What are hemorrhoids?
Hemorrhoids are swollen and inflamed veins around the anus or in the lower rectum.
External hemorrhoids are located under the skin around the anus. Internal hemorrhoids develop in the lower rectum and may protrude through the anus. Hemorrhoids are not dangerous or life threatening.

What causes hemorrhoids?
Hemorrhoid veins are preset in everyone and normally act to cushion the anal area.  The swelling in the anal or rectal veins causes hemorrhoids.  Common factors are chronic constipation or diarrhea, straining during bowel movements or a lack of fiber in the diet.  Hemorrhoids are also caused by the weakening of the connective tissue in the rectum and anus that occurs with age.  Pregnancy can also cause hemorrhoids by increasing pressure in the abdomen, which may enlarge the veins in the lower rectum and anus, but typically disappears after childbirth.

What are the symptoms of hemorrhoids?
The most common symptom of internal hemorrhoids is bright red blood on stool, on toilet paper, or in the toilet bowl after a bowel movement. Internal hemorrhoids that are not prolapsed are usually not painful.  However prolapsed hemorrhoids often cause pain, discomfort and anal itching. Bleeding as described can’t be assumed to be hemorrhoids.  Studies show that when rectal bleeding seems typically hemorrhoidal, 40% of the time it is coming from a different cause.

How are hemorrhoids diagnosed?
Your doctor can perform a physical exam to look for visible hemorrhoids or a digital rectal exam with a gloved, lubricated finger and an anoscope can also be used.
Additional exams (colonoscopy, sigmoidoscopy or barium enema x-ray) may be used to rule out other causes of bleeding, especially in people age 40 or older.

How are hemorrhoids treated?
Lifestyle changes can often reduce the swelling of hemorrhoids and relieve hemorrhoid symptoms. A fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining. Other changes that may help relieve hemorrhoid symptoms are drinking plenty of fluids, warm baths, regular exercise and avoid straining during bowel movements.

Over-the-counter creams and suppositories may temporarily relieve the pain and itching.  If lifestyle changes and at home therapies do not relieve symptoms, medical treatments may be needed. Outpatient treatments can be performed in a doctor’s office or a hospital. Treatments for internal hemorrhoids include:

  • Rubber band ligation- a special rubber band is placed around the base of the hemorrhoid to cut off circulation, causing the hemorrhoid to shrink.
  • Sclerotherapy-a chemical solution is injected into the blood vessel to shrink the hemorrhoid.
  • Infrared coagulation-heat is used to shrink the hemorrhoid tissue.

If external and internal hemorrhoids do not respond to other treatments, surgery may be necessary to remove the hemorrhoids.

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