hemorrhoids overview for patients

Overview

Hemorrhoids are swollen veins in the lowest part of your rectum and anus. They can be inside the rectum (internal) or under the skin around the anus (external). They are common and often cause discomfort, itching, and bleeding, but they are usually not serious.

Yes, hemorrhoids affect a large number of people worldwide. Nearly 3 out of 4 adults will experience them at some point in their lives.

Hemorrhoids can affect anyone, but they are more common as you get older. They also happen often during pregnancy and after childbirth, and in people who are constipated or strain during bowel movements.

Symptoms

Common symptoms

• Bright red blood on toilet paper or in the toilet bowl after a bowel movement
• Itching or irritation around the anus
• Pain or discomfort, especially when sitting
• A soft lump near the anus, which may be tender
• Swelling around the anus

Symptoms in children

• Hemorrhoids are not common in children, but they can happen with long-lasting constipation.
• If a child has blood in their stool or pain, it is important to see a doctor to rule out other causes.

Symptoms in older adults

• Older adults may have symptoms similar to others, but they are more likely to have thinning tissues and weaker muscles, which can make hemorrhoids more noticeable.
• They may also take medicines that affect bowel habits, so symptoms can vary.

Causes

Main causes

• Increased pressure in the veins of the lower rectum, often from straining during bowel movements
• Chronic constipation or diarrhea
• Sitting on the toilet for long periods
• Pregnancy and childbirth, which put pressure on these veins

Risk factors

• Age over 50
• Being overweight or obese
• Pregnancy
• A diet low in fiber
• Not drinking enough fluids
• Frequent heavy lifting
• Family history of hemorrhoids

When to see a doctor

See a doctor urgently if:

• If you see blood in your stool, on toilet paper, or in the toilet, always have it checked by a doctor, even if it stops.
• If you have severe pain or a lump that does not shrink with home care, see a doctor the same day.

Book a routine appointment if:

• Talk to your doctor if symptoms last longer than a week or keep coming back.
• If you have changes in bowel habits that last more than a few weeks, make an appointment.
• If you are pregnant and have hemorrhoid symptoms, ask your maternity care team for guidance.

Diagnosis

A doctor usually diagnoses hemorrhoids by asking about your symptoms and doing a gentle physical exam. They may look at the area around the anus and, if needed, check inside the rectum with a gloved finger.

Tests that may be done

• Visual inspection of the anus and surrounding area
• Digital rectal exam, where the doctor inserts a gloved, lubricated finger
• Anoscopy or proctoscopy, using a short tube with a light to see the lower rectum
• If there is bleeding, the doctor may suggest tests to check the colon, such as a colonoscopy, especially in older adults.

What to expect at your appointment

The exam is usually quick and not painful, though you may feel some pressure. The doctor will explain what they see and discuss treatment options. Most people can go home the same day and feel no lasting discomfort from the exam.

Treatment

Treatment for hemorrhoids usually starts with home care. Most people feel better within a week or two. If home care is not enough, doctors have several office-based treatments that are safe and effective.

Self-care at home

• Soak in a warm bath (sitz bath) for 10–15 minutes a few times a day, especially after bowel movements.
• Use unscented, soft toilet paper or wet wipes to clean gently.
• Apply a cold pack or ice wrapped in a cloth to reduce swelling and pain.
• Drink plenty of water and eat high-fiber foods like fruits, vegetables, and whole grains to soften stools.
• Avoid straining on the toilet. Take your time, but don't sit too long.
• Over-the-counter creams, ointments, or suppositories can help relieve itching and pain. Ask your pharmacist which product is safe for you.

Medical treatments

If home care isn't enough, a doctor may offer minimally invasive procedures. These include rubber band ligation, where a small band is placed around the hemorrhoid to shrink it; sclerotherapy, where a chemical solution is injected; or infrared coagulation, which uses heat to cut off blood flow. Your doctor will explain the options, but no specific drug or brand is recommended here.

When is surgery considered?

Surgery is only needed for a small number of people with very large or painful hemorrhoids that do not improve with other treatments. A surgical hemorrhoidecomy removes the hemorrhoid tissue and usually has a long-term success rate, though recovery can take a week or two.

Living with this condition

Most people manage hemorrhoids with daily habits. Keep bowel movements soft and regular with fiber and fluids, avoid long periods of sitting, and be gentle when cleaning the area. If you sit a lot at work, take short breaks to stand or walk.

Lifestyle tips

• Use a small cushion or padded ring when sitting to reduce pressure.
• Don't ignore the urge to go to the toilet.
• Stay active with regular walking or other gentle exercise.
• Manage your weight if needed.
• Avoid heavy lifting when possible, or lift properly and breathe out as you lift.

Diet and exercise

Eat plenty of fiber — aim for 25 to 30 grams a day from fruits, vegetables, beans, and whole grains. Drink enough water so your urine is light yellow. Regular exercise like brisk walking helps keep your bowels moving. If you use a fiber supplement, start slowly and drink even more water to avoid bloating.

Mental health and emotional wellbeing

Hemorrhoids can feel embarrassing and cause anxiety, especially when they cause bleeding or pain. It is normal to feel worried or self-conscious. Remember that hemorrhoids are a common medical condition, and doctors see them every day. Talking with your doctor can ease fear and help you get the right care.

Prevention

You can greatly lower your chances of getting hemorrhoids by preventing constipation and straining. Eat a high-fiber diet, drink enough fluids, exercise regularly, and go to the toilet as soon as you feel the urge. Also avoid sitting on the toilet for more than about 10 minutes.

Vaccines

There is no vaccine for hemorrhoids.

Screening programmes

There is no specific screening for hemorrhoids, but regular checkups with your doctor can help catch problems like constipation or colorectal conditions early. If you are over 50, you may be eligible for colorectal cancer screening, which can also reveal hemorrhoids.

Complications

If left untreated

• A blood clot can form inside an external hemorrhoid, causing a hard, painful lump called a thrombosed hemorrhoid.
• Straining from hemorrhoids can worsen constipation, leading to an anal fissure (a small tear in the skin) that also causes bleeding and pain.
• Rarely, long-term bleeding can lead to anemia (low iron levels).
• Most hemorrhoids do not become serious if untreated, but symptoms may become more uncomfortable.

Long-term outlook

For most people, hemorrhoids improve with simple treatment and home habits. Even when they do not go away, office procedures are highly effective and safe. Surgery works well for severe cases. With the right care, you can expect to return to your normal activities and stay symptom-free in the long run.

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