GASTROINTESTINAL
Hemorrhoids
What are Hemorrhoids?
Hemorrhoids are swollen veins in and around anus. They can be inside (internal) the anus or outside (external) the anus, causing a bulge or lump under the skin. Hemorrhoids are a common complaint, seen both in the clinic and in the emergency department. They can be uncomfortable and itchy, to downright painful and cause other distressing symptoms like rectal bleeding.
What Causes Hemorrhoids?
Pressure! Hemorrhoids are caused by increased pressure to anal or rectal veins. This can be from straining too hard to have bowel movements (like when you're constipated), or having extra pressure from a big belly (pregnancy). The pressure causes blood to pool in one spot and this causes the vein to swell – almost like a water balloon being filled. Hemorrhoids are very common and not usually serious.
You might be at increased risk of developing hemorrhoids if you:
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Have chronic constipation or diarrhea (IBS, Celiac disease)
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Often strain to have a bowel movement or sit too long waiting for bowel movements
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Don't have enough fiber in your diet
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Suffer from obesity
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Engage in anal intercourse
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Are pregnant or have recently been pregnant
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Have a connective tissue disorder
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Suffer from heart and/or liver disease
Symptoms of Hemorrhoids
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A lump around your anus
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Pain or tenderness when you wipe or clean around your anus
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Itching around your anus
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Small amounts of blood after you've had a bowel movement (especially if you had to strain)
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Pain or discomfort inside the rectum
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Stool leakage
Prevention of Hemorrhoids
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POOP! Don't hold it in.
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Avoid straining! If you sit down for a bowel movement and you can't go, try again later. We really mean it when we say sh%# or get off the pot. Don't sit there too long reading or scrolling on Facebook or TikTok. Sitting on the toilet increases the pressure in the rectum... and what causes hemorrhoids? Pressure!
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Use of a bench (Squatty Potty or other type of step) helps to eliminate straining and helps you to better empty your bowel.
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Avoid constipation, but if you do get constipated, treat it promptly (see our section on constipation for tips and tricks)
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Don't lift items that are too heavy for you. This also creates pressure that can contribute to hemorrhoids.
Treatment of Hemorrhoids
Most mild cases of hemorrhoids can be treated at home with these tips +/- over the counter medications:
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Don't rub the hemorrhoids, this will cause irritation. Instead, gently dab the area with moistened toilet paper. Alternatively, use personal care/baby wipes or medicated pads like Tucks.
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Only use mild soaps, avoid those with dyes or perfumes in them.
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Keep your stools very soft so you don't have to strain. Eat more fiber, drink more water and/or try a stool softener like Restoralax once a day to achieve soft and regular stools.
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Sit in a warm bath 1-2 times a day for 15 minutes.
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Use over the counter hemorrhoid ointments like Preparation H. Speak to your pharmacist if you are unsure which one is best for you.
When to See a Doctor and What to Expect
You should see a doctor or nurse practitioner if:
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You have increased pain.
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You have increased bleeding.
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Your symptoms have not improved after 3 or 4 days of trying the tips listed above.
If you need to see a health care provider for your hemorrhoids, they will need to examine your anus and probably have to do a rectal exam. We know this isn't comfortable, but we have to see what is going on to know what the next steps are.
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You may have to be referred to a specialist if we decide your hemorrhoids are severe and require surgical assessment. Some people need to have hemorrhoid banding done (simple procedure) while others may require a hemorrhoidectomy (minor surgery).