Hemorrhoids are unfortunately an all too common ailment in the United States; according to the American Society of Colon and Rectal Surgeons, hemorrhoids are responsible for over two million outpatient doctor visits each year. And because the symptoms related to hemorrhoids are often similar to other conditions, many people fear they have hemorrhoids when they really don’t. One of the most well-known of these symptoms is anal itching, an unpleasant and sometimes embarrassing problem. But why does a case of hemorrhoids cause anal itching?

What Are Hemorrhoids?

While the term hemorrhoid is typically only invoked when there’s a problem, in actuality hemorrhoids are normal vascular structures that everyone has. Also known as piles, hemorrhoids are located in and around the anus and the anal canal. Most of the time hemorrhoids are essentially pillowy clusters of blood vessels that act as cushions that help with the passage of stool out of the rectum and through the anus. The blood vessels only become a problem when they get swollen or inflamed.

The condition of having inflamed or swollen hemorrhoids is called hemorrhoid disease, and it can be painful and can have a significant impact on defecation, regular hygiene practices, and overall quality of life. Hemorrhoids can be classified as internal or external, depending on where the swelling and inflammation present. Internal hemorrhoids are inside the lower rectum and typically don’t cause many symptoms; patients with internal hemorrhoids may not even know it’s a problem. External hemorrhoids are found just under the skin that surrounds the anus and can be seen and felt.

What Causes Hemorrhoids?

The precise cause of hemorrhoids is still unknown, but a number of risk factors have been identified that make inflammation and swelling more likely. Generally speaking, anything that puts pressure on veins in the area may potentially trigger an episode of inflammation. Below are some common risk factors for hemorrhoids:

  • sitting on the toilet for a long time
  • excessive straining during a bowel movement
  • chronic constipation or diarrhea
  • having a diet low in fiber
  • being pregnant
  • regularly lifting heavy objects
  • aging (especially between the ages of 45-65)
  • obesity

    Symptoms of Hemorrhoids

    Internal hemorrhoids won’t be visible, and may not even have any symptoms; however it’s possible for them to bleed and cause rectal bleeding that might be seen on toilet paper after defecating. In rare cases it is also possible for an internal hemorrhoid to prolapse and push through the anal opening. External hemorrhoids are visible and are likely to present as one or more hard lumps on the skin surrounding the anus. In addition to being painful (especially when sitting down), these lumps are usually itchy and tender. All of these symptoms may be worsened by straining during defecation or excessive cleaning and rubbing.

    Why Do Hemorrhoids Itch?

    Anal itching, technically referred to as pruritus ani, is a relatively common symptom that is associated with hemorrhoids and other skin conditions (like psoriasis or a yeast infection). The sensation of itchiness is a normal manifestation of the body’s inflammatory response, and it is part of how the body rids itself of stimuli that may be dangerous. In the case of itchy hemorrhoids, anal itching is just one of the symptoms that similarly results from the underlying swelling. Yet since itching isn’t always a symptom, there are several possible reasons for it might be present:

    • Inflammation: As with a skin condition like a rash, sometimes inflammation itself causes a feeling of itchiness.
    • Friction: When friction or rubbing is introduced to already swollen hemorrhoids, further irritation can result. Examples of sources of friction include toilet paper, clothing, or washcloths. Friction like this can cause a small blood clot that may leave behind a skin tag that can also become irritated.
    • Defecation: Obviously the presence of hemorrhoids doesn’t stop other normal bodily functions like defecation. Bacteria and other material in feces can irritate hemorrhoids and cause itching; this effect can be exacerbated by straining when constipated or by having additional bowel movements because of diarrhea.
    • Mucus: Both internal and external hemorrhoids can increase the production of mucus in the anus that may leak out; when it dries, it can cause itchiness in the area.

      As noted, though, hemorrhoids aren’t the only cause of anal itching, and it will likely require a visit with a gastroenterologist to accurately diagnose the origin. One common cause that is similar to hemorrhoids is anal fissures; in this condition, small tears in the skin of the anal area can easily become irritated and cause itchiness, pain, and bleeding. In other cases, especially if the itching is short-lived, there may be a dietary explanation; spicy foods, dairy products, and carbonated beverages are all possible causes of anal itching for some people.

      Hemorrhoid Treatment Options

      The majority of treatment options for hemorrhoids involve managing the symptoms until the swollen veins return to normal. For most people, this includes a series of home remedies and over-the-counter medications that relieve pain, itchiness, and inflammation:

      • Proper hygiene: Even aside from instances of inflamed hemorrhoids, it’s important to keep the anal area clean, especially after a bowel movement. If you don’t have access to a bidet, you can gently clean the anus with a damp towel or baby wipe. It’s important to not rub aggressively, and then pat the area dry afterwards.
      • Unscented soaps: Scented soaps and hygiene products contain chemicals that can add to the irritation of the area, so it’s best to avoid them and look for unscented varieties.
      • Sitz bath: Taking a sitz bath means filling a bathtub with a few inches of warm water—enough to cover the perineal area. The warm water can relieve both pain and itchiness.
      • Creams: Over-the-counter hydrocortisone cream can be rubbed gently onto the swollen hemorrhoids to reduce inflammation and improve various symptoms. Lidocaine cream is another option that numbs the area.
      • Suppositories: In some cases, hemorrhoid medication in the form of a suppository may be more helpful and is inserted directly into the anus.

        In more severe cases of hemorrhoids that don’t respond to other forms of treatment, a medical procedure or surgery may be necessary. One example is sclerotherapy, a chemical injection that is intended to shrink the hemorrhoid. Other options include electrical coagulation and a hemorrhoidectomy. One of the most common methods for treating internal hemorrhoids is hemorrhoid banding ligation; in this procedure, small rubber bands are placed around the hemorrhoid, interrupting the blood supply and causing the hemorrhoid to eventually fall off.

        Trust Cary Gastro for Hemorrhoid Banding

        Hemorrhoids can be a temporary nuisance or a cause of significant discomfort that can affect your quality of life. If you have been experiencing anal itching or any other symptom connected with hemorrhoids, you might want to contact a gastroenterologist. At Cary Gastro, we have extensive experience treating hemorrhoids with banding ligation, and we are dedicated to helping patients find relief as quickly as possible. If you’d like to learn more about the procedure and how we can help, please contact us today to request an appointment.