Hemorrhoids are the pillow-like clusters of veins that lie just beneath the mucous membranes lining the lowest part of the rectum and the anus. The condition most of us call hemorrhoids (or piles) develops when those veins become swollen and distended, like varicose veins in the legs. .

Who is more likely to get hemorrhoids?

You are more likely to get hemorrhoids if you:

  • Strain during bowel movements
  • Sit on the toilet for long periods of time.
  • Have chronic constipation or diarrhea
  • Eat foods that are low in fiber
  • Are older than age 50.
  • Are pregnant.
  • Often lift heavy objects

Types of Hemorrhoids

Internal hemorrhoids. Internal hemorrhoids lie inside the anal canal, where they primarily cause the symptom of intermittent bleeding, usually with bowel movements, and sometimes mucous discharge. They are usually painless. Internal hemorrhoids also may protrude (prolapse) outside the anus, where they appear as small, grape-like masses. Usually, the prolapsed hemorrhoid can be pushed back into the anus with a fingertip.

External hemorrhoids. These lie just outside the anal opening, where they primarily cause symptoms of swelling or bothersome protrusions, and sometimes discomfort. Swelling and discomfort may occur only intermittently. External hemorrhoids may also cause difficulties keeping the anal area clean after bowel movements. External hemorrhoids sometimes develop a blood clot inside of them (“thrombosis”), often after a period of diarrhea or constipation. In that case, it produces a sudden firm and painful swelling or lump around the rim of the anus.

Hemorrhoids are a quite common health problem. Hemorrhoids are more likely to develop in individuals who eat insufficient dietary fiber and do not get enough exercise, which can lead to repeated episodes of constipation and straining to have bowel movements.

Symptoms of hemorrhoids

The symptoms of hemorrhoids depend on the type you have.

If you have external hemorrhoids, you may have:

  • Anal itching
  • One or more hard, tender lumps near your anus
  • Anal ache or pain, especially when sitting

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

If you have internal hemorrhoids, you may have:

  • Bleeding from your rectum––bright red blood on stool, on toilet paper, or in the toilet bowl after a bowel movement
  • A hemorrhoid that has fallen through your anal opening, called prolapse

Internal hemorrhoids that are not prolapsed most often are not painful. Prolapsed internal hemorrhoids may cause pain and discomfort.

Diagnosis of Hemorrhoids

Your doctor can often diagnose hemorrhoids based on your medical history and a physical exam. He or she can diagnose external hemorrhoids by checking the area around your anus. To diagnose internal hemorrhoids, your doctor will perform a digital rectal exam and may perform procedures to look inside your anus and rectum.

Your doctor will ask you to provide your medical history and describe your symptoms. He or she will ask you about your eating habits, toilet habits, enema and laxative use, and current medical conditions.

Physical exam

Your doctor will check the area around your anus for

  • lumps or swelling
  • Internal hemorrhoids that have fallen through your anal opening, called prolapse.
  • External hemorrhoids with a blood clot in a vein
  • Leakage of stool or mucus
  • Skin irritation
  • Skin tags–extra skin that is left behind when a blood clot in an external hemorrhoid dissolve.
  • Anal fissures—a small tear in the anus that may cause itching, pain, or bleeding.

Your doctor will perform a digital rectal exam to

  • Check the tone of the muscles in your anus
  • Check for tenderness, blood, internal hemorrhoids, and lumps or masses

Treatment of Hemorrhoids

You can most often treat your hemorrhoids at home by

  • Eating foods that are high in fiber
  • Take warm sitz baths, especially when the hemorrhoids are uncomfortable. Sit in a tub or pan of plain warm water, 3 or 4 times a day, for 15-20 minutes each time. (Large pharmacies and medical supply stores also sell convenient plastic sitz bath devices that fit into a toilet). The water will keep the area clean, and the warmth will reduce inflammation and discomfort. Be certain to dry the rectal area thoroughly after each sitz bath. If you work, you can still take a sitz bath in the morning, upon returning from work, and again at bedtime.
  • Taking a stool softener or a fiber supplement
  • Drinking water or other nonalcoholic liquids each day as recommended by your health care professional.
  • Not straining during bowel movements
  • Not sitting on the toilet for long periods of time
  • Taking over-the-counter pain relievers
  • Sitting in a tub of warm water, called a sitz bath, several times a day to help relieve pain.

Applying over-the-counter hemorrhoid creams or ointments or using suppositories – a medicine you insert into your rectum may relieve mild pain, swelling, and itching of external hemorrhoids. Most often, doctors recommend using over-the-counter products for 1 week. You should follow up with your doctor if the products.

  • Do not relieve your symptoms after 1 week.
  • cause side effects such dry skin around your anus or a rash


You can often prevent hemorrhoids by preventing constipation. Some of the following diet and lifestyle changes may help you to soften your stool, establish a regular schedule for bowel movements, and avoid the straining that can lead to hemorrhoids:

  • Add more fiber to your diet. Set a goal of 25 to 30 grams of fiber daily, from such high fiber foods as beans, broccoli, carrots, bran, whole grains and fresh fruits. Alternatively, many people find that it is more convenient to take a fiber powder such as psyllium (“Metamucil”), or methylcellulose (“Citrucel”), which is available at drug stores without prescription. To avoid bloating and gas, add fiber to your diet gradually over a period of several days.
  • Drink adequate amounts of fluid. For most healthy adults, this is the equivalent of 6 to 8 glasses of water daily.
  • Begin a program of regular exercise. As little as 20 minutes of brisk walking daily can stimulate your bowel to move regularly.
  • Train your digestive tract to have regular bowel movements. Schedule a time to sit on the toilet at approximately the same time each day. The best time to do this is usually right after a meal. Do not sit on the toilet for long periods (it tends to make hemorrhoids swell up and push out).
  • Respond immediately to the urge to have a bowel movement. Do not postpone until the time is more convenient.

Seek care right away!

You should seek medical care right away if you have severe anal pain and bleeding from your rectum, particularly with discomfort or pain in your abdomen, diarrhea, or fever. Also, see your doctor if you have severe rectal pain.

Eating, Diet, & Nutrition for Hemorrhoids

Your doctor may recommend that you eat more foods that are high in fiber. Eating foods that are high in fiber can make stools softer and easier to pass and can help treat and prevent hemorrhoids. Drinking water and other liquids, such as fruit juices and clear soups, can help the fiber in your diet work better. Ask your doctor about how much you should drink each day based on your health and activity level and where you live.


Hemorrhoids are not dangerous, and only need to be treated if they cause very bothersome symptoms. If hemorrhoids occur during pregnancy, they will usually regress spontaneously after childbirth. For hemorrhoids related to constipation, the prognosis is also good, provided you make the necessary changes to your diet and lifestyle. For hemorrhoids that cause persistent symptoms despite nonsurgical treatment, the results from office treatment or surgery are usually very good.


1. American Society of Colon and Rectal Surgeons

2. National Institute of Diabetes & Digestive & Kidney Disorders

3.  National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

4. American Gastroenterological Association

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