Hemorrhoids: FAQs for a Common Medical Condition
Medically reviewed by L. Anderson, PharmD. Last updated on Jan 8, 2019.
Talking about hemorrhoids may seem embarrassing, but it's a common problem encountered by millions of people. Plus, it's been one of the top medical Internet searches in years past. So let's clear up the frequent question of what exactly are hemorrhoids?
- Hemorrhoids are swollen and inflamed veins in the rectum or anus. Common symptoms are rectal bleeding, itching and pain. An increased pressure in the veins of the anus (such as with pregnancy or obesity) may cause or worsen the condition.
- Hemorrhoids can occur inside the rectum (internal hemorrhoids) or near the anal opening (external hemorrhoids).
- When a hemorrhoid pushes through the anal opening, it is known as a protruding or prolapsed hemorrhoid. External hemorrhoids can form swollen and painful blood clots.
Learn More: Common Anorectal Preparations
Are hemorrhoids serious?
Although hemorrhoids can be painful and irritating, they are not usually serious. Nonetheless, they can dramatically affect your quality of life. Today, there are many medical options to help relieve the discomfort from this condition.
- Hemorrhoids, also called piles, have been reported to occur in roughly 1 in 20 people in the U.S. About 50% of people over the age of 50 have hemorrhoids.
- Straining during bowel movements, usually due to constipation, is the most common cause of hemorrhoids with rectal bleeding as the most common symptom.
- Increased anal pressure in pregnancy, diarrhea, constipation and straining during a bowel movement, those with pelvic tumors, excessive sitting or inactivity (for example: long hours at the computer), and being overweight can all increase the risk for hemorrhoids.
Common symptoms of hemorrhoids can include:
Internal hemorrhoids can lead to bleeding from straining and constipation, and may push through the anal opening.
- If you see blood after a bowel movement or have severe pain, contact your doctor to rule out a more serious condition.
- Blood clots may also form in hemorrhoids. Bleeding hemorrhoids usually leave a bright red color on the toilet paper, in the stool or in the toilet bowl.
There are two basic type of hemorrhoids. Hemorrhoids may occur on the inside or outside of the body.
- Internal hemorrhoids occur just inside the anus at the beginning of the rectum and cannot usually be seen or felt by a doctor. These internal hemorrhoids may push through the anus and result in external hemorrhoids.
- External hemorrhoids occur at the anal opening and may protrude outside of the anus. Both hemorrhoid types can occur at the same time. Be sure to visit your healthcare provider for a diagnosis, especially if bleeding occurs.
A hemorrhoid diagnosis involves a visit to the doctor, who will examine your anus and rectum. A rectal exam using a gloved finger may be conducted. If blood is seen, a procedure may be scheduled to look inside the anus (anoscopy) or the colon (sigmoidoscopy or colonoscopy).
Treatments for hemorrhoids such as hemorrhoid creams, ointments, sprays and suppositories can be purchased at the pharmacy. These products may contain a local anesthetic for pain, a corticosteroid for itching, or a topical vasoconstrictor to decrease swelling. Creams and ointments are used on external and internal hemorrhoids, and suppositories are used inside the rectum to treat internal hemorrhoids.
- Talk to your healthcare provider if you need creams or suppositories for longer than one week.
- Common OTC brands include Preparation H, Americaine, and Tronolane - although many other brands and generics are available and may cost less. Prescription products are available, too.
- These remedies won't cure hemorrhoids, but can offer relief.
- Hemorrhoids may shrink and subside over time, but are always at risk of a flare-up. Preventing constipation and regular exercise is the best way to avoid flare-ups.
Treatment options: Medications for Hemorrhoids
Other options include soaking in a warm sitz bath of water only (no bubbles or oils). Moist toilettes specifically made for hemorrhoids can be used after a bowel movement. Avoid straining during a bowel movement; adding fiber and plenty of water to the diet can help alleviate constipation and straining.
Table 1: Common Hemorrhoid Treatments
|Examples||Treatment Type||Drug Action|
|Fiber supplements and bulk-forming laxatives (OTC*)||Softens hard stools; take with plenty of water; can help to prevent hemorrhoid formation.|
|Stool softeners (OTC)||Softens stool and eases bowel movement; can help to prevent hemorrhoid formation.|
|Topical anesthetics; numbing ointment or cream for hemorrhoid pain relief (OTC)||Temporarily numbs the area; use infrequently unless directed by your doctor.|
Anti-inflammatory (OTC, Rx*)
|Decreases swelling, pain, itching; limit use to one week or less unless directed by your doctor.|
|Combo anti-inflammatory and pain relief medication (Rx)||Decreases hemorrhoid swelling and pain, relieves itching.|
|A decongestant used to shrink blood vessels and hemorrhoids (OTC)||Relief from pain, burning, itching and discomfort, shrinks swollen hemorrhoidal tissue; clean and dry area before application.|
|witch hazel wipes, zinc oxide cream||Helps to dry the skin, protect from irritation.|
*OTC=over-the-counter; Rx=by prescription
Also avoid taking medications that can lead to constipation. Ask your pharmacist to review your medications with you to screen for this side effect. Drugs that are known as "anticholinergic" drugs can often cause or worsen constipation.
If these actions do not seem to relieve your symptoms, it may be time to visit with your healthcare provider to discuss other options.
If an over-the-counter (OTC) hemorrhoid treatment is not effective, and the hemorrhoid causes significant pain or bleeding, you may need a minimally invasive procedure to shrink or remove the hemorrhoid.
- Clot removal, rubber band ligation, and sclerotherapy are all options.
- These procedures are usually performed as an outpatient in the clinic or as day surgery, and may only require a local anesthetic.
Which surgical procedures are used for the remedy of hemorrhoids? Your physician will be able to examine you and tell you about your best options. Be sure to discuss the benefits and risks and each procedure with your doctor.
Rubber band ligation
- Rubber band ligation is the most common procedure for internal hemorrhoids and is effective in about 75% of patients.
- A rubber band is placed on the hemorrhoid to cut off the blood supply, and in a few days the hemorrhoid dies and falls off. This procedure is usually done in the clinic.
- Complications may include a raw area, bleeding, pain, infection, or thrombosis; however, serious complications are rare.
Laser light, infrared light, sclerotherapy
- Laser or infrared light may be used to destroy internal hemorrhoids.
- Another option is sclerotherapy, when a chemical injection may help the tissue to die and form a scar.
- A hemorrhoidectomy, where excess tissue is surgically removed, can be effective in up to 95% of patients for treatment of internal and external hemorrhoids, but is usually reserved for those that do not respond to other procedures. You may receive local or general anesthesia for this surgery.
- Pain and bleeding from your incision may occur for a few days after surgery. You will be given medication to help control pain. You may have bleeding with bowel movements for several weeks after the procedure.
Other options for internal hemorrhoids include hemorrhoid stapling and and arterial ligation.
Lifestyle changes can help to prevent hemorrhoids and lessen their impact, if they do occur:
- Avoid constipation, straining, and pushing during a bowel movement.
- Avoid sitting for prolonged periods of time; take a break or a short walk at least every one to two hours.
- Eat foods high in fiber, such as fresh fruits, vegetables and whole grains, or use a fiber supplement. Aim for 20 to 35 grams of fiber per day. Fiber supplements, such as Benefiber, FiberCon, or Metamucil may be needed.
- Drink plenty of water (6 to 8 glasses of water daily) and get regular exercise, at least 20 minutes per day of brisk walking or other aerobic exercise. Talk to your doctor about the best exercise program for you.
- When you feel an urge to have a bowel movement, do not postpone using the restroom.
- If needed, stool softeners or laxatives can be used for constipation and may help to prevent the development of hemorrhoids. Safe, over-the-counter options are now commercially available for constipation. Ask your pharmacist for recommendations.
- If constipation is an ongoing problem, see your doctor.
- A lukewarm sitz bath may be used to relieve the anal area and improve blood flow.
Learn More: Look at Over the Counter (OTC) Drugs to find remedies for constipation.
What's the bottom line on hemorrhoids?
Remember, hemorrhoids are a common topic in healthcare worth discussing with your doctor. Don't let embarrassment get in the way.
- Prevention is key. Staying at a normal weight, avoiding long periods of sitting, not straining during a bowel movement, preventing constipation, and adding extra fiber in your diet can help to keep hemorrhoids at bay.
- If you see blood during a bowel movement, contact your doctor quickly to rule out any complications.
- Consider using over-the-counter remedies and warm sitz baths for minor symptoms, but don't hesitate to seek out advice from your doctor, too.
- Don't use OTC hydrocortisone hemorrhoid cream for more than one week unless your doctor approves.
- Compare hemorrhoidal preparations and see ratings and reviews using the Drugs.com Comparison Tool.
- Join the Drugs.com Hemorrhoids Support Group to ask questions, review topics and keep up-to-date with the latest news on hemorrhoid diagnosis and treatment.
- The National Institute of Diabetes and Digestive and Kidney Diseases
Health Information Center. NIH. Hemorrhoids. Accessed Jan. 6, 2019 at https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids
- Hemorrhoids. Mayo Clinic Disease Reference. Drugs.com. Accessed 1/9/2019 at https://www.drugs.com/mcd/hemorrhoids
- Fox A, Tietze PH, Ramakrishnan K. Anorectal conditions: hemorrhoids. FP Essentials. 2014;419:11–19.
- Brown SR. Haemorrhoids: an update on management. Therapeutic Advances in Chronic Disease. 2017;8(10):141-147. Accessed 1/9/2019 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624348/.
- Enlarged Hemorrhoids. PubMed Health. Accessed 1/9/2019 at https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024809/
- Bleday R, Lamont J, Grover S. Patient Education: Hemorrhoids (Beyond the Basics). Up to Date. Accessed Jan. 7, 2019 at https://www.uptodate.com/contents/hemorrhoids-beyond-the-basics/print
- The Top Search Terms of 2012: Hemorrhoids, Herpes, and Heartburn. Accessed 1/9/2019. Health.com.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.