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The swollen vessels are caused by an increase in pressure.
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Lumps form inside or outside of the anus, which can cause pain or bleeding.
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The diagnosis is based on an examination of the anus and rectum with an anoscope, sigmoidoscope, or colonoscope.
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Most hemorrhoid symptoms go away without treatment, but fiber, stool softeners, and sitz baths can help relieve them.
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Some hemorrhoids are treated with a rubber band procedure, injection sclerotherapy, or infrared photocoagulation or sometimes surgery.
The rectum is the section of the digestive tract above the anus where stool is held before it passes out of the body through the anus. The anus is the opening at the end of the digestive tract where stool leaves the body. (See also Overview of the Anus and Rectum.)
Hemorrhoids occur when the blood vessels in the lower rectum or anus become enlarged.
Internal hemorrhoids are hemorrhoids that form above the junction between the anus and rectum (anorectal junction).
External hemorrhoids are hemorrhoids that form below the anorectal junction.
Both internal and external hemorrhoids may remain in the anus or protrude outside the anus.
Causes
Increased pressure in the vessels of the anorectal area leads to hemorrhoids. This pressure may result from pregnancy, frequent heavy lifting, or repeated straining during bowel movements (defecation). Constipation may contribute to straining.
Symptoms
External hemorrhoids form a lump on the anus. If a blood clot forms (called a thrombosed external hemorrhoid), the lump becomes larger and is more painful and more swollen than a hemorrhoid that is not thrombosed.
Internal hemorrhoids often do not cause a visible lump or pain, but they can bleed. Bleeding from internal hemorrhoids typically occurs with bowel movements, causing blood-streaked stool or toilet paper. The blood may turn water in the toilet bowl red. However, the amount of blood is usually small, and hemorrhoids rarely lead to severe blood loss or anemia.
Hemorrhoids may discharge mucus and create a feeling that the rectum is not completely emptied after a bowel movement. Itching in the anal region (anal itching or pruritus ani) is usually not a symptom of hemorrhoids, but itching may develop if hemorrhoids make proper cleansing of the anal region difficult.
Complications of hemorrhoids
Diagnosis
A doctor can readily diagnose swollen, painful hemorrhoids by inspecting the anus and rectum.
An examination with an anoscope (a short, rigid tube used to view the rectum) is done to evaluate painless or bleeding hemorrhoids. People who have bleeding from the rectum may require a sigmoidoscopy or colonoscopy (see Endoscopy) to rule out a more serious condition, such as a tumor.
Treatment
Usually, hemorrhoids do not require treatment unless they cause symptoms. Taking stool softeners or bulking the stools with fiber supplements (such as psyllium) may relieve straining with bowel movements. Hemorrhoid symptoms can sometimes be relieved by soaking the anus in warm water in what is known as a sitz bath. The soaking is accomplished by squatting or sitting for 10 to 15 minutes in a partially filled tub or using a container filled with warm (not hot) water placed on the toilet bowl or commode.
For external thrombosed hemorrhoids, especially those that cause severe pain, a doctor may inject a local anesthetic to numb the area and cut out the blood clot or hemorrhoid, which sometimes relieves the pain more rapidly.
Taking acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) can help alleviate the pain of a thrombosed hemorrhoid. Local anesthetic ointments or witch hazel compresses also may help. Pain and swelling usually diminish after a short while, and clots disappear over 4 to 6 weeks.
For bleeding internal hemorrhoids, a doctor can inject a substance that causes scar tissue to form and destroy the hemorrhoids. This procedure is called injection sclerotherapy. An alternative to injection sclerotherapy is infrared photocoagulation. During this procedure, an infrared light is used to treat bleeding hemorrhoids.
Large internal hemorrhoids and those that do not respond to injection sclerotherapy can be tied off with rubber bands (a procedure called rubber band ligation). The band causes the hemorrhoid to wither and drop off painlessly. One hemorrhoid is treated about every 2 weeks.
Banding a Hemorrhoid
Surgery to remove the hemorrhoids may be used if other treatments do not work. However, hemorrhoid surgery (called hemorrhoidectomy) may result in severe pain, as well as urine retention and constipation. Another technique is called circumferential stapled hemorrhoidopexy, in which a circular surgical stapler is used. This technique causes less pain after it is done, but it may result in a higher rate of complications than conventional surgical hemorrhoidectomy, and hemorrhoids may return.
Other methods to destroy internal hemorrhoids, such as Doppler-guided hemorrhoid artery ligation, are being tried. In this method, hemorrhoid arteries are identified using ultrasonography and tied off with a suture, thus reducing the blood supply to the hemorrhoids.
Treatments using lasers, freezing probes, or an electrical current (electrocoagulation) are unproved. Rubber band ligation is still the standard treatment.
