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Whether you consider them a fit topic for conversation or not, it's evident that people want information about hemorrhoids.
In Google's annual roundup of popular search terms, hemorrhoids was the top trending health issue in the United States for 2012. (The "top trending health issue" means that this particular search had the highest amount of traffic over a sustained period in 2012 as compared to 2011.)
According to the National Institutes of Health (NIH), these swollen and inflamed veins in the lower part of the rectum or anus affect 75% of people at some point in their lives. Hemorrhoids are most common in adults ages 45 to 65, and particularly for women during pregnancy and after childbirth. Obesity and a sedentary lifestyle are also contributors.
The Food and Drug Administration (FDA) is responsible for evaluating a number of products used to treat and remove the often itchy and sometimes painful protuberances.
What causes hemorrhoids? How are they treated? Are there preventive steps you can take to keep from having hemorrhoids yourself?
For the most part, hemorrhoids are caused by increased pressure in the veins of the anus. There are two kinds of hemorrhoids: internal (not covered by skin), which form inside the rectum, and external (covered by skin), located near the anal opening.
"You often can't see or feel the internal ones," says FDA medical officer Herbert Lerner, M.D., a colon-rectal surgeon. "But straining during bowel movements and constipation can cause these hemorrhoids to bleed and occasionally push through the anal opening." This is known as a protruding or prolapsed hemorrhoid, and it causes pain or irritation.
Sometimes blood pools in an external hemorrhoid and forms a clot, Lerner says, which can result in severe pain, swelling and inflammation. If the blood is dark red or black, you should call your health care professional, as it can be a sign of something more serious, he cautions.
Common symptoms of hemorrhoids include:
- itching and pain (especially when sitting);
- bright red blood on toilet tissue, stool, or in the toilet bowl;
- pain during bowel movements; and
- one or more hard, sore lumps near the anus.
There are a number of over-the-counter creams and other products that are available to patients with hemorrhoids. "These products may help you feel more comfortable," Lerner says, "but they won't get rid of the underlying hemorrhoids, such as internal hemorrhoids, that commonly cause bleeding."
According to FDA gastroenterologist Rajat Malik, M.D., other ways to relieve mild symptoms may include soaking regularly for 10 to 15 minutes in a warm bath, and using wet toilet paper after a bowel movement.
"With these measures, mild symptoms should decrease in two to seven days," Malik says "If your symptoms don't improve with these home treatments, and certainly if they get worse, it's time to talk to your health care provider."
If the hemorrhoid is thrombosed (there is a blood clot), your physician may decide to remove the clot with a small incision, Lerner explains. "You can do this under local anesthesia and as an outpatient," he says. "I've had a lot of uncomfortable, unhappy patients walk into my office with a thrombosis, and then leave happy after it's been excised."
Other procedures include ligation (cutting off the hemorrhoid's blood supply with a rubber band), sclerotherapy (the injection of a chemical solution into the hemorrhoid tissue to shrink it), and coagulation, which uses a laser or infrared light to harden and shrink hemorrhoids. "FDA is responsible for reviewing the devices used in both ligation and coagulation," Lerner says.
Large hemorrhoids may not be able to be treated with less invasive procedures such as ligation and sclerothapy, and may require surgery, known as a hemorrhoidectomy.
Of course with hemorrhoids, as with so many other ailments, prevention is key, Malik says. For the most part, the best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. Some ways to do this are:
- eating foods high in fiber, such as fruits, vegetables and whole grains;
- drinking plenty of fluids;
- exercising and not sitting for long periods of time;
- using stool softeners; and
- using fiber supplements.
Asked if he believes most people would rather search anonymously online for information about hemorrhoids than ask their doctors, Lerner says not necessarily. "Most people came to see me not because of the hemorrhoid itself, but because of the bleeding associated with it."
"By the time they came to see me, they were usually pretty uncomfortable," he adds. "They were more than happy to talk about hemorrhoids if it meant getting some relief."
This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.
Feb. 11, 2013