Hemorrhoids are enlarged blood vessels in and around the anus and lower rectum. They are defined by their location. Internal hemorrhoids are located within the anus and external hemorrhoids are located near or around the anus. Many people will never have any problems associated with their hemorrhoids. However, after the age of 30 nearly half the population will develop symptomatic hemorrhoids.

Symptoms associated with internal hemorrhoids

  • Bright red blood associated with bowel movements
  • Prolapsing tissue (falls out of the rectum)
  • Mucous drainage from anus
  • Anal soilage, inability to “get clean”
  • Itching
  • Painless (if you are having pain, there is most likely another cause)

Symptoms associated with external hemorrhoids

  • Skin tags present around the anus
  • Swelling
  • Discomfort and pressure that can come and go

Symptoms associated with thrombosed external hemorrhoids

When a blood clot forms within an external hemorrhoid, this is called thrombosis.

  • Pain (usually constant and can be severe) for 5-7 days
  • Swelling
  • Bleeding

Testing & diagnosis

History and physical: If you are concerned with your symptoms, you should seek medical attention. After discussing your medical history and current symptoms, your physician will inspect the outside of the anus, perform a digital exam (placement of their finger into the anus) and look inside the anus with a small, lighted instrument (anoscopy).

Colonoscopy: A colonoscopy may also be ordered if you are having a large amount of bleeding, if symptoms do not improve with treatment, if there is a change in bowel habits, weight loss, abdominal pain, or a family history or personal history of colorectal cancer. Colonoscopy is performed with the patient under IV sedation in an outpatient setting. (see colonoscopy)

Treatment: Most patients will not need surgery for their hemorrhoids. Your physician will create a treatment plan based on your symptoms. Below is a list of possible treatment options in order of severity.

  • Dietary changes – Increase the amount of fiber and fluids in your diet. This will help produce soft, bulky stools and eliminate straining.
  • Sitz bath – Soaking the area in warm water can provide some relief.
  • Rubber band ligation – This procedure is usually done in the office. A small rubber band is placed over the hemorrhoid to cut off its blood supply. The hemorrhoid and rubber band fall off in a few days. This procedure may cause mild discomfort and bleeding and may need to be repeated.
  • Stapled hemorrhoidectomy – This procedure is done in the operating room on an outpatient basis. A surgical device is used to staple and remove internal hemorrhoids. This procedure is generally more painful than the rubber band ligation and there is a risk for recurrence.
  • Excisional hemorrhoidectomy – This procedure is done in the operating room on an outpatient basis and is the most effective treatment for both external and internal hemorrhoids. It is the surgical removal of the hemorrhoidal tissue. This is the most painful option, but has the lowest risk for recurrence.

Follow-up: Continuing to follow a high-fiber diet and drinking adequate fluids is essential to preventing recurrence of symptoms.

If your symptoms don’t improve with treatment, you should contact your physician.

*Symptoms associated with hemorrhoids are very similar to many other conditions such as: anal fissures, pruritus ani, anal fistulas, anal cancer and colorectal cancer.