Better Me

Getting to the Bottom of Hemorrhoids

Let’s talk about something that might not be the easiest topic to bring up in casual conversations: hemorrhoids. Although they are rarely dangerous, hemorrhoids are more common than you might think and can be a real pain in the, well, you know where.

Whether you’re dealing with hemorrhoids or just curious about what they’re all about, Bradford Keeler, MD, a general surgeon specializing in colon and rectal surgeries with Banner Health, helps us get to the bottom of them.

What are hemorrhoids?

Hemorrhoids are cushions of swollen veins in the rectal and anal area. Similar to varicose veins, these conditions are related to increased pressure on the veins, leading to swelling. 

“Hemorrhoids can form internally, inside the rectum where you can’t see them, or externally, developing under the skin around the anus,” Dr. Keeler said. 

Who is most at risk for getting hemorrhoids?

Wondering how these unwelcome guests make their appearance? A few common reasons include straining during bowel movements (pushing too hard), sitting on the toilet for too long (yes, scrolling on your smartphone doesn’t help), heavy lifting and chronic constipation.

Other factors that can put you at greater risk are:

  • Pregnancy: Pregnant people often develop hemorrhoids due to the pressure their growing baby puts on the rectal veins.
  • Age: As you get older, the tissue supporting the veins in the rectum and anus weakens and begins to stretch, making you more likely to develop hemorrhoids.
  • Obesity: Additional weight can put pressure on the pelvic veins.
  • Diet: Low-fiber diets can lead to straining during your bowel movements (BMs) because of smaller, harder stools.

How do I know if I have hemorrhoids?

“Symptoms of hemorrhoids can vary from feeling a painless lump around your anus and painless bleeding to pain when you pass stool (poop) or a mixture of some or all of the above,” Dr. Keeler said. 

Internal hemorrhoids are usually painless. You might not even know you have them until you see bright red blood on the toilet paper or in the toilet bowl. Sometimes, internal hemorrhoids can enlarge enough that they bulge out of the anus (prolapsed internal hemorrhoids). This can cause itching.

External hemorrhoids are more uncomfortable. They can be felt or seen and might cause more discomfort, itching and pain. 

Sometimes, external hemorrhoids can have their blood supply blocked by clotting, and they can become thrombosed hemorrhoids. If a blood clot forms, the pain can be sudden and severe but is usually not serious. The clot often gets smaller over time but may leave excess skin (a skin tag) behind, which might itch or become irritated.

Do I need to see my health care provider for a hemorrhoid?

Most hemorrhoids can be treated at home, but let your provider know if you aren’t certain so they can properly examine you. It’s easy to confuse the symptoms of hemorrhoids with that of anal fissures or something more serious like ulcerative colitis or colon, rectal or anal cancer.

If you have a hemorrhoid, here are some home treatments to help with your symptoms:

  • Take a sitz bath: Spend 10 to 20 minutes in a shallow amount of warm water. Add baking soda to the water to reduce inflammation but avoid soap and bubble bath.
  • Fiber up: Add more fiber to your diet with fruits, vegetables, whole grains, fiber supplements like Metamucil or a combination of these choices. This helps make stools easier to pass and reduces the need to strain. Add fiber slowly to your diet to reduce symptoms of bloating or gas.
  • Stay hydrated: Drink plenty of water to keep things soft and less painful when you go to the bathroom.
  • Don’t push too hard: Straining when you go can make hemorrhoids worse. Take it easy and let nature do its thing.
  • Find over-the-counter (OTC) relief: Consider using creams, ointments or pads containing hydrocortisone or witch hazel to help reduce swelling and skin irritation. 

“Creams and ointments work fine for external hemorrhoids,” Dr. Keeler said. “For internal hemorrhoids, you need a suppository treatment with an internal application device similar to a low-pressure enema.”

Do hemorrhoids ever require surgery?

If your hemorrhoid is large and isn’t responding to treatment, your provider might recommend surgery. However, only a small number of people will require surgery. 

“Everyone has hemorrhoids, but only some people will have problems,” Dr. Keeler said. “Between 50% to 75% of people will have some type of hemorrhoidal irritation in their lifetime, but only 5% will need surgery.”

There are several treatments available today to treat hemorrhoids. Some might be more effective than others in preventing hemorrhoids from coming back. These treatments include: 

  • Rubber band ligation: This is a common office-based procedure where a small rubber band is placed around the base of the hemorrhoid, cutting off its blood supply. The hemorrhoid then falls off during normal bowel movements.
  • Hemorrhoidectomy: This surgical procedure is the most effective and complete way to remove severe and recurring hemorrhoids. 
  • Stapled hemorrhoidopexy: This procedure treats bleeding or prolapsed internal hemorrhoids. The surgeon uses a stapling device to remove extra tissue and move the remaining tissue to its normal position.

Other treatments may include sclerotherapy or laser or infrared coagulation, which can be done during an in-office visit.

Is there a way for me to avoid getting hemorrhoids?

You can’t always prevent hemorrhoids, but you can make several lifestyle changes to reduce your chances of developing them in everyday life.  

  • Limit distractions in the bathroom: Try to leave the phone out of the bathroom so you don’t get distracted. 
  • Don’t wait to go: Go to the bathroom when you feel the urge.
  • Avoid pushing too hard: Try to spend only 10 to 15 minutes having a bowel movement. If you are having trouble going, it’s better to get up and try again later than to simply keep sitting.
  • Eat more fiber and drink plenty of water: Adding high-fiber foods and supplements to your diet can help. Drink water and limit alcohol and caffeine.
  • Keep moving: Exercise and avoid sitting for long periods. If you currently sit at a desk for a long time, take plenty of breaks to walk and stretch your legs. 
  • Watch your weight: Maintain a healthy weight with a balanced diet and regular exercise.

Bottom line

While hemorrhoids aren’t the easiest conversation, they shouldn’t be ignored. Early treatment and care can ease symptoms and reduce complications such as bleeding, anemia, pain or possible infection.

If you notice rectal pain, bleeding or discomfort that concerns you, talk to your health care provider or a Banner Health specialist

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