Hemorrhoids: A Common Ailment with Frequent Questions
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Jan 21, 2021.
What Are Hemorrhoids?
It's a difficult topic to discuss, but one that's so common it deserves some attention.
What are hemorrhoids? Hemorrhoids are swollen, inflamed and often painful veins in the rectum or anus. Older adults are usually affected, and an increased pressure in the veins of the anus may lead to, or even worsen, the condition.
But today, even younger people have issues due to prolonged sitting at computers for work. It's a common issue during pregnancy, too.
- 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.
Are Hemorrhoids Common?
Yes, roughly 1 in 20 people are affected by hemorrhoids at some point in their lives.
- Plus, as we age the risk gets higher -- about half of adults older than age 50 have hemorrhoids.
- In fact, a few years back, the search term "hemorrhoids" was the number one health topic searched on Google, highlighting its impact.
Although hemorrhoids can be painful and irritating, they are not usually a serious condition. Straining during bowel movements is the most common cause of hemorrhoids, with rectal bleeding as the most common symptom. For many people -- about 40% -- hemorrhoids are asymptomatic, meaning they don't cause any medical issues even though they are present.
What increases your risk for hemorrhoids?
- increased anal pressure in pregnancy
- constipation (leading to straining)
- excessive sitting or inactivity
- older age
- lack of fluid and fiber in your diet
- being overweight
What Are the Symptoms of Hemorrhoids?
Painful bowel movements, pain in anal area, itching, hard lumps, rectal bleeding, and swelling are common symptoms of hemorrhoids. Internal hemorrhoids can lead to bleeding from straining and constipation, and may push through the anal opening.
Bleeding hemorrhoids usually leave a bright red color on the toilet paper, in the stool or in the toilet bowl. If you see blood after a bowel movement or develop severe pain, contact your doctor to rule out a more serious condition. Bleeding from the rectum is definitely not normal, and this must be addressed.
Blood clots (a thrombosis in the vein) may also form in hemorrhoids. These can be extremely painful, but can be removed under local anesthesia to provide quick relief. It's best if the procedure is done within 3 days of symptom onset. Thrombosed hemorrhoids may bleed or not.
Are There Different Types of Hemorrhoids?
Hemorrhoids may occur on the inside or outside of the anal opening.
- Internal hemorrhoids occur just inside the anus at the beginning of the rectum and cannot usually be seen or felt by a doctor during a regular exam. These internal hemorrhoids may push though 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.
Can You Prevent Hemorrhoids?
Lifestyle changes can help to prevent hemorrhoids. Avoid sitting for prolonged periods of time; take a break 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. Drink plenty of water and get regular exercise.
If needed, stool softeners or laxatives can be used short-term for constipation and may help to prevent the development of hemorrhoids. If constipation is a chronic problem, see your doctor.
Visit the Drugs.com Over the Counter (OTC) Drug Section to find remedies for your constipation.
OTC Treatments For Hemorrhoids
Maybe you'd like to try to treat this sensitive issue yourself first before scheduling an appointment with your doctor? Just be sure to talk to your healthcare provider if you need OTC hemorrhoidal products for longer than one week or if there is any rectal bleeding.
Products for hemorrhoids such as creams, ointments, sprays, pads, foams and suppositories can be purchased at the pharmacy. These agents may contain a local anesthetic for pain, a corticosteroid for itching, or a topical vasoconstrictor to decrease swelling.
Common brands include:
- Preparation H (glycerin and lidocaine)
- Preparation H Maximum Strength (glycerin, petrolatum, phenylephrine, and pramoxine topical)
- Americaine (benzocaine topical)
- Tronolane (pramoxine and zinc oxide topical)
- Hemorrhoidal Hygiene Pads (glycerin and witch hazel topical)
Store brands or generics are available and will cost less.
What Else Can Be Done to Help Relieve Hemorrhoids?
OTC remedies won't cure hemorrhoids, but can offer relief.
- Other options include soaking in a warm sitz bath of water (avoid a bubble bath and soaps, however, due to possible irritation).
- Moist towelettes specifically made for hemorrhoids can be used after a bowel movement to help relieve irritation. These often contain witch hazel.
- Avoid straining during a bowel movement; adding fiber to the diet or using a stool softener can help alleviate straining.
Check any medications to see if constipation is a side effect, and ask your doctor or pharmacist about it.
- If medicine is a causative factor in your constipation, you may be able to switch to a different drug without this side effect.
- For example, many drugs with anticholinergic side effects can lead to constipation and should probably be avoided in the elderly.
- See a list of anticholinergic drug here: Anticholinergic Drugs to Avoid in the Elderly
If these actions do not seem to relieve your symptoms, it may be time to visit with your healthcare provider to discuss other options.
What if the OTC Remedies Aren't Helpful for My Hemorrhoids?
If an 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, coagulation, and sclerotherapy (a solution injected to shrink hemorrhoid) are all options.
- These procedures are usually performed as outpatient surgery or even in the office in some cases, and may only require a local anesthetic.
- For larger hemorrhoids, a hemorrhoidectomy may be suggested, which is a surgical procedure used in more extreme cases.
Which Surgical Procedures Are Used for Hemorrhoids?
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 tissue dies and falls off.
A hemorrhoidectomy can be effective in up to 95% of patients for treatment of hemorrhoids, but is usually reserved for larger internal hemorrhoids. This procedure is done with a local anesthetic combined with sedation, a spinal block or a general anesthetic.
Other options include a sclerotherapy injection where your doctor injects a chemical solution into the hemorrhoid tissue to shrink it, coagulation techniques such as with laser heat, or hemorrhoid stapling, typically used for internal hemorrhoids to block blood flow to the tissue.
Some procedures, such as the hemorrhoidectomy, may require a longer recovery time, so it is important to discuss the risks and benefits of each option with your physician.
What's the Bottom Line on Hemorrhoids?
Prevention is key here. Staying at a normal weight, avoiding long periods of sitting, not straining during a bowel movement, and extra fiber and fluid in your diet can help to prevent hemorrhoids. If you see blood during a bowel movement, contact your doctor to rule out any serious concerns.
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.
Remember, hemorrhoids are a common topic in healthcare worth discussing with your provider. Don't let it embarrass you -- as you are not alone in dealing with this health issue.
Learn More: Hemorrhoids: FAQs for a Common Medical Condition
Finished: Hemorrhoids: A Common Ailment with Frequent Questions
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- Brown SR. Haemorrhoids: an update on management. Therapeutic Advances in Chronic Disease. 2017;8(10):141-147. Accessed Jan. 21, 2021 at PMID: 28989595
- National Digestive Diseases Information Clearinghouse (NDDIC). Hemorrhoids. Accessed Jan. 21, 2021 at https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids
- Hemorrhoids. Mayo Clinic Disease Reference. Accessed Jan. 21, 2021 at https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268
- Sun Z. Migaly J. Review of Hemorrhoid Disease: Presentation and Management. Clin Colon Rectal Surg. 2016 Mar; 29(1): 22–29. Accessed Jan. 21, 2021 at PMID: 26929748
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