Learn about hemorrhoids and how to prevent them.


Hemorrhoidal veins are a normal part of human anatomy. We have hemorrhoidal veins both internally and externally, but people are usually unaware they have hemorrhoidal veins unless they become enlarged, painful, or swollen.

When this happens, you may be diagnosed with symptomatic hemorrhoids. In the United States, it is estimated that at least 4.4 percent of the general population have symptomatic hemorrhoids, and though usually harmless, they can be painful, inconvenient and cause bleeding.

A Brief History of Hemorrhoids

Hemorrhoids were first noted in 1975 when W.H. Thomson’s master thesis described "vascular cushions” based on anatomic and radiologic studies. Thompson found that the submucosa is not a continuous ring of thickened tissue but rather a discontinuous series of questions. Over the past 40 years, our understanding of hemorrhoidal anatomy has not changed substantially.

What Are the Symptoms of Hemorrhoids?

There are actually two types of hemorrhoids. Internal hemorrhoids are found inside the rectum and you normally won’t feel them because of the lack of nerves in that area. Symptoms of internal hemorrhoids include:

  • Blood on your stool, on toilet paper or in the toilet bowl
  • The presence of tissue that bulges outside anus that feels painful when you poop. These prolapsed hemorrhoids sometimes look like bumps that are brighter and pinker than the surrounding tissue.

External hemorrhoids usually present around your anus. Symptoms of an external hemorrhoid include:

  • Pain
  • Bleeding
  • Itching
  • Swelling

When hemorrhoidal veins become very large, they will often protrude after bowel movements or cause painless bleeding with bowel movements. Sometimes a clot can form in an external hemorrhoid which causes a painful lump around the anus. Called a thrombosis or a thrombosed hemorrhoid, they can cause itching, bleeding and pain.

How Are Hemorrhoids Diagnosed?

In many cases, your doctor does a visual exam of your anus and rectum to check for lumps, swelling, irritation or other problems. In other cases, your physician may have to physically examine the inside of your rectum to feel for problems.

Hemorrhoids are also diagnosed during a routine physical exam using a small scope called an anoscope. This is a small plastic or metal tool, about the size of an index finger, that has a small window or cut out that helps the healthcare provider visualize the inside of the rectum in order to see the internal hemorrhoids.

This exam is painless and helps determine the severity of the hemorrhoids, but this particular exam is not performed if the patient is having pain.
Oftentimes hemorrhoids are found during a colonoscopy, which is a test performed using a small camera to look inside the colon for polyps, inflammation, cancer or any other issues.

How Are Hemorrhoids Treated?

Hemorrhoid symptoms usually go away on their own, but depending on how severe your symptoms are, your doctor may come up with a specialized treatment plan.

Small hemorrhoids can be treated with lifestyle changes such as increasing water intake, increasing dietary fiber, avoiding prolonged sitting on the toilet or straining. Mildly enlarged hemorrhoids may also be treated with topical corticosteroids for short periods of time to reduce inflammation.

Larger hemorrhoids that protrude with bowel movements or bleed heavily can be treated with ligation, which is a quick, painless procedure that may be done in the office where rubber bands or sutures are placed on the internal hemorrhoids. This blocks off blood supply to the hemorrhoids causing the excessive part of the hemorrhoids to slough off.

Because ligation only removes part of the hemorrhoid, this procedure may need to be repeated every 3 to 4 weeks if bleeding or protrusion of the hemorrhoids occurs.

If the hemorrhoids are too large for the above treatments, they may be removed surgically. This is a quick outpatient procedure performed while the patient is asleep under sedation.

The recovery can be painful, but the benefit is the hemorrhoids do not grow back after this procedure.

How Can I Prevent Hemorrhoids?

Why we get hemorrhoids is a complicated topic. Sometimes you’re more likely to develop hemorrhoids if close family members had them, but straining during bowel movements or straining while lifting something heavy could be a cause.

Pregnancy can cause additional pressure on your veins, as does being overweight. A lack of fiber and anal sex can cause hemorrhoids as well.

Drinking plenty of water and eating plenty of fruits, vegetables and other foods high in fiber is helpful in preventing hemorrhoids.

Avoiding constipation, straining during the bowel movement or sitting on the toilet too long can also help in preventing hemorrhoids or the severity of symptoms.

While hemorrhoids are rarely dangerous, you may need to call your INTEGRIS healthcare provider if symptoms last longer than a week or if bleeding occurs to make sure you don’t have a more serious condition.

Find a Doctor

Whether you are looking to find a physician to support you with a chronic illness, or you simply need to make a change in your primary care doctor, you want a physician you can trust and who is close to home. At INTEGRIS Health you get both.