Hemorrhoids (HEM-uh-roids), also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).
Nearly three out of four adults will have hemorrhoids from time to time. Hemorrhoids have a number of causes, but often the cause is unknown.
Fortunately, effective options are available to treat hemorrhoids. Many people get relief with home treatments and lifestyle changes.
Signs and symptoms of hemorrhoids usually depend on the type of hemorrhoid.
These are under the skin around your anus. Signs and symptoms might include:
Internal hemorrhoids lie inside the rectum. You usually can't see or feel them, and they rarely cause discomfort. But straining or irritation when passing stool can cause:
Painless bleeding during bowel movements. You might notice small amounts of bright red blood on your toilet tissue or in the toilet.
A hemorrhoid to push through the anal opening (prolapsed or protruding hemorrhoid), resulting in pain and irritation.
If blood pools in an external hemorrhoid and forms a clot (thrombus), it can result in:
A hard lump near your anus
When to see a doctor
If you have bleeding during bowel movements or you have hemorrhoids that don't improve after a week of home care, talk to your doctor.
Don't assume rectal bleeding is due to hemorrhoids, especially if you have changes in bowel habits or if your stools change in color or consistency. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer.
Seek emergency care if you have large amounts of rectal bleeding, lightheadedness, dizziness or faintness.
The veins around your anus tend to stretch under pressure and may bulge or swell. Hemorrhoids can develop from increased pressure in the lower rectum due to:
As you age, your risk of hemorrhoids increases. That's because the tissues that support the veins in your rectum and anus can weaken and stretch. This can also happen when you're pregnant, because the baby's weight puts pressure on the anal region.
Complications of hemorrhoids are rare but include:
The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:
Your doctor might be able to see external hemorrhoids. Diagnosing internal hemorrhoids might include examination of your anal canal and rectum.
Your doctor might want to examine your entire colon using colonoscopy if:
You can often relieve the mild pain, swelling and inflammation of hemorrhoids with home treatments.
With these treatments, hemorrhoid symptoms often go away within a week. See your doctor in a week if you don't get relief, or sooner if you have severe pain or bleeding.
If your hemorrhoids produce only mild discomfort, your doctor might suggest over-the-counter creams, ointments, suppositories or pads. These products contain ingredients such as witch hazel, or hydrocortisone and lidocaine, which can temporarily relieve pain and itching.
Don't use an over-the-counter steroid cream for more than a week unless directed by your doctor because it can thin your skin.
External hemorrhoid thrombectomy
If a painful blood clot (thrombosis) has formed within an external hemorrhoid, your doctor can remove the hemorrhoid, which can provide prompt relief. This procedure, done under local anesthesia, is most effective if done within 72 hours of developing a clot.
Minimally invasive procedures
For persistent bleeding or painful hemorrhoids, your doctor might recommend one of the other minimally invasive procedures available. These treatments can be done in your doctor's office or other outpatient setting and don't usually require anesthesia.
Only a small percentage of people with hemorrhoids require surgery. However, if other procedures haven't been successful or you have large hemorrhoids, your doctor might recommend one of the following:
Hemorrhoid removal (hemorrhoidectomy). Choosing one of various techniques, your surgeon removes excessive tissue that causes bleeding. The surgery can be done with local anesthesia combined with sedation, spinal anesthesia or general anesthesia.
Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. Complications can include temporary difficulty emptying your bladder, which can result in urinary tract infections. This complication occurs mainly after spinal anesthesia.
Most people have some pain after the procedure, which medications can relieve. Soaking in a warm bath also might help.
Hemorrhoid stapling. This procedure, called stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. It is typically used only for internal hemorrhoids.
Stapling generally involves less pain than hemorrhoidectomy and allows for earlier return to regular activities. Compared with hemorrhoidectomy, however, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus.
Complications can also include bleeding, urinary retention and pain, as well as, rarely, a life-threatening blood infection (sepsis). Talk with your doctor about the best option for you.
Preparing for your appointment
If you have signs and symptoms of hemorrhoids, make an appointment with your regular doctor. If needed, your doctor might refer you to one or more specialists — including a doctor with expertise in the digestive system (gastroenterologist) or a colon and rectal surgeon — for evaluation and treatment.
Here are some suggestions to help you get ready for your appointment.
What you can do
Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance.
Make a list of:
For hemorrhoids, some questions to ask your doctor include:
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you questions, including:
What you can do in the meantime
Before your appointment, take steps to soften your stools. Eat more high-fiber foods, such as fruits, vegetables and whole grains, and consider an over-the-counter fiber supplement, such as Metamucil or Citrucel. Drinking six to eight glasses of water a day also might help relieve your symptoms.