Hemorrhoids are swollen veins located in the lower part of the rectum or anus. They affect an estimated one in 20 Americans and about 50% of adults over the age of 50.
If you suffer from an uncomfortable, painful episode due to hemorrhoids, you probably wonder what are the causes? Do hemorrhoids go away on their own? Are there ways to prevent them? What are the best treatments? Well, this article answers all of these questions.
Causes and risk factors
The veins in the lower rectum and anus are more likely to swell and cause hemorrhoids if there is increased pressure in the area, let’s say due to straining during a bowel movement, or sitting for a long period of time on the toilet seat. In these instances, individuals with chronic constipation or diarrhea are at higher risk of developing hemorrhoids. In addition, excess weight, pregnancy, and lifting heavy objects put additional pressure on the pelvis, including the anal area, and should be avoided at all costs.
What you eat also factors into your risk of developing hemorrhoids. Diets that are low in fiber tend to cause constipation, which in turn causes hemorrhoids. Meanwhile, the aging process itself increases the risk for hemorrhoids, because the supporting tissue in the rectum and anus weakens as you get older.
In addition, while anal intercourse is known to irritate the anal region, such activity is more likely to worsen existing hemorrhoids rather than cause them.
Signs and symptoms
In many cases, hemorrhoids do not cause any symptoms. They may simply protrude, or be discovered during a routine medical investigation like a colonoscopy.
There are two types of hemorrhoids:
- External. Located under the skin in the anal area.
- Internal. That form in the lining of the lower rectum and anus.
Each type of hemorrhoid has its own set of symptoms.
External hemorrhoids:
- Itching or skin irritation around the anus
- Pain and/or swelling around your anus, which can be felt by touch
- In rare cases, external hemorrhoids can ulcerate and cause bleeding
External hemorrhoids can also complicate and form a clot, turning them into thrombosed hemorrhoids that can cause severe swelling and pain. A person with this condition may feel a hard lump near the anus.
Internal hemorrhoids:
- Bleeding after a bowel movement (most common)
- Sensation of incomplete defecation
- Mucus in the stool
Internal hemorrhoids are less likely to cause discomfort compared with thrombosed external hemorrhoids, which can be quite painful.
Do hemorrhoids go away on their own?
Yes, small hemorrhoids often go away on their own. It may take a few days to clear up without treatment, but they can go away. In fact, many mild cases can be successfully managed with home remedies alone. Only a small percentage of individuals require surgery. Note that chronic hemorrhoids can last for weeks with occasional flare-ups.
Prevention
- Start with your diet. Consume high-fiber foods like vegetables, fruits, whole grains, and legumes. One study found that vegetables like onions, leeks, rhubarb, pumpkin, and herbs such as dill, parsley, and basil are particularly beneficial to help prevent or manage hemorrhoids. Stay hydrated, and drink at least two liters of water. Both high-fiber diets and hydration promote soft, regular stools, reducing the straining and longer trips to the toilet.
- Consider ingesting fiber supplements. If your diet does not provide the recommended 20–30 grams of fiber daily, add some fiber supplements. Research studies found that popular fiber supplements like Metamucil and Methylcellulose may help manage bleeding and other symptoms associated with hemorrhoids. However, make sure you are well hydrated because having extra fibers without drinking enough water may actually worsen the condition.
- Avoid straining when using the toilet. If consuming extra fiber and water does not help enough, consider squatting when you have a bowel movement. Squatting helps to straighten out the rectum, reduce straining, prevent constipation, and thus help to manage hemorrhoids. Squatting is similar to using Squatty Potty, a special tool created to help you empty the bowels more easily and more comfortably. A small stool or simply squatting when you go to the toilet could work if you do not have a Squatty Potty.
- Do not delay that trip to the toilet. If you feel you need to have a bowel movement, go right away.
- Stay active. If your work involves spending long hours at your desk, take a few-minute break every hour and move around. In addition, exercise regularly, because activity helps prevent complications, decreases pressure in the veins, and keeps the vessels strong and flexible.
- Avoid excess weight. A combination of diet and regular exercise is the best way to maintain a healthy weight and help avoid developing hemorrhoids.
Treatment
If your symptoms are mild, you can often manage them with home remedies (see below). Severe symptoms exacerbated by large or recurring hemorrhoids require medical or surgical treatment.
Treatment for mild symptoms:
- Medicated creams and pads. There are over-the-counter hemorrhoid creams and medicated pads whose ingredients include ‘soothers’ like Witch Hazel and numbing medication (i.e., 1% lidocaine) that can be applied on the affected area a few times daily.
- Sitz baths can be placed over the toilet. Use them for 10–15 minutes, two to three times a day to soak the anal area in warm water.
- Ibuprofen or acetaminophen can be taken orally to relieve pain, inflammation, and discomfort.
If home remedies do not provide enough relief and you still experience symptoms for more than a week, see your doctor to evaluate the need for minimally invasive procedures and surgery. In case of blood in the stool, your doctor will recommend additional tests to rule out other medical conditions:
- Minimally invasive procedures include rubber band ligation, injections into the hemorrhoid, or infrared or lasers are considered before more invasive surgeries. Painful, thrombosed hemorrhoids can be treated in the doctor’s office under local anesthesia.
- Hemorrhoidectomy. If the hemorrhoids are too large or other procedures fail, the doctor may recommend the surgical removal of the hemorrhoid using a technique called hemorrhoidectomy. Possible complications include pain and urinary tract infections from difficulty emptying the bladder post-surgery.
- Hemorrhoid stapling. This is another surgical option for large, recurring hemorrhoids. The goal of the surgery is to block the blood flow to the hemorrhoids and relieve the symptoms. Although this procedure is associated with less pain and early return to normal activities compared with hemorrhoidectomy, it does carry a higher risk of recurrence, rectal prolapse, and other complications.
Hemorrhoids are often mild and can be managed at home. Seek professional advice if the symptoms are severe or if they progress or persist for more than one week.
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