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Overview

Hemorrhoids are swollen blood vessels in and around the anus and lower rectum. While not something people generally talk about, hemorrhoids are very common in both men and women. About half of the population has hemorrhoids by age 50. They are also common among pregnant women.

In the case of a pregnant woman, the pressure of the fetus in the abdomen as well as hormonal changes, cause the hemorrhoidal vessels to enlarge. Hemorrhoids caused by pregnancy are a temporary problem. In some cases, hemorrhoids may result from straining to move stool. Other contributing factors include, aging, chronic constipation or diarrhea, and anal intercourse.

Symptoms of hemorrhoids include:

• Anal itching
• Anal ache or pain, especially while sitting
• Bright red blood on toilet tissue, stool, or in the toilet bowl
• Pain during bowel movements
• One or more hard tender lumps near the anus

Although many people have hemorrhoids, not all experience symptoms. The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding hemorrhoid.

Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.

Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching (pruritus ani), have similar symptoms and are incorrectly referred to as hemorrhoids.

Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.

Treatment

Treatment of hemorrhoids is aimed initially at relieving symptoms and may include:

• application of an over-the-counter hemorrhoidal or corticosteroid cream to the affected area for a limited time can reduce pain and swelling
• tub baths several times a day in clear, warm water for about 10 minutes
• wear cotton undergarments
• avoid perfumed or coloured toilet tissue
• try not to scratch the affected areas

Preventing the recurrence of hemorrhoids will require relieving the pressure and straining of constipation. Doctors will often recommend increasing fibre and fluids in the diet. Eating the right amount of fibre and drinking six to eight glasses of fluid (not alcohol) result in softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on hemorrhoids caused by straining. Eliminating straining also helps prevent the hemorrhoids from protruding.

Good sources of fibre are fruits, vegetables, and whole grains. In addition, doctors may suggest a bulk stool softener or a fibre supplement such as psyllium (Metamucil) or methylcellulose (Citrucel).

See your doctor if symptoms do not improve with home treatment or if you have rectal bleeding or blood in the stool. Call 911 if blood loss is significant or if you feel dizzy, lightheaded, or faint.

A thorough evaluation and proper diagnosis by the doctor is important whenever there is bleeding from the rectum or blood in the stool as this may be a symptom of a more serious condition, including colorectal cancer.

The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an exam with an anoscope, a hollow, lighted tube useful for viewing internal hemorrhoids, or a proctoscope, useful for more completely examining the entire rectum.

To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and lower colon (sigmoid) with sigmoidoscopy or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures that also involve the use of flexible tubes inserted through the rectum.

In some cases, hemorrhoids must be treated endoscopically or surgically. These methods are used to shrink and destroy the hemorrhoidal tissue. The doctor will perform the procedure during an office or hospital visit.

The best way to prevent hemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure and straining, and to empty bowels as soon as possible after the urge occurs. Exercise, including walking, and increased fibre in the diet help reduce constipation and straining by producing stools that are softer and easier to pass.