Hemorrhoids Patient Information Fact Sheet

What are hemorrhoids?
Hemorrhoids (also known as "piles") are caused by enlarged blood vessels that cause small swellings, either inside or outside your rectum. The blood vessels become enlarged when subjected to pressure, for example, when straining to pass stools when constipated or during childbirth.

Who suffers from hemorrhoids?
Hemorrhoids are particularly common among pregnant women, because the pressure of the baby, as well as hormonal changes, can cause the blood vessels to enlarge. Hemorrhoids are also more likely to occur if you are overweight, constipated or elderly. Hemorrhoids are usually a minor and temporary inconvenience. However, if symptoms are persistent your doctor should be able to offer advice and medication to help.

What are the symptoms of hemorrhoids?
The main symptoms of hemorrhoids are swelling and irritation, in or around your rectum. Hemorrhoids are painful and sometimes there is bleeding when you pass a stool. Internal hemorrhoids usually cause less severe symptoms. Ordinarily they cannot be seen or touched, but they can cause pain and bleeding during a bowel movement. Fresh, bright red blood on the toilet paper is a sign of an internal hemorrhoid. External hemorrhoids tend to be more uncomfortable and are more troublesome. These too can bleed, usually when rubbed by toilet paper or tight fitting underwear. Sometimes a blood clot can form into a hemorrhoid (thrombosed piles). This will feel like a painful lump, about the size of a grape, sticking out through your rectum.

Should I see a doctor?
In most cases, hemorrhoids are nothing more than a temporary problem. If they are uncomfortable you may want to ask your pharmacist for a hemorrhoid cream, ointment or suppository (tablets that you push gently into your rectum). You can also take steps to reduce the chance of a recurrence (see Self-Help below). If you notice dark blood mixed with your stools, experience pain or suffer excessive irritation or mucus leakage, you should make an appointment with your doctor. Your doctor will examine you and may want to examine inside your rectum. Although this may seem embarrassing, it is very important to exclude any serious illnesses such as cancer.

How are hemorrhoids treated?
Most hemorrhoids get better within a few days without any specific treatment. Simple measures such as bathing in warm water, applying ice packs, or using a hemorrhoid cream, ointment or suppository (Preparation H) can relieve some of the discomfort. For serious or prolonged irritation, it may be necessary for your doctor to prescribe a treatment. Prescribed topical medications (Anamantle-HC Forte, Anusol-HC, Peranex HC, Rectagel HC) are highly effective and often contain a combination of a local anesthetic and a steroid to treat pain, inflammation and itching. You should use your treatment as directed by your doctor and make another appointment if your symptoms last for more than seven days. Surgical removal might be warranted in the case of recurring or very bothersome hemorrhoids.

Self-help measures

  • Try to avoid becoming constipated by eating plenty of fiber, including fresh fruit, vegetables, whole wheat bread and cereals.
  • Drink plenty of fluids to prevent constipation. Drink more during hot weather or if you are exercising.
  • Try to exercise regularly. This will also help to prevent constipation and ease the pressure on the hemorrhoids.
  • Avoid using hard toilet paper, use soft paper or medicated wipes instead.
  • Reduce discomfort by washing gently with warm water or sitting in a tub of warm water for 10 minutes several times a day. Using an ice pack can also help reduce the pain and swelling.
  • Do not scratch the area as this will make it more painful and uncomfortable.
  • Wear loose fitting underwear made from natural materials such as cotton.
  • If you are overweight, try to lose weight.
  • Do not hold back bowel movements and take your time when you do go.

Further Information
National Digestive Diseases Information Clearinghouse: http://www.digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids/index.aspx

Last Reviewed: May 2013