• Ken D. Nguyen, MD

Hemorrhoids

Updated: Jul 4, 2018

Dr. Ken D. Nguyen is a gastroenterologist at Pacifica Digestive Health. He is also the President and was one of the co-founders of Pacifica Digestive Health. His clinical interests include screening and management of gastric cancer in Asian patients, viral hepatitis (including hepatitis B and hepatitis C), advanced liver disease and cirrhosis, colon cancer screening, and international medicine.


What are Hemorrhoids?


Hemorrhoids is a medical condition whereby the veins located in the anus and the lower rectum become swollen, causing discomfort, pain, and even bleeding.


What are the Symptoms of hemorrhoids?


There are certain signs and symptoms that you may have that could be due to hemorrhoid:

  • Being in pain and discomfort in the rectum and anus area

  • Having a lump near the anus that may be sensitive or even painful

  • Irritation or itching of in the anus area

  • Having painless bleeding during bowel movements.


What are the Different Types of Hemorrhoids?


There are two types of hemorrhoids that may effect you based on the location in which they are found. These two types include:

Types of Hemorrhoids (Credit: By WikipedianProlific and Mikael Häggström via Wikimedia Commons)
  • Internal hemorrhoids: These are hemorrhoids located inside the rectum, and they are normally not visible and not able to be felt. You may not have any discomfort as a result of these type of hemorrhoids. However, if you end up straining or irritating the region when passing stool, then this may damage the surface of the hemorrhoid and may cause it to bleed.

  • External hemorrhoids: These types of hemorrhoids are located under the skin surrounding the anus. Because they are external, they are more sensitive than internal hemorrhoid. Irritation of these hemorrhoids may cause itchiness and bleeding as well.


What are Causes of Hemorrhoids?


Some risk factors that may be associated with development of hemorrhoids include:

Hemorrhoid may worsen during pregnancy
  • Sitting down for long periods of time on the toilet

  • Obesity

  • Chronic constipation or diarrhea

  • Straining during bowel movements

  • Pregnancy

  • Lower-fiber diet

  • Anal intercourse

  • Heavy lifting


What are Complications Associated With Hemorrhoids?


  • Anemia: This is usually very rare but you may develop anemia with chronic bleeding from hemorrhoid. If this occurs, it is recommend that you underwent go endoscopy to evaluate for other causes of anemia besides hemorrhoids.

  • Strangulated hemorrhoid: If the blood supply to the internal hemorrhoid is suddenly cut off, then this may result in the hemorrhoid being strangulated which may cause severe pain.

  • Thrombosed hemorrhoid: This primarily occurs with external hemorrhoids where repeat irritation results in formation of blood clot (i.e. thrombus) in the hemorrhoid column. This may then result in a lot of pain, inflammation, swelling and a hard lump near the anus.


How Can Hemorrhoid Be Prevented and Treated?


Here are recommended lifestyle and dietary changes that help prevent as well as treat hemorrhoid:


A high fiber diet may help with hemorrhoid
  • High fiber diet: You should include more fruits, whole grains and vegetables into you diet as this helps with softening the stool and increases its bulk, which then helps avoid straining that may lead to development of hemorrhoids.

  • Drink plenty of fluids: In addition, you should drink a lot of water and other fluids, at least 6-8 glasses each day to help keep your stool soft.

  • Take fiber supplements: If you don't have enough fiber in your diet, you may alternatively consider taking fiber supplements to help bulk up your stool. This will also improve overall symptoms and bleeding from hemorrhoids.

  • Avoid straining: Straining, such as holding you breath, while having a bowel movement cause increased pressure in the veins located in the lower rectum and leads to hemorrhoid. Therefore, straining should be avoid and you should try to have an effortless bowel movement.

  • Go as soon as you feel the urge: It is advised that you have a bowel movement as soon as you have the urge to go, because the longer you hold your stool the more likely the stool will become dry and harder to pass.

  • Exercise: By exercising, you may be able to reduce the pressure on the veins that may occur due to sitting or standing for long periods of time. Losing weight also reduce risk of developing hemorrhoid. However, you should avoid heavy lifting with exercise as this may exacerbate or cause hemorrhoid.

  • Avoids sitting for long periods: Sitting for long periods of time, especially on a toilet, leads to increased pressure on the veins found in the anus and leads to hemorrhoid.


There are many over-the-counter medications, including topical creams and ointments, as well as home remedies that can be used to treat hemorrhoids. However, they are mainly used to relieve symptoms and may not be as effective as procedural treatment described below. Here are a few of them:


  • Taking a warm sitz bath several times a day.

  • Using ice packs to reduce the swelling.

  • Topical ointments: Some topical ointments may contain steroid and analgesics, such as combination hydrocortisone/lidocaine. They may relieve acute symptoms related to hemorrhoid but may have much long-term efficacy. Topical steroids, such as hydrocortisone cream or suppository, may shrink the hemorrhoid and reduce itching and irritation. However, its long-term use is not recommend as it may lead to thinning of the skin around the anus.


If the above lifestyle changes, dietary changes, over-the-counter medications, and home remedies still do not improve your hemorrhoids, your doctor may recommend the following procedures to help treat your hemorrhoids:


  • Band ligation: First, your doctor will exam you with an anoscope to visualize the anus and rectum looking for hemorrhoids and other abnormalities. Then using a banding kit, a rubber band is placed around the base of the hemorrhoid to cut off the blood supply. The hemorrhoid with wither away after a few days. The procedure can be repeated for multiple columns of hemorrhoid. This procedure is used to treat internal hemorrhoid. Hemorrhoid banding can be done in the office without any sedation, only takes a few minutes, and is the preferred method for treating hemorrhoid. Click here to learn more about hemorrhoid banding.

  • Endoscopic techniques: Hemorrhoid may also be treated with an endoscope, or a long flexible tube with tiny camera at the end. During the procedure your doctor may use various techniques such as freezing, electrical or laser heat, or infrared light to destroy the hemorrhoid tissue.

  • Sclerotherapy: This is when a chemical is injected into the vein which causes the blood supply of the hemorrhoid to be cut off.

  • Hemorrhoidectomy: A general surgeon, colorectal surgeon, or proctologist may surgically cut out the hemorrhoid (hemorrhoidectomy). This is typically done at an ambulatory surgery center or hospital. It does requires anesthesia and may carry a painful recovery.

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