I've got hemorrhoids and it's painful. What's causing it? What can I do for some relief?

Christopher J. Bruce, M.D. is a Colorectal Surgeon and the Chief of Surgery at Mercy Suburban Hospital in East Norriton. 

First and foremost, hemorrhoids should not be embarrassing.  Hemorrhoids are part of the normal anatomy and everybody has them. When people complain of "hemorrhoids", they are referring to symptoms in the perianal area. Hemorrhoidal symptoms are one of the most common ailments affecting humans.  Almost everyone will develop hemorrhoidal symptoms at some time in their life, while a smaller percentage will develop chronic symptoms. Although hemorrhoids are not life threatening, they can certainly interfere with one's quality of life.

Hemorrhoids are vascular cushions comprised of a network of arteries and veins that occur just inside and outside of the rectum. Their function is largely unknown, but they act like cushions and might have a role in the passage of stool. Hemorrhoids can occur inside the rectum (internal hemorrhoids) or outside (external hemorrhoids), and they differ in their symptoms and treatment.

Internal hemorrhoids don't have sensory nerves and therefore result in painless bleeding with bowel movements. The blood is often bright red and the blood is visualized on the tissue paper and in the commode. If the attachments of the internal hemorrhoids to the rectal wall weaken over time, the hemorrhoids can protrude, also known as prolapse. Prolapsing hemorrhoids will either reduce back inside by themselves or in their later stages, require one to manually push them back inside.

External hemorrhoids have a rich nerve supply and often present as a painful swelling, known as thrombosis. The pain typically lasts a few days and slowly subsides. Bleeding can occur once the swelling softens; the blood is often dark and occurs without bowel movements.

Once hemorrhoidal problems begin, relief can often be achieved by soaking in warm water either in a bathtub or Sitz bath, applying a topical cream or suppository, moist wiping, and dietary management.  Warm water, sometimes with Epsom salts, can relax the anal sphincter and relieve spasm and pain. Over the counter creams and suppositories often contain a topical anesthetic (lidocaine, pramoxine) to relieve pain and a steroid (hydrocortisone) to reduce swelling.  A variety of medicated wipes are also available.

There are many risk factors for the development of hemorrhoidal symptoms, but it is generally believed that hemorrhoids are caused or exacerbated by constipation and straining. It is recommended that individuals suffering from hemorrhoidal symptoms soften their stools by increasing their dietary fiber and fluid intake. Fiber should be increased slowly to avoid abdominal bloating and gassiness. Drinking plenty of fluids, and possibly taking stool softeners, can also help keep the stools soft and easier to pass.

There are many new techniques to treat hemorrhoids that are not painful, and fear or embarrassment should not prohibit patients from seeing a physician.

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