercise regularly.