Hemorrhoids are swollen veins that can develop inside or outside of the anus. They affect nearly 1 in 20 Americans. While hemorrhoids are often not serious, they can cause symptoms like itching, discomfort, and bleeding. Many people experience hemorrhoids at some point, but when is it time to worry and see a doctor?
What are the symptoms of hemorrhoids?
The most common symptom of hemorrhoids is bleeding during bowel movements. The blood is typically bright red. Other symptoms include:
- Itching or irritation around the anus
- Pain or discomfort
- Swelling around the anus
- A lump near the anus, which may need to be pushed back in after passing a stool
Many people with hemorrhoids do not have symptoms. The most common symptom, bleeding, is usually not severe and goes away in a few days. Mild symptoms can often be treated at home with over-the-counter remedies.
When should you see a doctor?
In most cases, you only need to see your doctor if symptoms persist or get worse. Recommendations for when to see a doctor include:
- Bleeding persists for more than 1-2 weeks
- Bleeding is heavy or severe
- Pain or irritation persists for more than 1-2 weeks
- Lump near the anus persists for more than 1-2 weeks
- Symptoms don’t improve with over-the-counter treatments
You should see a doctor right away if you experience the following:
- Bleeding is very heavy or will not stop
- Dizziness or fainting from blood loss
- Bleeding is dark and sticky, rather than bright red
- Intense pain in the anus
- A hemorrhoid that cannot be pushed back inside the anus
These can be signs of a serious condition that needs prompt treatment. Seeking immediate care is recommended.
What causes hemorrhoids?
The most common causes of hemorrhoids include:
- Straining during bowel movements
- Sitting for long periods of time on the toilet
- Chronic diarrhea or constipation
- Low fiber diet
- Pregnancy
- Obesity
Hemorrhoids can be caused by increased pressure in the veins of the anus and rectum. Straining during bowel movements, constipation, and diarrhea can all increase pressure. Pregnancy can also cause increased pressure due to the weight of the fetus.
How are hemorrhoids diagnosed?
If you see your doctor about hemorrhoids, they will likely perform a physical exam to look for signs of hemorrhoids. This involves visually inspecting the anus and anal canal with a scope.
Your doctor may also perform a digital rectal exam by inserting a gloved finger into the anus to feel for lumps or abnormalities. This allows the doctor to evaluate the tone of the anal sphincter muscle.
In some cases, additional tests may be recommended:
- Anoscopy – Using a small scope to examine the anal canal and lower rectum
- Colonoscopy – Using a scope to examine the entire colon
- Sigmoidoscopy – Using a scope to examine the sigmoid colon, the lower part of the colon
These procedures allow the doctor to further evaluate the hemorrhoids and rule out more serious causes of bleeding, like colorectal cancer or polyps.
What are the treatment options for hemorrhoids?
There are several options available for treating hemorrhoids based on the severity of symptoms:
Over-the-counter remedies
Mild symptoms can often be treated at home with over-the-counter topical ointments, creams, suppositories, or pads that contain witch hazel or hydrocortisone. Pain relievers like acetaminophen can help relieve discomfort.
Procedures
If symptoms persist, procedures may be recommended, including:
- Rubber band ligation – Placing rubber bands around the hemorrhoid to cut off circulation so it shrinks and dies
- Sclerotherapy – Injecting a chemical into the hemorrhoid to shrink it
- Coagulation therapies – Using infrared light, heat, or extreme cold to shrink small hemorrhoids
- Surgical removal – Removing hemorrhoids with surgery, usually reserved for severe cases when other treatments fail
Lifestyle changes
Making lifestyle changes can often help treat and prevent recurrence of hemorrhoids by reducing strain and pressure on the veins. Recommendations include:
- Eating more fiber to avoid constipation and straining
- Staying hydrated by drinking plenty of fluids
- Avoid sitting on the toilet for long periods
- Gentle exercise to stimulate bowel function
- Avoid sitting for long periods of time
- Losing weight if overweight or obese
How can hemorrhoids be prevented?
Some tips to help prevent hemorrhoids include:
- Eat a high fiber diet with fruits, vegetables, and whole grains
- Drink plenty of water to stay hydrated
- Exercise regularly
- Avoid prolonged sitting or straining when using the bathroom
- Avoid heavy lifting
- Lose weight if overweight or obese
- Avoid overly aggressive wiping after a bowel movement
Pregnant women should take steps to avoid constipation, use cushions to relieve pressure, and sleep on their side to improve blood flow.
Are hemorrhoids serious?
In most cases, hemorrhoids are not serious and tend to clear up on their own or with at-home treatments. However, there are some instances in which hemorrhoids can indicate an underlying medical issue:
- Bleeding that is persistent, severe, or does not improve with over-the-counter remedies may indicate a more serious condition and you should see a doctor.
- Pain that persists or gets worse, especially if accompanied by bleeding, can be a sign of thrombosis, in which a hemorrhoid blood clot forms. This requires medical treatment.
- A hemorrhoid that cannot be pushed back inside may be a sign of prolapse and requires medical care.
- Hemorrhoids that repeatedly recur may point to an underlying condition that needs treatment.
Hemorrhoids can usually be effectively treated, but if they are persistent despite trying fixes, it is important to consult a doctor to rule out other problems.
When is surgery necessary for hemorrhoids?
Hemorrhoid surgery is only necessary in about 10-20% of cases and is reserved for severe cases when other treatments have failed. Reasons surgery may be needed include:
- Very large hemorrhoids
- Persistent prolapse of internal hemorrhoids
- Persistent bleeding
- Persistent pain that does not improve
- Blood clots (thrombosis) that do not respond to other treatments
- Significant loss of rectal muscle control
There are many types of surgeries that can remove hemorrhoids. Most are done as outpatient procedures using general anesthesia. Recovery time is usually 2-3 weeks.
What complications are associated with hemorrhoids?
Most hemorrhoids can be treated effectively without complications. Potential complications include:
- Anemia – Significant bleeding can lead to anemia, which is a low red blood cell count. This can cause fatigue.
- Strangulated hemorrhoid – Cut off blood supply can cause tissue death. Requires emergency surgery.
- Blood clots – A formed blood clot in a hemorrhoid causes sudden severe pain, swelling, and inflammation. May require surgery.
- Infections – Bacteria can enter through ruptured hemorrhoids, causing infections in tissues and the bloodstream. Requires antibiotics.
- Stool leakage – Some internal hemorrhoids may prolapse outside the anus, causing inability to control bowel movements.
Seeking prompt treatment can reduce the risks of complications. Bleeding and pain that persist or get worse require immediate medical care.
Conclusion
Hemorrhoids are a common condition but can cause distressing symptoms. Mild cases can usually be treated at home with simple remedies and lifestyle changes. But if hemorrhoids persist or bleed severely, it is important to see a doctor. Prompt treatment can reduce complications. Surgery may be needed for severe cases not helped by other methods. Understanding when hemorrhoids should cause concern can help ensure proper treatment and relief.