Hemorrhoids are varicose (swollen or dilated) veins located in or around the anus. Internal hemorrhoids are varicose veins that surround the rectum and, when dilated, protrude inside, sometimes extending out of the anus.

Scientists aren't sure why people get hemorrhoids. They are usually not painful, but they can be bothersome. Hemorrhoid sufferers can frequently and safely push them back inside.

Certain conditions might cause internal hemorrhoids to bulge, become irritated and bleed, including:

•Trauma during childbirth
•The extra weight of pregnancy
•Obesity
•Chronic constipation with straining
•Anal intercourse

Rarely, a bulging internal hemorrhoid might thrombose, meaning a blood clot might occur.

External hemorrhoids are varicose veins located under the skin on the outside of the anus. They are frequently painful and usually arise when a blood clot blocks off the vein.

Hemorrhoids caused by a blood clot, medically referred to as thrombosed hemorrhoids, need to be treated right away by a doctor. The doctor usually will remove the blood clot. Otherwise, most cases of hemorrhoids can be treated at home, with the most important aspect of care being good hygiene. Rarely, surgery is required to remove them.

What are the symptoms of hemorrhoids?

•Pain and pressure in the anal canal
•A grape-like lump on the anus
•Itching and soreness in and around the anus
•Blood on underwear, toilet paper, the surface of the stool, or in the toilet bowl

Symptoms can be made worse by straining during constipation and overly aggressive wiping of the anus.

What causes hemorrhoids?

Hemorrhoids are caused by repeated pressure and strain, which might be caused by:

•Straining at stool
•Frequent constipation (hard or difficult bowel movements)
•Diarrhea (frequent, loose, watery stool)
•Pregnancy (especially in the third trimester)
•Cirrhosis of the liver (can cause pooling of blood in the vessels around the rectum)

How are hemorrhoids diagnosed?

Usually, an explanation of your symptoms is an important clue to your doctor. On examination, external hemorrhoids and bulging hemorrhoids might be visible.

When hemorrhoids are not visible beyond the anus, your doctor might examine the inside of the anal canal using a lighted instrument called an anoscope.

Often, your doctor will recommend a detailed examination of your sigmoid colon and rectum using a lighted scope (a procedure called flexible sigmoidoscopy) to ensure that there is no inflammatory disease such as Crohn's disease or ulcerative colitis or cancer.

How can I relieve the pain and itching?

•Take warms soaks in the bath (sitz baths). Sit in plain warm water for about 10 minutes several times a day.
•Apply a hemorrhoid cream or use a suppository. Follow the directions on the package.
•Don't strain during bowel movements.

How can I relieve constipation?

•Increase the amount of fiber in your diet. Good sources of fiber are fruits, vegetables, and whole grains. Five to ten servings of fruits and vegetables are recommended each day. Fiber supplements might be helpful, examples include Metamucil and Citrucel.
•Sparingly use over-the-counter laxatives or stool softeners. Stool softeners such as Colace are relatively safe, but prolonged use of osmotic or stimulant laxatives might not be.
•Exercise regularly. Even walking regularly helps improve the normal flow of material through the intestine.
•Empty the bowels when you feel the urge to do so. Immediately following a meal, the body will have a natural urge to defecate. That's a good time to plan a visit to the bathroom.

How can I prevent hemorrhoids?

The best way to prevent hemorrhoids is to keep bowel movements regular and stool soft. Try some of the tips for relieving constipation listed above. Also, avoid prolonged standing, sitting, and heavy lifting, and chronic coughing, straining at stool, and aggressive wiping.

How are hemorrhoids treated?

Medical treatment of hemorrhoids is first directed at relieving symptoms. This includes:

•Warm tub baths several times a day in plain, warm water for about 10 minutes
•Application of a hemorrhoidal cream or suppository to the affected area
In some cases, hemorrhoids must be treated surgically. Surgery is used to shrink and destroy the hemorrhoidal tissue and is performed during an office or hospital visit.
A number of methods might be used to remove or reduce the size of internal hemorrhoids. These techniques include:
•Rubber band ligation — A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, causing the hemorrhoid to wither away within a few days.
•Sclerotherapy — A chemical solution is injected around the blood vessel to shrink the hemorrhoid.
•Infrared coagulation — A special device is used to burn hemorrhoidal tissue.
•Hemorrhoidectomy — Occasionally, extensive or severe internal or external hemorrhoids might require removal by surgery known as hemorrhoidectomy.