Hemorrhoids 101

What They Are, Why They Happen, and How They’re Treated

The topic of hemorrhoids can be uncomfortable in more ways than one, but it is important to understand this very common medical condition.

What are hemorrhoids?

Hemorrhoids are when the normal tissues in and around your anus, which is at the end of your digestive tract, become swollen and bothersome. They can be on the inside of the anus (internal) or under the skin around the outside of the anus (external). They are common, affecting approximately 1 in 20 people. While they are rarely dangerous, they can negatively impact your quality of life.

What causes hemorrhoids?

The most common causes of hemorrhoids include chronic constipation or diarrhea, straining, pregnancy, and childbirth. These conditions all put pressure on your rectum and anus which can cause the tissues to swell up. Sitting on the toilet for too long can also cause hemorrhoids, even if your bowel movements are normal.

How you tell if you have hemorrhoids?

Common signs and symptoms of hemorrhoids include:

• Bright red blood on the toilet paper or in the toilet bowel with bowel movements
• Itching or pain around your anus
• A lump near your anus

While it may feel embarrassing, the best way to confirm that you have hemorrhoids is for a doctor to examine the affected area. Your primary care provider may refer you to a general surgeon who are experts at diagnosing and treating hemorrhoids. Sometimes an internal exam is required to see internal hemorrhoids. Depending on your age, the pattern of your symptoms, and your family history, your doctor may recommend a colonoscopy to make sure you don’t have colon cancer.

How are hemorrhoids treated?

Most people do not need a surgery for their hemorrhoids and will be able to shrink existing hemorrhoids and prevent new hemorrhoids by making lifestyle changes such as:

• Increasing your fiber intake by increasing vegetables and whole grains or by adding a fiber supplement. Fiber helps regulate your stools making them easier to pass.
• Avoiding foods that trigger your constipation or diarrhea
• Using stool softeners when constipated
• Staying active which helps your bowels move regularly
• Limiting time on the toilet (no phone or reading material)
• Using a step stool (“squatty potty”) to elevate your feet while on the toilet to reduce straining

It often takes 8-12 weeks of lifestyle changes to notice a difference. While you are working on these lifestyle changes, you can improve your symptoms by:

• Soaking in plain, warm water in the bathtub or a sitz bath (a warm, shallow soak you’re your buttocks) several times a day
• Using ice packs to decrease swelling
• Using over-the-counter creams to help with burning and itching

In some cases, surgery is needed. The most common types of procedures include:

• Rubber band ligation: A rubber band is placed at the base of an internal hemorrhoid to cut off circulation to the hemorrhoid and cause it to shrink. This is a quick procedure done by a general surgeon in their clinic.
• Hemorrhoidectomy: Surgical removal of external and/or large internal hemorrhoids. This is done by a general surgeon in the operating room.

Remember, while hemorrhoids can be uncomfortable and disruptive, they’re also incredibly common — and most people find relief with simple, consistent lifestyle changes. If your symptoms persist or worsen, talk with your primary care provider to figure out the next steps. Understanding what hemorrhoids are and how they’re treated can make the experience far less stressful and help you get back to feeling like yourself.

By Tessa Cattermole, MD, General Surgeon, Rutland General Surgery, a clinic of Rutland Regional Medical Center