Hemorrhoids are without doubt one of the most uncomfortable of health subjects. You would be hard-pressed to find anyone who will admit to having them, or who wants to talk about treating them. If you’ve experienced a hemorrhoid, calling it “uncomfortable” may be putting it mildly.
But keep in mind you are far from alone if you find yourself dealing with hemorrhoids. According to the National Institute of Diabetes and Digestive and Kidney Diseases, an estimated 75% of people ages 45 and over have hemorrhoids. Some people may never experience hemorrhoid symptoms. But many people will, at some point, contend with hemorrhoid-related problems, including rectal pain, itching, and bleeding.
Yes, hemorrhoids can be unpleasant, painful, and embarrassing, but they’re rarely dangerous. This Harvard Medical School guide discusses simple self-help and over-the-counter remedies to help you find relief. The guide will help you identify the type of hemorrhoids you have and understand why they occur, and then guide you through different treatment options.
Prepared by the editors of Harvard Health Publishing in consultation with Jeffrey A. Linder, M.D., M.P.H., Associate Physician, Brigham and Women’s Hospital and Associate Professor of Medicine, Harvard Medical School and Howard E. LeWine, M.D., Assistant Professor of Medicine, Harvard Medical School. 29 pages. (2017)
About Harvard Medical School Guides
Harvard Medical School Guides delivers compact, practical information on important health concerns. These publications are smaller in scope than our Special Health Reports, but they are written in the same clear, easy-to-understand language, and they provide the authoritative health advice you expect from Harvard Health Publishing.
- Help for hemorrhoids
- Types of hemorrhoids
- What causes hemorrhoids?
- Diagnosis and Prognosis
- Self-help measures
- Non-surgical office-based procedures
- Surgical treatment of hemorrhoids
- Treat constipation to help prevent hemorrhoids
- Other lifestyle approaches for prevention and treatment
What causes hemorrhoids?
Any increase in abdominal pressure may produce hemorrhoids; however, some people can get hemorrhoids for no apparent reason. Typically, the problem is associated with chronic constipation or diarrhea, accompanied by straining during bowel movements and prolonged sitting on the toilet—all of which interfere with blood flow to and from the rectum and the anus. Under these circumstances, blood starts to pool and enlarge the vessels of the hemorrhoidal plexus. We discuss symptoms and treatments for constipation in depth later in this report.
There are some factors associated with the development of hemorrhoids you cannot control, while others you can.
Research has shown that people at high risk for hemorrhoids tend to have a tighter anal canal than average, even when not straining. Pregnancy also raises a person’s risk, as the enlarging uterus places more pressure on the cluster of veins of the anus. Finally, the connective tissues that support and hold hemorrhoids in place can weaken with age, causing hemorrhoids to bulge and eventually protrude.
Constipation, or difficulty passing stool, adds to these troubles, because straining during a bowel movement increases pressure in the anal canal and pushes the hemorrhoids against the sphincter. Also, hemorrhoids are more likely to develop in people who don’t consume enough dietary fiber and don’t get enough exercise, which can make bowel movements more difficult.
Some people with hemorrhoids never have any symptoms. When symptoms do occur, you may experience one or several of them, and their severity may vary. The most common symptoms include the following:
- itching or discomfort around the anus
- bleeding during or after a bowel movement (especially if the stool was hard, dry, or large), apparent from bright red blood on the toilet paper, streaking the surface of the stool, or coloring the toilet bowl water
- a soft, grape-like mass protruding from the anus—a prolapsed hemorrhoid—that may discharge mucus
- bothersome protrusions of excess skin (skin tags) arising from external hemorrhoids, making it difficult to keep the anal area clean
- the sudden appearance at the rim of the anus of a painful bulge or firm lump (likely a thrombosed external hemorrhoid), which may be bleeding or tinted blue or purple.
Severe pain is not a typical symptom, except in the case of a thrombosed external hemorrhoid.
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