Hemorrhoids

National Digestive Diseases Information Clearinghouse

What are hemorrhoids?

U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH

Hemorrhoidsareswollenandinflamedveins aroundtheanusorinthelowerrectum.The rectumisthelastpartofthelargeintestine leadingtotheanus.Theanusistheopening attheendofthedigestivetractwherebowel contentsleavethebody. Externalhemorrhoidsarelocatedunder theskinaroundtheanus.Internalhemorrhoidsdevelopinthelowerrectum.Internal hemorrhoidsmayprotrude,orprolapse, throughtheanus.Mostprolapsedhemorrhoidsshrinkbackinsidetherectumontheir own.Severelyprolapsedhemorrhoidsmay protrudepermanentlyandrequiretreatment.

What are the symptoms of hemorrhoids?

Themostcommonsymptomofinternal hemorrhoidsisbrightredbloodonstool, ontoiletpaper,orinthetoiletbowlafter abowelmovement.Internalhemorrhoids thatarenotprolapsedareusuallynotpainful.Prolapsedhemorrhoidsoftencausepain, discomfort,andanalitching. Bloodclotsmayforminexternalhemorrhoids.Abloodclotinaveiniscalleda thrombosis.Thrombosedexternalhemorrhoidscausebleeding,painfulswelling,ora hardlumparoundtheanus.Whentheblood clotdissolves,extraskinisleftbehind.This skincanbecomeirritatedoritch. Excessivestraining,rubbing,orcleaning aroundtheanusmaymakesymptoms,such asitchingandirritation,worse.

Internal hemorrhoid

Hemorrhoidsarenotdangerousorlife threatening.Symptomsusuallygoaway withinafewdays,andsomepeoplewith hemorrhoidsneverhavesymptoms.

Rectum Anus

External hemorrhoid Hemorrhoids

How common are hemorrhoids?

About75percentofpeoplewillhavehemorrhoidsatsomepointintheirlives.1Hemorrhoidsaremostcommonamongadultsages 45to65.2Hemorrhoidsarealsocommonin pregnantwomen.

How are hemorrhoids diagnosed?

Thedoctorwillexaminetheanusandrectum todeterminewhetherapersonhashemorrhoids.Hemorrhoidsymptomsaresimilarto thesymptomsofotheranorectalproblems, suchasfissures,abscesses,warts,andpolyps. Thedoctorwillperformaphysicalexamto lookforvisiblehemorrhoids.Adigitalrectal examwithagloved,lubricatedfingerandan anoscopeahollow,lightedtubemaybe performedtoviewtherectum. Athoroughevaluationandproperdiagnosis byadoctorisimportantanytimeaperson noticesbleedingfromtherectumorblood inthestool.Bleedingmaybeasymptomof otherdigestivediseases,includingcolorectal cancer. Additionalexamsmaybedonetoruleout othercausesofbleeding,especiallyinpeople age40orolder: Colonoscopy.Aflexible,lightedtube calledacolonoscopeisinsertedthrough theanus,therectum,andtheupperpart ofthelargeintestine,calledthecolon. Thecolonoscopetransmitsimagesof theinsideoftherectumandtheentire colon. Sigmoidoscopy.Thisprocedureis similartocolonoscopy,butitusesa shortertubecalledasigmoidoscopeand transmitsimagesoftherectumandthe sigmoidcolon,thelowerportionofthe colonthatemptiesintotherectum. Barium enema x ray.Acontrastmaterialcalledbariumisinsertedintothe colontomakethecolonmorevisiblein x-raypictures.

What causes hemorrhoids?

Swellingintheanalorrectalveinscauses hemorrhoids.Severalfactorsmaycausethis swelling,including chronicconstipationordiarrhea strainingduringbowelmovements sittingonthetoiletforlongperiodsof time alackoffiberinthediet Anothercauseofhemorrhoidsistheweakeningoftheconnectivetissueintherectum andanusthatoccurswithage. Pregnancycancausehemorrhoidsbyincreasingpressureintheabdomen,whichmay enlargetheveinsinthelowerrectumand anus.Formostwomen,hemorrhoidscaused bypregnancydisappearafterchildbirth.

1BakerH.Hemorrhoids.In:LongeJL,ed.Gale Encyclopedia of Medicine.3rded.Detroit:Gale;2006: 17661769. 2ChongPS,BartoloDCC.Hemorrhoidsandfissure inano.Gastroenterology Clinics of North America. 2008;37:627644.

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How are hemorrhoids treated?

At-home Treatments
Simpledietandlifestylechangesoften reducetheswellingofhemorrhoidsand relievehemorrhoidsymptoms.Eatinga high-fiberdietcanmakestoolssofterand easiertopass,reducingthepressureonhemorrhoidscausedbystraining. Fiberisasubstancefoundinplants.The humanbodycannotdigestfiber,butfiber helpsimprovedigestionandpreventconstipation.Goodsourcesofdietaryfiberare fruits,vegetables,andwholegrains.On average,Americanseatabout15gramsof fibereachday.3TheAmericanDietetic Associationrecommends25gramsoffiber perdayforwomenand38gramsoffiberper dayformen.3 Doctorsmayalsosuggesttakingabulk stoolsoftenerorafibersupplementsuch aspsyllium(Metamucil)ormethylcellulose (Citrucel). Otherchangesthatmayhelprelievehemorrhoidsymptomsinclude drinkingsixtoeight8-ounceglassesof waterorothernonalcoholicfluidseach day sittinginatubofwarmwaterfor
10minutesseveraltimesaday
exercisingtopreventconstipation notstrainingduringbowelmovements

Over-the-countercreamsandsuppositories maytemporarilyrelievethepainanditching ofhemorrhoids.Thesetreatmentsshould onlybeusedforashorttimebecauselongtermusecandamagetheskin.

Medical Treatment
Ifat-hometreatmentsdonotrelievesymptoms,medicaltreatmentsmaybeneeded. Outpatienttreatmentscanbeperformedin adoctorsofficeorahospital.Outpatient treatmentsforinternalhemorrhoidsinclude thefollowing: Rubber band ligation.Thedoctor placesaspecialrubberbandaroundthe baseofthehemorrhoid.Thebandcuts offcirculation,causingthehemorrhoid toshrink.Thisprocedureshouldbe performedonlybyadoctor. Sclerotherapy.Thedoctorinjectsa chemicalsolutionintothebloodvessel toshrinkthehemorrhoid. Infrared coagulation.Thedoctoruses heattoshrinkthehemorrhoidtissue. Largeexternalhemorrhoidsorinternalhemorrhoidsthatdonotrespondtoothertreatmentscanbesurgicallyremoved.

DieteticAssociation:healthimplicationsofdietary fiber.Journal of the American Dietetic Association. 2008;108(10):17161731.

3SlavinJL.PositionstatementoftheAmerican

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What foods have fiber?

Examples of foods that have fiber include Beans, cereals, and breads 1/2cupofnavybeans 1/2cupofkidneybeans 1/2cupofblackbeans
Whole-graincereal,cold 1/2cupofAll-Bran 3/4cupofTotal 3/4cupofPostBranFlakes 1packetofwhole-graincereal,hot (oatmeal,Wheatena) 1whole-wheatEnglishmuffin

Fiber 9.5grams 8.2grams 7.5grams

9.6grams 2.4grams 5.3grams 3.0grams

4.4grams

Fruits 1mediumapple,withskin 1mediumpear,withskin 1/2cupofraspberries 1/2cupofstewedprunes Vegetables 1/2cupofwintersquash 1mediumsweetpotatowithskin 1/2cupofgreenpeas 1mediumpotatowithskin 1/2cupofmixedvegetables 1cupofcauliflower 1/2cupofspinach 1/2cupofturnipgreens

3.3grams 4.3grams 4.0grams 3.8grams

2.9grams 4.8grams 4.4grams 3.8grams 4.0grams 2.5grams 3.5grams 2.5grams

Source:U.S.DepartmentofAgricultureandU.S.DepartmentofHealthandHumanServices,Dietary Guidelines for Americans,2005.

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Points to Remember
Hemorrhoidsareswollenand inflamedveinsaroundtheanusor inthelowerrectum. Hemorrhoidsarenotdangerousor lifethreatening,andsymptomsusuallygoawaywithinafewdays. Athoroughevaluationandproper diagnosisbyadoctorisimportant anytimeapersonnoticesbleeding fromtherectumorbloodinthe stool. Simpledietandlifestylechanges oftenreducetheswellingofhemorrhoidsandrelievehemorrhoid symptoms. Ifat-hometreatmentsdonotrelieve symptoms,medicaltreatmentsmay beneeded.

For More Information

American College of Gastroenterology P.O.Box342260 Bethesda,MD208272260 Phone:3012639000 Internet:www.acg.gi.org American Gastroenterological Association 4930DelRayAvenue Bethesda,MD20814 Phone:3016542055 Fax:3016545920 Email:member@gastro.org Internet:www.gastro.org American Society of Colon and Rectal Surgeons 85WestAlgonquinRoad,Suite550 ArlingtonHeights,IL60005 Phone:8472909184 Fax:8472909203 Email:ascrs@fascrs.org Internet:www.fascrs.org

Acknowledgments Hope through Research

TheNationalInstituteofDiabetesand DigestiveandKidneyDiseases(NIDDK) sponsorsresearchtoimprovetreatmentfor peoplewithdigestivedisorders,including hemorrhoidsandconstipation.Researchers arestudyingnewdrugsandsurgicalprocedurestotreatorpreventhemorrhoids. Participantsinclinicaltrialscanplayamore activeroleintheirownhealthcare,gain accesstonewresearchtreatmentsbefore theyarewidelyavailable,andhelpothers bycontributingtomedicalresearch.For informationaboutcurrentstudies,visit www.ClinicalTrials.gov. PublicationsproducedbytheClearinghouse arecarefullyreviewedbybothNIDDKscientistsandoutsideexperts.Thisfactsheet wasreviewedbyAdilE.Bharucha,M.B.B.S., M.D.,MayoClinic,Rochester,MN.

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Youmayalsofindadditionalinformationaboutthis topicbyvisitingMedlinePlusatwww.medlineplus.gov. Thispublicationmaycontaininformationabout medications.Whenprepared,thispublication includedthemostcurrentinformationavailable. Forupdatesorforquestionsaboutanymedications, contacttheU.S.FoodandDrugAdministration toll-freeat1888INFOFDA(18884636332)or visitwww.fda.gov.Consultyourdoctorformore information.

National Digestive Diseases Information Clearinghouse

2InformationWay Bethesda,MD208923570 Phone:18008915389 TTY:18665691162 Fax:7037384929 Email:nddic@info.niddk.nih.gov Internet:www.digestive.niddk.nih.gov TheNationalDigestiveDiseasesInformation Clearinghouse(NDDIC)isaserviceofthe NationalInstituteofDiabetesandDigestive andKidneyDiseases(NIDDK).The NIDDKispartoftheNationalInstitutesof HealthoftheU.S.DepartmentofHealth andHumanServices.Establishedin1980, theClearinghouseprovidesinformation aboutdigestivediseasestopeoplewith digestivedisordersandtotheirfamilies, healthcareprofessionals,andthepublic. TheNDDICanswersinquiries,developsand distributespublications,andworksclosely withprofessionalandpatientorganizations andGovernmentagenciestocoordinate resourcesaboutdigestivediseases.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health

NIHPublicationNo.113021 November 2010

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