Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 11, 2016

Also called piles, hemorrhoids are a condition that is characterized by the inflammation of the veins in the anus and lower rectum. Hemorrhoids can be located internally or externally and may be slightly uncomfortable to extremely painful depending on the severity. In any case, hemorrhoids can typically be treated; however, few adults affected by the condition actually seek treatment.


Definition & Facts

Hemorrhoids are swollen blood vessels located in the rectum. Internal hemorrhoids lie within the rectum far enough that they cannot be seen or felt and usually do not cause pain. Many times bleeding is the only indication of internal hemorrhoids. External hemorrhoids are located within the anus and are typically very painful. If an external hemorrhoid prolapses or moves to the outside, the inflamed vein can be seen and felt.

Research suggests that roughly 75 percent of adults in Europe and North American will experience hemorrhoids at some point in life; however, only around 4 percent of affected individuals will actually seek treatment. While adults between the ages of 45 and 65 are the most heavily effected by hemorrhoids, individuals of all ages, including children, can develop hemorrhoids.

Symptoms & Complaints

Symptoms of hemorrhoids vary by individual, location of the inflammation, and severity of the condition. As internal hemorrhoids are inside the rectum and cannot be seen or felt, this condition typically causes few to no symptoms. External hemorrhoids located under the skin surrounding the anus can often become irritated and itch or even bleed. Additionally, symptoms more common of external hemorrhoids include:

While most hemorrhoids cause little to no discomfort, straining during a bowel movement and additional pressure in the region can initiate pain and itching. In some cases, blood can actually begin to pool in an external hemorrhoid and form a clot )(thrombus). This condition causes significant pain, swelling, and inflammation.


The exact cause of hemorrhoids is unknown. However, most doctors tend to believe that some individuals are more likely to develop the condition because they seem to have weak veins. This weakness leads to a variety of vascular conditions, including hemorrhoids as well as varicose veins and others. If this is the case, it is likely due to genetic factors..

There are other factors that seem to contribute to the condition as well, though. For example, excessive abdominal pressure causes the veins to swell and have a greater tendency to become irritated. Different factors that may contribute to this added pressure include obesity and pregnancy.

Likewise, certain activities or actions may cause additional force in the anal region and contribute to the development of hemorrhoids. Sitting or standing for long periods, straining during bowel movements, excessive coughing, forceful sneezing, repetitive vomiting, and even holding one’s breath when doing physical labor may all contribute to the development of inflamed anal veins.

Diagnosis & Tests

In most cases, if an individual experiences any of the symptoms of the condition, it is advisable to see a doctor. Because rectal bleeding can be an indicator of other conditions, such as [[colorectal cancer\\ and anal cancer, it is important to see a physician to rule these diseases out. A doctor will conduct a physical examination as well as perform a few additional tests to determine if an individual does have hemorrhoids.

A common test for the condition is a digital rectal exam, which involves an anoscope and a gloved, lubricated finger used to examine deeper within the anal region. A change in bowel habits, such as very dark or black stools or blood in stool, is an indicator that immediate medical attention is required. In this case, a colonoscopy, a sigmoidoscopy, and/or a barium enema X-ray will likely be used to determine the issue.

Treatment & Therapy

In most cases, hemorrhoids can be treated using home remedies, such as lifestyle modifications. Drinking additional water and adopting a diet rich in fiber can help soften the stool, reduce straining during bowel movements, and remedy hemorrhoids effectively. However, in some cases, medication or surgical procedures are required.

If the discomfort caused by the condition is mild, a doctor may suggest over-the-counter treatments, such as creams, ointments, suppositories, or pads. These treatments typically contain ingredients such as hydrocortisone or witch hazel that relieve pain and itch temporarily. If a clot has formed with an external hemorrhoid, the doctor may remove the clot with a small incision, providing quick relief.

In the case of persistent or painful hemorrhoids, however, more invasive procedures may be required. In any case, the treatments may typically be performed in the doctor’s office or another outpatient setting. Common treatments include rubber band ligation, injection or sclerotherapy, and coagulation by laser or infrared light. If other treatments are unsuccessful or the hemorrhoids are large, surgery may be required. Hemorrhoid removal and hemorrhoid stapling are both common treatments of the condition.

Prevention & Prophylaxis

The most effective way to prevent hemorrhoids is to keep the stool soft. Many lifestyle remedies can be applied to do some. Eating high-fiber foods, drinking plenty of fluids, and even taking a regular fiber supplement are all ways to keep the stool softer and more easily passable.

Avoiding straining, going as soon as one feels the urge, exercising, and avoiding sitting for long periods also reduce the risk of developing the condition. Hemorrhoids are a very common but highly treatable and preventable condition. Adopting simple lifestyle remedies is the most effective way to prevent and even treat hemorrhoids.