Hemorrhoids – Symptoms, Diagnosis and Treatment


Hemorrhoids are clumps of large and swollen veins in the lowest part of the rectum and anus. The occurrence of hemorrhoids can be painful, but in most cases it is not. Hemorrhoids are usually temporary and rarely dangerous.

The tissue in the colon is interwoven with blood vessels involved in triggering bowel movements. Any additional pressure on that part of the digestive system can cause changes in the blood vessels, the most common one being the formation of hemorrhoids.

What Causes Hemorrhoids?

Increased pressure on the veins in the rectal area is the most common cause of hemorrhoids. As the pressure increases, the blood progressively accumulates in the veins and causes swelling. If the pressure is not reduced and if it lasts long enough, swollen and varicose veins spread at the expense of the surrounding tissue. At that point they form hemorrhoids.

The cause of hemorrhoids can be related to defecation habits, primarily:

  • hurry – excessive strain, pushing during bowel movements in order to be done with defecation as soon as possible puts pressure on the rectum
  • diarrhea or constipation – this may also put pressure on the colon or rectum

Other risk factors include:

  • obesity – excessive body weight, especially stomach fat tissue, exerts pressure on the pelvic area
  • pregnancy – hormonal changes in pregnant women cause increased blood flow to the lower parts of the body and tissue loosening. The fetus creates additional pressure. During labor the situation may worsen because of the short, yet intense pressure on the rectal area
  • chronic conditions – predominantly heart and liver diseases, the tendency to develop varicose veins; in addition to that, people with low blood pressure are somewhat more likely to get hemorrhoids than those with high blood pressure

Symptoms of Hemorrhoids, Internal and External Hemorrhoids

The occurrence of hemorrhoids becomes apparent when it causes blood in the stool, itching in the rectal area, and pain, if the hemorrhoid is particularly big.

We differentiate between internal and external hemorrhoids with regards to the area in which they appear. External hemorrhoids are visible and located on the wall of the rectum. Internal hemorrhoids are located in the rectal canal. They both cause bleeding during bowel movements. A small trail of blood on the toilet paper or in the stool signals the possibility of hemorrhoids.

Aside from bleeding these are the most common and usually the first symptoms to appear:

  • itching – because internal hemorrhoids press the surrounding tissue causing irritation
  • a sensation that the bowel is not really empty – a phenomenon which causes you to feel like you did not get it all out of your system even after the defecation. This uncomfortable feeling occurs when the hemorrhoid develops under the skin that surrounds the anus and the larger it is, the stronger the feeling that the bowel movements are not fully completed.
  • pain – in most cases, hemorrhoids are painless; however, third-degree or fourth-degree hemorrhoids may cause painful bowel movements (there are 4 hemorrhoid types/degrees when it comes to size, the first one being the smallest, and the fourth being the largest and most serious)


Based on the reported symptoms and a medical exam, the doctor reccomends treatment. Taking into consideration that the symptoms of colon cancer are similar to the symptoms of hemorrhoids (bleeding and severe pain), if the patient is older than 50 years or is at risk of colon cancer, the doctor will reccomend further examination, usually in the form of colonoscopy.


Hemorrhoid Treatment

For the treatment of smaller hemorrhoids introducing some changes into the diet and the defecation habits should be enough. Most do not need surgery and the treatment of hemorrhoids comes down to lifestyle changes.

First Step: Proper Nutrition

  • eat a lot of fiber – (foods with whole grains such as whole wheat bread and cereal, dried fruit, legumes)
  • avoid junk food that does not contain nutrients nor fibers, eg. ice cream, soft drinks, white bread
  • drink plenty of water, 8 to 10 glasses a day. Avoid too much caffeine and alcohol because they can lead to constipation
  • natural stool softeners can be useful if you have hard stool. The most commonly recommended natural products contain psyllium. Avoid laxatives because they can cause diarrhea and irritate the hemorrhoids so as to worsen the situation.
  • avoid too much spicy food

Hemorrhoids, diet and activity

Moderate physical activity in combination with a diet rich in fiber may be sufficient to address the first-degree hemorrhoids.


It is recommended to go to the toilet as soon as you feel the urge, do not wait too long because it puts pressure on the rectal area.

Avoid excessive straining, relax and let things run their natural course. Do not hold your breath while performing bowel movements.

Sitting for long periods

If you tend to spend a lot of time sitting, try to take breaks so that every once in a while you take a little walk; sitting for longer periods is good neither for preventing hemorrhoids nor health in general.

If these mild and preventive changes in habits have not led to the disappearance of hemorrhoids, especially when it comes to third- and fourth-degree hemorrhoids, then it is on to one of the following methods for efficient removal.

Rubber band ligation (Barron ligature)

This is the most common method for removing hemorrhoids and it works in about 75% of patients. It is performed in the doctor’s office. Rubber rings or strips are placed around the top of the internal hemorrhoid. This prevents blood flow to the hemorrhoid which is then reduced and it eventually completely shrinks and falls off.

Operative Treatment of Hemorrhoids

Very large hemorrhoids require surgery. The success rate of this type of surgery is a high 95%. There are various surgery techniques which differ in the amount of cutting. A brand new technique, the THD, is the least invasive.

Hemorrhoids – Creams and Ointments

Both the cream and ointment for hemorrhoids contain active agents that are applied directly to the problem area in order to mitigate the problem and stop the pain. When the hemorrhoids are accompanied by bleeding, it is necessary to use a milder cream to avoid irritation. The cream can be applied with fingers or with a cotton ball.

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