Hemorrhoids are also known as piles, and they are one of the most common gastrointestinal complaints. It’s estimated that 1 in 20 Americans are affected by hemorrhoids. While hemorrhoids aren’t typically serious, they can cause pain and discomfort and can certainly affect a patient’s quality of life. Very often, hemorrhoids can be treated at home, such as with over-the-counter hemorrhoid cream and other medications; however, sometimes hemorrhoid treatment does involve medical intervention. Read on to learn more about what hemorrhoids are, how hemorrhoid treatment is conducted, and when you should consult a gastroenterologist.
What Are Hemorrhoids?
Hemorrhoids are swollen veins that can form either outside of the anus or rectum or inside. Everyone has veins around the anus and rectum, but it’s only when they become swollen and painful that it becomes a problem. Hemorrhoids can have many causes, such as straining during bowel movements, but often, the cause is unknown. Pregnant women are also predisposed to hemorrhoids.
Types of Hemorrhoids
There are two distinct types of hemorrhoids, and they have different symptoms as well.
External hemorrhoids appear on the skin around the anus. These types of hemorrhoids can cause the most discomfort. You may experience frequent anal itching, pain (especially when having a bowel movement), and you may experience rectal bleeding and notice blood on toilet paper after wiping. Sometimes, these types of hemorrhoids can also form blood clots around the anus. These blood clots are not necessarily serious, however, they can affect the quality of life with pain and swelling symptoms.
Internal hemorrhoids, as the name suggests, form inside of the body as swollen veins inside the rectum. The rectum is the part of the digestive system that connects the anus to the colon. Internal hemorrhoids often do not have the same painful symptoms as external hemorrhoids, however, with internal hemorrhoids, you may notice a greater chance of rectal bleeding.
There is another type of hemorrhoid called a prolapsed hemorrhoid. This occurs when hemorrhoids stretch and become bigger and push outside of the anus. These especially can cause bleeding and pain and may require medical attention.
What Are the Symptoms of Hemorrhoids?
The symptoms of hemorrhoids vary depending on whether they are internal or external. With internal hemorrhoids, you’re more likely to experience rectal bleeding, while with external hemorrhoids, you’re more likely to experience pain and swelling. Symptoms of external hemorrhoids include:
- Lumps near the anus that are tender or soft
- Anal itching
- Pain in the anus, especially when sitting
- Rectal bleeding
Internal hemorrhoids often don’t have symptoms, and many times patients don’t even know they have internal hemorrhoids. However, rectal bleeding is the one symptom of internal hemorrhoids that may alert a patient that something is wrong.
Symptoms of prolapsed hemorrhoids are very obvious, because of the pain and swelling in the hemorrhoid tissue.
What Are the Causes of Hemorrhoids?
Hemorrhoids are very similar in type to that of varicose veins. One of the more common causes of hemorrhoids is straining while having a bowel movement. However, other types of straining can cause hemorrhoids. Pregnant women often get hemorrhoids because of the pressure from the pelvis. Also, straining while performing heavy lifting can contribute to the development of hemorrhoids.
Often, the cause of hemorrhoids is unknown, but there are certain risk factors associated with hemorrhoids. These include:
- Not eating a diet of high-fiber foods
- Obesity or being overweight
- Having chronic diarrhea or constipation
- Spending a lot of time on the toilet
Constipation can particularly affect hemorrhoids because this is a common reason why many people strain on the toilet. Often, for hemorrhoid treatment, you have to treat an underlying condition as well. For example, stool softeners can help constipation, which can lower your risk of developing hemorrhoids.
What Are the Risks Associated with Hemorrhoids?
The symptoms of hemorrhoids are also similar to more serious gastrointestinal problems, so it’s wise to have them evaluated by a gastroenterologist to ensure you only have hemorrhoids and not a more serious condition. Some conditions that share symptoms with hemorrhoids include:
- Colorectal cancer
- Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease
Both of these conditions require medical intervention, so it’s important to be evaluated, particularly if you notice rectal bleeding. Ideally, any change in stool habits whatsoever is reason enough to see your provider.
Hemorrhoids on their own are usually quite benign and are often eradicated with home treatments, but occasionally, hemorrhoids can lead to more serious complications, although these situations are rare. Untreated hemorrhoids can lead to:
- Blood clots
- Skin flags
Those with untreated prolapsed hemorrhoids may also experience the blood flow being cut off to the hemorrhoid by the anus. This is known as a strangulated hemorrhoid.
How to Prevent Hemorrhoids
It is possible to prevent hemorrhoids if you have a predisposition to them. Here are a few key things to keep in mind:
- Don’t sit too long on the toilet or strain during bowel movements.
- Add more fiber to your diet, or take a fiber supplement, as directed by your doctor.
- Women should consume at least 25 grams of fiber per day.
- Men should consume at least 35 grams of fiber per day.
- Don’t be sedentary and keep physically active.
- Don’t put off bowel movements, and go right away if you need to go.
- Stay hydrated and drink plenty of water.
- Only take laxatives when necessary. Taking laxatives too often can cause a sudden change in bowel habits.
When to See a Doctor for Your Hemorrhoids
Quite often, hemorrhoids can be treated at home. However, if any notice of rectal bleeding, you should consult your gastroenterologist immediately to rule out other causes, or to make sure the hemorrhoids themselves aren’t serious.
Your GI doctor may suggest home treatments first for hemorrhoid treatment, even if over-the-counter creams don’t work. They may recommend a sitz bath or warm baths, where you will sit in warm water two to three times per day to ease the pain. Your physician may also suggest over-the-counter pain relievers to ease pain.
Witch hazel is also commonly used as a home treatment for hemorrhoids. Technically, it is an astringent, which can reduce swelling and shrink hemorrhoids.
Sometimes, medical intervention is required to treat hemorrhoids when they are persistently bleeding or incredibly painful. Some of the hemorrhoid treatments used include:
- Rubber band ligation. This is a minimally invasive outpatient procedure where a rubber band is tied around an external hemorrhoid to cut off blood flow to it. Typically, within a week, the hemorrhoid falls off on its own.
- Sclerotherapy. A chemical solution is injected into the hemorrhoid to allow it to shrink.
- Coagulation techniques. Coagulation techniques use either infrared light or heat, which shrink and shrivel hemorrhoids.