Though it’s not a very pleasant topic to think about, the fact is that hemorrhoids are one of the most common gastrointestinal problems. The National Institutes of Health (NIH) estimates that about 1 in 20 Americans will develop hemorrhoids at some point during their life. For most people, though, getting hemorrhoids is a temporary problem that isn’t much of a cause for concern. Sometimes the problem is more severe and the hemorrhoids cause rectal bleeding; in those cases, a more proactive treatment approach is usually necessary. 

What Are Hemorrhoids?  

Most people only associate the negative symptoms of hemorrhoids with the words, but the truth is that they are normal vascular structures that everyone has in their body. Also known as piles, hemorrhoids are located in and around the anus and anal canal. Under normal circumstances, these pillowy clusters of blood vessels function as a sort of cushion that makes it easier for stool to pass through the rectum and out the anus. It’s only when something goes wrong that they actually become a problem. 

So when people complain about having hemorrhoids, what they really mean is that the vein clusters in or around the anus have become inflamed or swollen. This kind of distension and inflammation can actually be very painful, and it also makes defecation and regular hygiene practices more difficult and additionally painful. The medical term for this condition is hemorrhoid disease, and it is somewhat similar to having varicose veins in that both conditions involve veins that have become swollen or inflamed. 

The two main types of hemorrhoids are classified as internal and external. Internal hemorrhoids, as the name implies, are located inside the lower rectum and are therefore not visible on the body. This type is usually not painful, and many people don’t even know that a problem exists. External hemorrhoids, by contrast, are located just under the skin surrounding the anus; this is the type with the symptoms most people associate with the condition. 

Sometimes, when external or internal hemorrhoids become swollen, blood begins to pool in the vein clusters. In this situation, a blood clot known as a thrombus can form in the hemorrhoid; that is why this third type is called a thrombosed hemorrhoid. Beyond the typical discomfort that goes with swelling and inflammation, thrombosed hemorrhoids are identifiable by the significantly higher pain they cause. Over time, the thrombosed hemorrhoid may also cause a hard lump to form in the tissue around the anus. 

Hemorrhoid Symptoms 

As noted above, internal hemorrhoids are not visible outside the body and tend not to cause much pain or discomfort; the main symptom is occasional rectal bleeding (which will show up on toilet paper or in the toilet bowl as bright red blood). External hemorrhoids, on the other hand, tend to cause anal itching in addition to aches or pain; it is also possible for hard lumps to form. Thrombosed hemorrhoids begin as “regular” hemorrhoids, and they can quickly become noticeable because of a sharp increase in the amount of pain as well as a related discomfort with sitting down. If bleeding occurs with external or thrombosed hemorrhoids, the blood will usually be darker than with the internal type. 

Why Do Hemorrhoids Bleed?  

Even though internal, external, and thrombosed hemorrhoids are all slightly different, one of the commonalities between them is possible bleeding as a symptom. Bleeding can occur for a variety of reasons, but the main reason is due to straining during a bowel movement; when swollen, inflamed hemorrhoids are subjected to excessive straining, the surface of the hemorrhoid can become damaged and start to bleed. This can also happen when a person is constipated and has dry, hard stools. Because of pressure from pooling blood, thrombosed hemorrhoids can actually burst and cause significant bleeding as well. 

Bleeding Hemorrhoids Treatment    

In almost all cases, the potential bleeding associated with hemorrhoids is due to damage of the swollen tissue; in other words, the bleeding can be traced to an action like straining during defecation or aggressive wiping. In that sense, bleeding hemorrhoids are treated in much the same way as any other hemorrhoid. Differences in treatment options have more to do with severity and duration of the inflammation. Below are some common at-home treatment options that can help ease the symptoms until the hemorrhoids go away: 

  • sitz bath with warm water and epsom salt 
  • wiping with moist towelettes rather than dry toilet paper 
  • sitting on ice packs wrapped in a towel can ease discomfort 
  • stay hydrated and ensure sufficient dietary fiber to help keep stools soft
  • stay physically active to help reduce the chances of constipation 
  • high fiber foods or fiber supplements (Metamucil) to make defecation easier 
  • over-the-counter pain medication like ibuprofen 
  • suppositories or stool softeners 

Sometimes, though, the hemorrhoids won’t really go away on their own and require medical care and more extensive treatment. This kind of greater care is usually needed for thrombosed hemorrhoids or hemorrhoids that are causing extreme, constant severe pain or significant bleeding. If you have symptoms like that, you should make an appointment with a gastroenterologist. Below are some medical treatment options doctors may employ to treat hemorrhoids: 

  • Rubber Band Ligation: Hemorrhoid banding ligation is one of the most effective treatments for hemorrhoids. This procedure involves placing a small elastic band around the base of the swollen vein cluster so that its blood supply is cut off. After about a week, the withered hemorrhoid will fall off. 
  • Sclerotherapy: Sclerotherapy seeks to achieve a similar effect as rubber band ligation, but it is done with a medicated solution. This solution is injected directly into the hemorrhoidal tissue, causing the vein walls to collapse and the hemorrhoid to shrink. In 7-10 days, the shrunken hemorrhoid will similarly fall off. 
  • Coagulation Therapy: Typically reserved for internal hemorrhoids, coagulation therapy uses infrared light to lase the hemorrhoid; the heat from the laser causes scar tissue to form that will eventually destroy the hemorrhoid. Only one hemorrhoid can be treated at a time, however, and the procedure can only be performed every 10-14 days. 
  • Electrocoagulation: Electrocoagulation is similar to coagulation therapy in that the goal is also to cut off blood flow so that the hemorrhoid will fall off. In this case, though, an electric current is sent into the hemorrhoid.  
  • Hemorrhoidectomy: When other methods are unsuccessful, the doctor may turn to surgical treatment. A hemorrhoidectomy involves surgically removing any hemorrhoid that has prolapsed or is especially large or complicated. 
  • Hemorrhoidopexy: Also known as hemorrhoid stapling, this procedure involves using surgical staples to return a prolapsed hemorrhoid to its normal position in the wall of the anal canal. Because the hemorrhoid isn’t actually being removed, it can be less painful and have a faster recovery time. 

Contact a Gastroenterologist 

Hemorrhoids can be nothing more than a mild nuisance, but sometimes they can turn into an incredibly painful malady that requires rapid treatment. Even though hemorrhoids are rarely dangerous, the disruption to daily life can become significant enough that medical intervention is the only path. 

If you have hemorrhoids that are bleeding or extremely painful, you should contact a gastroenterologist soon. At Cary Gastro, we are passionate about promoting good digestive health and helping improve the quality of life when a gastrointestinal problem arises. If you’d like more information about hemorrhoid banding ligation, or hemorrhoid treatments in general, reference our Hemorrhoid Center for more information, or request an appointment