Hemorrhoids are very common, especially during pregnancy and after childbirth. They are caused by increased pressure in the veins of the anus. The most common cause is straining during bowel movements. Constipation, prolonged sitting during bowel movements, and anal infection may also contribute to the development of hemorrhoids. In some cases they may be a manifestation of other diseases, such as liver cirrhosis.

Internal hemorrhoids occur near the beginning of the anal canal, and external hemorrhoids occur at the anal opening. They may protrude outside the anus.

• Rectal bleeding, particularly after bowel movements
• Bright red blood in the stool
• Pain during bowel movements
• Anal itching
• Rectal prolapse

Rectal examination may be sufficient to diagnose hemorrhoids. If necessary, tests that may be used in diagnosis include the following:

• Stool guaiac (shows the presence of blood)
• Sigmoidoscopy
• Anoscopy
• Proctoscopy

Mild cases are controlled by preventing constipation, drinking fluids, adhering to a high-fiber diet, and using stool-bulking agents such as fiber supplements. Stool softeners may also be useful. Corticosteroid creams help reduce pain and swelling. Sitz baths may provide symptomatic relief.

For more severe cases, possible treatments include rubber band ligation or surgical hemorrhoidectomy. These procedures are generally used for patients with severe pain or bleeding who have not responded to conservative therapy.

Most treatments are effective, but to prevent recurrence the patient must adhere to a high-fiber diet with adequate fluids.

The blood in the enlarged veins may form clots, causing thrombosis, and the tissue surrounding the hemorrhoids can die (necrosis). In this case, there are acute painful lumps in the anal area. Thrombosed hemorrhoids generally require surgical hemorrhoidectomy.

Severe bleeding and prolapse may also occur. Iron deficiency anemia can result from prolonged loss of blood. Significant bleeding from hemorrhoids is unusual, however.

Call for an appointment with your health care provider if hemorrhoid symptoms do not improve with home treatment.

Avoiding contributing factors and eating a high-fiber diet with plenty of fluids may help prevent the development of hemorrhoids.