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Patient Education

Hemorrhoids

What are hemorrhoids?

Hemorrhoids are veins in your lower rectum and anus that have become swollen. They may develop in the skin surrounding the anus (external hemorrhoids) or inside the rectum (internal hemorrhoids).

The majority of adults will experience occasional hemorrhoids.  They are usually caused by increased pressure from straining during bowel movements, pregnancy, or being overweight.

Gastroenterology Consultants of San Antonio - Hemorrhoids

Hemorrhoids

In this figure A represents an internal hemorrhoid, B represents an external prolapsed hemorrhoid, C is a mixed hemorrhoid (both internal and external), D is a thrombosed hemorrhoid and E is an external hemorrhoid.
In this figure A represents an internal hemorrhoid, B represents an external prolapsed hemorrhoid, C is a mixed hemorrhoid (both internal and external), D is a thrombosed hemorrhoid and E is an external hemorrhoid.

Types of Hemorrhoids

Internal Hemorrhoids – When hemorrhoids develop inside the rectum.

External Hemorrhoids – When hemorrhoids develop on the exterior skin around the anus.

Thrombosed Hemorrhoids – Some hemorrhoids may develop blood clots (thrombosis) known as thrombosed hemorrhoids.  Thrombosis can occur in internal and external hemorrhoids. External thrombosed hemorrhoids develop hard lumps that are often blue or purple in color.  These may cause the skin around the anus to become further inflamed and cause extreme pain.

Hemorrhoid Symptoms

The symptoms of hemorrhoids may be different depending on the type.  It is possible to have different types of hemorrhoids at the same time.

  • Irritation in and around the anus
  • Pain or discomfort
  • Itching
  • Swelling around the anus
  • Protrusion around the anus (hemorrhoid)
  • Inflammation
  • Hard lump near the anus
  • Bleeding (may be painless and during bowel movements)

Hemorrhoid Causes

Hemorrhoids are most often caused by:

  • Straining to pass stools
  • Being obese
  • Being pregnant
  • Lack of fiber in diet
  • Sitting on the toilet a long time
  • Chronic constipation or diarrhea
  • Anal intercourse
  • Heavy lifting on a regular basis

As you get older, your risk of developing hemorrhoids increases. The support tissues around the rectum and anus can stretch and weaken as you age or if you become pregnant.

Diagnosing Hemorrhoids

External hemorrhoids may be visible to your doctor. To diagnose internal hemorrhoids, your doctor may examine the rectum and anal canal.  This may include inserting a gloved finger or performing a sigmoidoscopy or colonoscopy.

Hemorrhoid Treatment

Home remedies for hemorrhoids

Mild pain and swelling from hemorrhoids can often be relieved with home remedies.  Some home remedies for hemorrhoids include:

Eating high-fiber foods

Eating more whole grains, fruits, and vegetables can help soften stools.  Softer stools will reduce straining which can make symptoms of existing hemorrhoids worse.

The average adult should consume 20 to 35 grams of fiber per day.  If you currently eat a low-fiber diet, consider adding fiber slowly to avoid problems with gas.

Several fiber supplements are available at most grocery and drug stores.  These include psyllium seed (Metamucil®), methylcellulose (Citrucel®), and calcium polycarbophil (Fibercon®)

You can use fiber supplements alone or with food and they are safe to use every day. Fiber supplements are non-habit forming and may be used for your entire life.

Click to expand dietary fiber table

Provisional dietary fiber table

Food Fiber g/serving

Fruits

Apple (with skin) 3.5/1 medium-sized apple
Apricot (fresh) 1.8/3 apricots
Banana 2.5/1 banana
Cantaloupe 2.7/half edible portion
Dates 13.5/1 cup (chopped)
Grapefruit 1.6/half edible portion
Grapes 2.6/10 grapes
Oranges 2.6/1 orange
Peach (with skin) 2.1/1 peach
Pear (with skin) 4.6/1 pear
Pineapple 2.2/1 cup (diced)
Prunes 11.9/11 dried prunes
Raisins 2.2/packet
Strawberries 3.0/1 cup

Juices

Apple 0.74/1 cup
Grapefruit 1.0/1 cup
Grape 1.3/1 cup
Orange 1.0/1 cup

Vegetables, Cooked

Asparagus 1.5/7 spears
Beans, string, green 3.4/1 cup
Broccoli 5.0/1 stalk
Brussels sprouts 4.6/7-8 sprouts
Cabbage 2.9/1 cup (cooked)
Carrots 4.6/1 cup
Cauliflower 2.1/1 cup
Peas 7.2/1 cup (cooked)
Potato (with skin) 2.3/1 boiled
Spinach 4.1/1 cup (raw)
Squash, summer 3.4/1 cup (cooked, diced)
Sweet potatoes 2.7/1 baked
Zucchini 4.2/1 cup (cooked, diced)

Vegetables, Raw

Cucumber 0.2/6-8 slices with skin
Lettuce 2.0/1 wedge iceberg
Mushrooms 0.8/half cup (sliced)
Onions 1.3/1 cup
Peppers, green 1.0/1 pod
Tomato 1.8/1 tomato
Spinach 8.0/1 cup (chopped)

Legumes

Baked beans 18.6/1 cup
Dried peas 4.7/half cup (cooked)
Kidney beans 7.4/half cup (cooked)
Lima beans 2.6/half cup (cooked)
Lentils 1.9/half cup (cooked)

Breads, pastas, and flours

Bagels 1.1/half bagel
Bran muffins 6.3/muffin
Cracked wheat 4.1/slice
Oatmeal 5.3/1 cup
Pumpernickel bread 1.0/slice
White bread 0.55/slice
Whole-wheat bread 1.66/slice

Pasta and rice cooked

Macaroni 1.0/1 cup (cooked)
Rice, brown 2.4/1 cup (cooked)
Rice, polished 0.6/1 cup (cooked)
Spaghetti (regular) 1.0/1 cup (cooked)

Flours and grains

Bran, oat 8.3/oz
Bran, wheat 12.4/oz
Rolled oats 13.7/1 cup (cooked)

Nuts

Almonds 3.6/half cup (slivered)
Peanuts 11.7/1 cup

Reproduced with permission from the American Gastroenterological Association. Kim, YI, Gastroenterology

Hemorrhoid creams

Over-the-counter hemorrhoid creams or suppositories containing hydrocortisone may help. These options may help temporarily relieve pain, itching, and inflammation.

Warm Sitz Bath

Soak the rectal area in warm water for 10 to 15 minutes two to three times a day.

Laxatives

If increasing fiber intake doesn’t relieve constipation, or if the side effects are not tolerable, your doctor may recommend a laxative.
Some may be concerned that laxatives may increase the risk constipation in the future or that they will become constipated when laxatives are stopped.  There is little to no evidence to support these claims. In fact, using laxatives may help reduce long-term problems with constipation.

Oral pain relievers

Acetometifin (Tylenol), aspirin, or ibuprofen (Advil, Motrin IB) may help temporarily reduce pain and discomfort.

Minimally Invasive Hemorrhoid Relief

If home remedies for hemorrhoids haven’t worked, you may consider minimally invasive treatment options. These procedures are used for internal hemorrhoids and are usually performed in out-patient settings.

Hemorrhoid Banding (Rubber Band Ligation)

Hemorrhoid banding is a painless, 5-minute and nonsurgical solution to aggravating hemorrhoids.

Using a special applicator, we’ll place a small rubber band around the base of the hemorrhoid, restricting its blood supply. This doesn’t cause pain because there aren’t any nerves at the base of the hemorrhoid. Over the next few days, the hemorrhoid will shrink and eventually fall off during a bowel movement. You may not even notice it.

The procedure only takes a few minutes, can be performed in a doctor’s office and allows you to return to your life immediately. Plus, our specialists and staff will provide you with a comfortable, professional experience. We understand the sensitive nature of this condition, and we’ll make every accommodation necessary to ensure your privacy.

Read more about hemorrhoid banding…

Laser, infrared, or bipolar coagulation

These techniques use a laser or infrared light or heat to treat hemorrhoids.  They cause the hemorrhoids to harden and shrivel. Coagulation may have fewer complications than rubber band ligation. However, recurrence rates may be higher than with rubber band ligation.

Sclerotherapy (Injection)

During sclerotherapy, the physician injects a chemical solution into the hemorrhoid.  This causes the hemorrhoids to shrink and form a scar. Sclerotherapy may be less effective than rubber band ligation.

Hemorrhoid Surgery

Most people will find hemorrhoid relief with home remedies or minimally invasive procedures.  However, some people will continue to have discomfort from large or severe hemorrhoids, and your doctor may recommend removing them surgically.

Hemorrhoidectomy

Surgical removal of hemorrhoids is known as a hemorrhoidectomy.  It is the procedure of choice for patients with large, internal hemorrhoids. A hemorrhoidectomy involves removing excess tissue that causes bleeding and is successful in 95% of patients.  General or spinal anesthesia are most common with a hemorrhoidectomy.

Patients may experience pain after the procedure which can usually be treated with medication during the recovery period.

Complications of hemorrhoid surgery include rectal bleeding, difficulty emptying the bladder or bowels, or a bladder infection.

Hemorrhoid Prevention

Keeping your stools soft and avoiding straining during bowel movements is the best way to prevent hemorrhoids.  Here are some tips for hemorrhoid prevention:

Eat high-fiber foods: Adding more whole-grains, fruits, and vegetables to your diet will soften stools and increase bulk.  This may help reduce straining, which can cause hemorrhoids.  However, you should add fiber to your diet slowly to reduce the chances of excess gas.

Stay hydrated: Drinking plenty of water and other fluids (other than alcohol) throughout the day will help keep your stools soft.  Six to eight glasses of water per day is sufficient for most people.

Consider fiber supplements:  Most people don’t get enough fiber through their diet.  The recommended amount of fiber is 20 to 30 grams per day.  If you’re not getting enough fiber in your diet, consider taking an over-the-counter fiber supplement.

Drinking plenty of water is important when taking fiber supplements.  Taking fiber supplements without adequate fluid intake could cause constipation or make it worse.

Don’t strain: Holding your breath or straining when trying to pass a stool can cause hemorrhoids to form.

Go when you feel the urge: Waiting to pass a bowel movement could cause the stool to dry out and become hard to pass.

Stay active: Even moderate exercise such as walking can help prevent constipation that leads to hemorrhoids.  Staying active may also help with losing excess weight, which could be affecting hemorrhoid development.

Avoid sitting for long periods: Sitting for too long, especially on the toilet, increases the pressure around the anus and contribute to hemorrhoids.


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