Hemorrhoids occur when veins in the rectum or anus become swollen and painful and may bleed. Sometimes they go away by themselves, but in other cases they can cause lingering pain, itching, and bleeding. There are two types of hemorrhoids: those that are just inside the anus or lower rectum (internal) and those that are outside the opening to the anus (external). You can have both at the same time. Internal hemorrhoids usually don't cause pain or discomfort, while external hemorrhoids often do. However, internal hemorrhoids can protrude outside the anus (prolapsed hemorrhoid) and become painful. In some cases, a blot clot (thrombosis) may form in the vein, making the hemorrhoid more painful and sometimes requiring surgery.

Symptoms of hemorrhoids include:

• Anal itching
• Anal pain, especially while sitting
• Bright red blood on toilet tissue, stool, or in the toilet bowl
• Pain during bowel movements
• One or more hard tender lumps near the anus

Hemorrhoids are a type of varicose vein that tends to occur as we get older; about 75 percent of Americans have hemorrhoids at some point. Being constipated or passing large, hard stools may contribute to developing hemorrhoids. In many cases, however, there is no obvious cause. In addition to age and constipation, other contributing factors include the following:

• Some medical conditions (like cirrhosis – end stage liver disease)
• Pregnancy
• Sitting for a long period of time (especially sitting on the toilet)
• Obesity
• Chronic diarrhea
• Diet low in fiber or fluids

Your doctor can often diagnose external hemorrhoids by looking. For internal hemorrhoids, your doctor may do a rectal examination (inserting a gloved finger in the rectum). He or she may also use an anoscope or sigmoidoscope to look inside the anal canal.

It's important to avoid being constipated so that you don't strain when having a bowel movement, so adding more fiber (fruits, vegetables, whole grains) to your diet can be helpful. You may want to consider fiber supplements. Drink plenty of fluids (at least 8 glasses per day) and get enough exercise.

Medications can ease pain and discomfort while hemorrhoids to heal. In addition, certain lifestyle measures can help you feel better and even prevent the recurrence of hemorrhoids.

Lifestyle

Try the following approaches to reduce the pain and itching from hemorrhoids:

• Avoid pressure on the area (for example, sit on an inflatable ring)
• Wear cotton undergarments
• Avoid toilet tissue with perfumes or colors
• Try not to scratch the area
• Sit in a warm bath (or use a sitz bath – ask your doctor) for 10 to 15 minutes 1 to 2 times per day
• Avoid straining during bowel movements
• Limit the amount of time you sit on the toilet

There are also dietary and other lifestyle steps you can take to prevent or treat constipation, which will help you avoid hemorrhoids. See article entitled Constipation for more information.

Medications

• Over-the-counter corticosteroid creams, ointments, or pads can help reduce pain and swelling. Hemorrhoid creams with lidocaine (also available over-the-counter) can reduce pain.
• Stool softeners help reduce straining during bowel movements and prevent hard stools.
• Bulk laxatives help prevent hard stools and constipation.

Surgery and Other Procedures

For cases that don't respond to home treatments, your doctor may recommend other procedures:

Rubber band ligation — A tiny rubber band is placed around an internal hemorrhoid, which cuts off the blood supply and causes the hemorrhoid to fall off.

Sclerotherapy — Used to treat varicose veins, in this procedure a chemical solution is injected into the vein, which causes the hemorrhoid to collapse.

Surgery — If other options, fail, your doctor may recommend a hemorrhoidectomy.

Nutrition and Dietary Supplements

• Psyllium and other fiber may help soften stool and reduce the pain associated with hemorrhoids.
• The flavonoids diosmin and hesperidin (1350 mg and 150 mg two times per day for four days, respectively, followed by 900 mg and 100 mg two times per day for three days) may help stop bleeding, reduce pain, and possibly lessen the duration of any flare-ups. Flavonoids are antioxidants found in plants that may help keep veins and blood vessels strong or help strengthen them once they've weakened. Weak blood vessels can contribute to the development of hemorrhoids. These flavonoids are available by prescription as a medication called Daflon. One study suggested that taking blond psyllium along with Daflon may help relieve bleeding from nonprolapsed hemorrhoids.
• Probiotics, or "friendly” bacteria, such as lactobacillus and bifidus, can help prevent and treat hemorrhoids.
• Drinking more water can greatly decrease constipation and straining during bowel movements, which can help prevent hemorrhoids.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner.

Witch hazel (Hamamelis virginiana), applied topically or used as a sitz bath, may temporarily shrink hemorrhoids and relive symptoms.

Other herbs that are often suggested for hemorrhoids, but which lack scientific evidence of benefit, include:

• Goldenrod (Solidago virgaurea), used topically in traditional herbal medicine to reduce inflammation of hemorrhoids.
• Gotu kola (Centella asiatica), used for venous insufficiency or varicose veins.
• Yarrow (Achillea millefolium ), popular in European folk medicine, and has traditionally been used to treat wounds and bleeding hemorrhoids.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of hemorrhoids based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. The following are examples of remedies from which a homeopath might select to treat someone with hemorrhoids.

• Aesculus — for burning hemorrhoids with a sensation of a lump in anus that feels worse when walking
• Aloe — for a sensation of pulsation in the rectum with large, external hemorrhoids
• Collinsonia — for chronic, itchy hemorrhoids with constipation
• Hamamelis — for large bleeding hemorrhoids with a raw feeling

Prognosis and Complications

Most treatments for hemorrhoids are very effective. Talk with your doctor if the hemorrhoids are still a problem after one to two weeks. To prevent hemorrhoids from coming back, eat a high-fiber diet and drink plenty of fluids.This is especially important if you get hemorrhoids often.

The blood in the enlarged veins may form clots, and the tissue surrounding the hemorrhoids can die. Hemorrhoids with clots generally require surgical removal.

Severe bleeding may also occur, although it is unusual.

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