Hemorrhoid Types, Symptoms, Causes and Treatments

Hemorrhoids are painful veins located inside or outside the anus. They are often caused by straining during bowel movements, constipation, pregnancy, or sitting too long. The pain associated with hemorrhoids can range from mild discomfort to severe bleeding.

After the age of 50, about half of the US population suffers from hemorrhoids. That’s a staggering statistic, and what’s more amazing is that the majority suffer silently because of the embarrassing nature of hemorrhoids.

You are not alone and there are solutions to stop the pain and symptoms that come along with hemorrhoids.

This article will take a look at what hemorrhoids are, the symptoms, causes, and what treatment and prevention measures you can take. 

What are Hemorrhoids?

A hemorrhoid is an enlarged or inflamed vein in your rectum and anus. They are caused by increased pressure in the veins of your lower rectum.

Activities that may cause an increase of pressure in the rectum and lead to hemorrhoid development include:

  • Constipation, diarrhea or prolonged time on the toilet
  • Straining to have a bowel movement
  • Standing or sitting for long periods of time
  • Obesity
  • Heavy lifting
  • Pregnancy or childbirth
  • Genetics

Hemorrhoids usually cause symptoms such as bleeding, itching, pain, inflammation, and a feeling that something is stuck in the rectum. Some people may experience a mucus discharge from their anus or feces leaking through their rectum. Hemorrhoids aren’t usually life-threatening, and treatment options are readily available.

Symptoms and Different Types of Hemorrhoids

There are four different types of hemorrhoids based on location and characteristics:

1. Internal Hemorrhoids

Internal hemorrhoids are not painful because the internal anal cavity and the rectum lack the nerve endings that feel discomfort. Internal hemorrhoids typically cause some bleeding, even though it might not be painful.

Internal hemorrhoids tend to be smaller than external hemorrhoids and are more common.

2. Prolapsed Hemorrhoids

A prolapsed hemorrhoid is an internal hemorrhoid that has protruded through the anal opening. Prolapsed hemorrhoids aren’t usually painful, but they may be accompanied by symptoms such as itching, burning, or bleeding.

Hemorrhoids can become irritated and swollen. If they get stuck inside, this can be a medical emergency.

3. External Hemorrhoids

External hemorrhoids occur outside the anal canal. External hemorrhoids can be extremely painful because of the nerve endings in this region. You may still experience some bleeding with external hemorrhoids. However, you may also experience swelling, inflammation, and itching.

4. Thrombosed Hemorrhoids

A thrombosed hemorrhoid is a hemorrhoidal condition where a blood clot has formed inside of it. They are purple or bluish in color and form just below the skin in the veins running through the rectum or anus (the blood vessels). If it becomes inflame­d or irritated, the skin around the hemorrhoid can become red and very painful.  

Milder cases can be treated with sitz baths (warm baths), creams (hydrocortisone and lidocaine), and a change in dietary habits with an increase in fiber intake. If the hemorrhoids become too painful, they may be removed surgically. This is usually done by a colorec­tal surgeon who will drain or remove the hemorrhoid.

Hemorrhoid Diagnosis

A doctor will first want to ask questions about the patient’s symptoms, including their bowel habits:

  • Frequency of bowel movements
  • Consistency of bowel movements
  • Presence of blood
  • Difficulties with evacuation, like straining or having to apply pressure or insert a finger to help evacuate stool.

This will help to determine what might be causing the patient to experience the hemorrhoids.

First, a visual examination of the anus is performed by the doctor. He is looking for red or swollen veins, as well as any skin tags or skin lesions. The doctor may also conduct an internal examination. This is called a digital rectal exam (DRE).

The doctor uses a lubricated glove to feel for any abnormalities, including polyps, masses, narrowing, or anal fistulas. These exams should be capable of detecting external and thrombosed hemorrhoids.

If a patient is having trouble feeling his/her hemorrhoids during a digital rectal exam, then a more invasive exam may need to be performed. This is done using a scope: either an anoscope (an endoscope) or a colonoscope.

The scopes are lighted and flexible tubes that are inserted through the anal canal and then used to do a more extensive examination of the colon. Internal hemorrhoid and anal lesion evaluations are typically performed using anoscopes.

Colonoscopes are used for colonoscopies and are able to visualize everything from the beginning of the colon (where it meets the small intestine) to the end. Most colonoscopies in the U.S. are done under anesthesia.

Hemorrhoids often bleed when they become inflamed, so it’s important for you to identify the cause of the bleeding. Rectal bleeding can typically be a symptom of many other ailments, so a proper diagnosis is essential to rule out colon cancer and other serious illnesses. .

Hemorrhoid Treatment

Hemorrhoid treatment is basically geared towards alleviating the pain and discomfort that someone might be feeling. A doctor will often start with more conservative treatment methods, and as the situation becomes more complicated, more extensive treatments will be used.

For mild cases, treatment would start with sitz baths and over-the-counter creams. A sitz bath consists of soaking in a tub filled with warm water for about 10 minutes. After taking a sitz bath, it is important to make certain that the area has been thoroughly dried to reduce the potential for future irritation.

An over-the-counter suppository or topical hemorrhoid cream can also be used to relieve pain and itching. It typically contains an anti-inflammatory steroid such as hydrocortisone or pramoxine. There are also topical medications (lidocaine creams) that can help to relieve the pain associated with hemorrhoids. These types of treatments will help give a patient relief as the hemorrhoids heal themselves.

Eating a high fiber, drinking plenty of water and exercising regularly, as well as taking stool softeners/lactulose if necessary, can help prevent hemorrhoids from occurring and reduce their severity when they occur.

There are some simple non-invasive procedures that can be done for recurring hemorrhoids. Banding hemorrhoid surgery is one of the most common and least invasive procedures for treating hemorrhoids. Banding involves wrapping a small elastic band around the base of the hemorrhoid.

The band will cut off the blood supply to the hemorrhoid, so it will eventually dry up, die and fall off.  This may require multiple procedures because there are 3 columns of hemorrhoidal vessels in the anal canal.  

It can be an extremely effective procedure, but there’s a small chance of recurrence or other immediate complications like bleeding or pain.

Another very simple treatment method is sclerotherapy. Sclerotherapy is a procedure where chemicals are injected into the hemorrhoids to shrink them.

Laser treatments are the final simple non-invasive procedures. An infrared light provides a 1 to 2 second burst of light that cuts off blood circulation to the hemorrhoid, causing it to shrink. All of these are common procedures that can be done in a doctors’ office.

Depending on individual training and expertise, some of these procedures are performed either by gastroenterologists or by colorectal surgery specialists.

If none of the above treatments work for your hemorrhoids, then a more intense surgical procedure might be necessary. A hemorrhoidectomy is a surgical procedure that removes large or persistent hemorrhoids.

This surgery removes all of the hemorrhoidal tissue from the anus. The surgery can be performed under a local anesthetic, a general anesthetic (GA), or a spinal anesthetic (SA). It is usually performed as an outpatient day surgery procedure. After the surgery, there may be some mild discomfort which can be relieved with sitz baths and medication.

Hemorrhoid Prevention

Preventing hemorrhoid flare ups will actually help relieve some of the pain and discomfort from existing ones. Prevention is never popular. However, when it comes to hemorrhoid treatment, adopting a prevention mindset is critical to helping relieve existing and prevent future symptoms.

Hemorrhoids can sometimes be hereditary and can’t always be prevented, but these prevention tips will still help alleviate some pain and discomfort of frequent flare-ups.

  • Don’t delay when you feel an urgent need to go to the bathroom.
  • Increase daily fiber intake by modifying your diet and taking fiber supplements.
  • Drink plenty of fluids, especially water, to soften stools.
  • To keep your stools soft and regular, use stool softeners and o­smotic laxatives as necessary.
  • Don’t spend too long on the toilet.
  • Regular exercise has been proven to be linked to regular bowel movements.
  • Keep the anal area as dry and clean

Proper anal care plays a key role in reducing the pain and discomfort and can help you feel normal again. Following the tips above will help reduce and prevent the build up of stool in the large intestine which leads to constipation and straining to have a bowel movement.

Hemorrhoids Final Thoughts

If you suffer from hemorrhoids, know that you are not alone. Prevention techniques are your best tool for preventing future hemorrhoid development and easing the pain of existing ones.

Combining the prevention techniques with topical creams and sitz baths will give you both short-term and long-term relief.

Treating existing hemorrhoids with bandings, sclerotherapies, or lasers is also a relatively simple solution to your current problem. Surgical is the last solution for hemorrhoid removal.

For your own comfort and long-term mental and physical health, we recommend considering all of these prevention tips for their many positive side benefits.

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Hemorrhoids FAQs

What is the main cause of hemorrhoids?

Hemorrhoids are caused by straining during bowel movements. Hemorrhoids occur when veins become swollen and inflamed. They usually develop around the anus and rectum. Other causes include chronic constipation or diarrhea, and sitting for long periods of time on the toilet.

What foods trigger hemorrhoids?

Foods low in fiber can irritate the veins and cause swelling due to constipation. Chronic constipation can lead to hemorrhoids. Foods that are low in fiber include meat, bread, pasta, rice, milk, eggs, cheese, ice cream, and candy.

How do hemorrhoids go away?

There are a number of ways to treat hemorrhoids. In mild cases, an over-the-counter cream or suppository can work. Topical creams with hydrocortisone, pramoxine, or lidocaine are best. A sitz bath with warm water for 10-15 minutes will provide relief as well. 

Can hemorrhoids be caused by stress?

Stress is known to cause constipation and other problems that can contribute to hemorrhoid formation. Hemorrhoids are swollen veins in the rectum. They can be painful and cause bleeding when they become inflamed. A diet rich in fiber and exercise can help prevent hemorrhoids from forming.

How do you poop with hemorrhoids?

You can poop with hemorrhoids by using a stool softener. These products help soften the stool and make it easier to pass. There are different kinds of stool softeners, including fiber supplements, oat bran, psyllium seed husks, and aloe vera juice.

Do hemorrhoids block poop?

Hemorrhoids are swollen veins in the anus and rectum, so they can cause pain when passing stool and sometimes bleeding. It will feel like you won’t be able to poop. There are different kinds of hemorrhoids. Internal hemorrhoids occur inside the anal canal and external hemorrhoids occur outside the anal canal. External hemorrhoids are usually caused by straining during bowel movements. Internal hemorrhoids are often caused by constipation.

Julie C. Guider MyGoodGut

Medically reviewed by Julie Guider, M.D.

Dr. Julie Guider earned her medical degree from Louisiana State University School of Medicine. She completed residency in internal medicine at the University of Virginia. She completed her general gastroenterology and advanced endoscopy fellowships at University of Texas-Houston. She is a member of several national GI societies including the AGA, ACG, and ASGE as well as state and local medical societies.