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What are Hemorrhoids?

Hemorrhoids bother about 89% of all Americans at some time in their lives. Hemorrhoids are enlarged veins that develop in the anal canal. This common condition may be uncomfortable at times, but it rarely pose a serious problem.

Normally, tissue surrounding the inside of the anus, sometimes called "anal cushions," fills with blood to help control bowel movements. Hemorrhoids develop when excessive pressure or other factors cause the veins within these cushions to swell and stretch.

Nearly everyone has hemorrhoids at some time. They can develop at any age, but the incidence increases after age 30. About 50% of people over age 50 have had hemorrhoids at some time in their life; the condition is more common in white than in black people. 1


Pictures: Hemorrhoids and Anal Fissures

Internal Hemorrhoid

Internal hemorrhoids occur higher up in the anal canal, out of sight. Bleeding is the most common symptom of internal hemorrhoids, and often the only one in mild cases. View hemorrhoid gallery for detailed photos.




External Hemorrhoid


External hemorrhoids are visible-occurring out side the anus. They are basically skin-covered veins that have ballooned and appear blue. Usually they appear without any symptoms. When inflamed, however, they become red and tender. View hemorrhoid gallery for detailed photos.                                                                                                                                                                             



Prolapsed Internal Hemorrhoid

Sometimes, internal hemorrhoids will come through the anal opening when straining to move your bowels. This is called a prolapsed internal hemorrhoid ; it is often difficult to ease back into the rectum, and is usually quite painful. View hemorrhoid gallery for detailed photos.




Thrombosed External Hemorrhoid

When a blood clot forms inside an external hemorrhoid, it often causes Severe pain. This thrombosed external hemorrhoid can be felt as a firm, tender mass in the anal area, about the size of a pea. View hemorrhoid gallery for detailed photos.




Anal Fissure

Anal fissure . A thin slit-like tear in the anal tissue, an anal fissure is likely to cause itching, pain, and bleeding during a bowel movement. For more detailed information, view our page on Anal Fissure .





What are the types of hemorrhoids?

Hemorrhoids can develop inside the anal canal (internal hemorrhoids) or near the anal opening (external hemorrhoids). Both types can occur at the same time. The symptoms, progression, and treatment differ depending on where hemorrhoids develop.

Internal hemorrhoids have four stages of severity. Bleeding may occur with any of these.

First degree: The hemorrhoid does not protrude from the anus.
Second degree: The hemorrhoid protrudes from the anus during a bowel movement but spontaneously returns to the anal canal afterward.
Third degree: The hemorrhoid protrudes from the anus during a bowel movement, but you can push it inside the anus with your finger.
Fourth degree: The hemorrhoid is always outside the anus and cannot be pushed into the anal canal.
What causes hemorrhoids?

Excessive pressure on the veins in the pelvic and rectal area causes hemorrhoids. As pressure increases, blood pools in veins and causes them to swell, stretching the surrounding tissue and forming hemorrhoids.

Pregnant women frequently develop hemorrhoids during the last 6 months of pregnancy because of pressure on the blood vessels in the pelvic area. Being overweight also can contribute to developing hemorrhoids.

Constipation or persistent diarrhea can lead to hemorrhoids if it causes too much straining during bowel movements.

What are the symptoms of hemorrhoids?

External hemorrhoids: External hemorrhoids can cause itching, burning, irritation, or difficulty cleaning the anal area. You also might notice streaks of bright red blood on toilet paper after straining to have a bowel movement. If a vein inside an external hemorrhoid breaks because of a sudden increase in pressure, blood may pool under the skin and form a hard, painful lump. This is called a thrombosed, or clotted, hemorrhoid.

Internal hemorrhoids: Rectal bleeding is the most common symptom of internal hemorrhoids. You may notice bright red streaks of blood on toilet paper or bright red blood in the toilet bowl after having a normal bowel movement. You may see blood on the surface of the stool. Internal hemorrhoids can range from small, swollen veins in the wall of the anal canal to large, sagging veins and tissue that bulge out of the anus all the time. Internal hemorrhoids can be painful if they protrude all the time and are squeezed by the anal muscles, or if they are thrombosed, or clotted. You also may see mucus on stool or toilet tissue from hemorrhoids that protrude.

How are hemorrhoids diagnosed?

The diagnosis of hemorrhoids is based on a medical history and physical exam, which help a doctor identify the type of hemorrhoid-external or internal-and determine the appropriate treatment.

If a doctor thinks that hemorrhoids are the obvious cause of rectal bleeding in a person younger than age 50, an examination with a gloved finger (digital rectal exam) or a short lighted scope (anoscopy) are the only tests needed for an initial evaluation.

If you are older than age 50, or if anoscopy does not provide a clear diagnosis, a doctor may use a flexible sigmoidoscope to look at the lower third of the colon or a colonoscope to examine the entire colon.

The doctor will evaluate symptoms of hemorrhoids to rule out other, more serious problems.

How are hemorrhoids treated?

External hemorrhoids: Home treatment is recommended for most external hemorrhoids. Treatment includes sitting in a warm bath (sitz bath) several times daily, increasing fiber and water in the diet, and taking stool softeners or laxatives. In rare cases, a hemorrhoid may burst and a hard, painful lump forms under the skin. This is called a thrombosed hemorrhoid. A doctor may remove the contents of the lump (incision) or the entire lump (excision) to lessen the pain and speed recovery. If the lump is not removed, the pain will gradually lessen after about 3 days, even though the lump is still present.

Internal hemorrhoids: Most first-degree hemorrhoids can be treated at home with the same measures used for external hemorrhoids. Generally, second-degree hemorrhoids can be treated with nonsurgical procedures such as tying off hemorrhoids with rubber bands (rubber band ligation); scarring the tissue around them (coagulation therapy); or injecting them with chemicals (injection sclerotherapy). Most third- and fourth-degree hemorrhoids are removed surgically (hemorrhoidectomy).
Can you prevent hemorrhoids?

How Are Hemorrhoids Prevented?

The best way to prevent hemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure, and to empty bowels without undue straining as soon as possible after the urge occurs. Exercise, including walking, and eating a high fiber diet , help reduce constipation and straining by producing stools that are softer and easier to pass.




This web site is not intended to provide medical advice or to be a substitute for a visit to your own doctor. Registration for this web site does not create a doctor-patient relationship.

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