Hemorrhoids

What is hemorrhoids?

Hemorrhoids are swollen vascular cushions in the anal canal that can bleed, itch or prolapse. They are extremely common and usually respond to fibre, fluid and avoiding straining. The important caution is that rectal bleeding should never simply be assumed to be hemorrhoids, particularly over the age of 40 or with any change in bowel habit.

Causes

• Straining during bowel movements
• Chronic constipation or diarrhoea
• Prolonged sitting on the toilet
• Raised abdominal pressure in pregnancy
• Heavy lifting
• Low fibre diet

Symptoms

• Bright red blood on the toilet paper or in the pan
• Itching or irritation around the anus
• Discomfort or a feeling of fullness
• A lump at the anus that may need pushing back
• Mucus discharge
• Severe pain if a clot forms, called thrombosis

Risk factors

• Constipation and low fibre intake
• Pregnancy and childbirth
• Obesity
• Ageing with weakening supportive tissue
• Sedentary occupation

Diagnosis

• Visual inspection of the anus
• Digital rectal examination
• Proctoscopy to view internal hemorrhoids
• Colonoscopy or sigmoidoscopy when bleeding needs fuller assessment
• Full blood count if bleeding has been significant

Treatment

• Increasing dietary fibre and fluid intake
• Avoiding straining and limiting time on the toilet
• Topical preparations for short term symptom relief
• Warm baths for comfort
• Rubber band ligation for persistent internal hemorrhoids
• Sclerotherapy or infrared coagulation
• Surgical haemorrhoidectomy for severe disease

Self care

• Increase fibre and fluids to keep stool soft
• Do not strain or sit on the toilet for long periods
• Use a footstool to raise the knees while sitting
• Take warm baths for comfort
• Apply cold packs for a painful thrombosed pile
• Keep the area clean and pat dry rather than rubbing
• Use topical preparations for short periods only

When to see a doctor

Book an appointment if:

• Bleeding that persists despite treating constipation
• Any rectal bleeding if you are over 40
• A lump that will not reduce
• Itching or discomfort not improving
• Recurrent episodes
• Bleeding with a change in bowel habit

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• Eat enough fibre and drink adequately
• Avoid straining and do not delay going
• Limit time sitting on the toilet
• Stay physically active
• Treat constipation and diarrhoea promptly
• Manage weight

Outlook

Hemorrhoids usually improve substantially once constipation and straining are addressed. Symptoms recur if bowel habits do not change. Banding and other office procedures are effective for persistent internal hemorrhoids, and surgery is reserved for severe disease. The condition is benign, but bleeding should never simply be assumed to come from hemorrhoids.

Related conditions

Common questions