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Veins and related structures in and around the ANUS that distend and swell. Hemorrhoids can be internal or external. An old term for hemorrhoids that remains in common use is piles, a reference to the appearance of external hemorrhoids. Hemorrhoids alone do not cause symptoms; about two thirds of adults in the United States have hemorrhoids. Hemorrhoids cause PAIN, itching, and bleeding when they become inflamed, develop BLOOD clots, or prolapse (protrude). Factors that contribute to symptomatic hemorrhoids include
- chronic CONSTIPATION and straining with BOWEL MOVEMENTS
- sitting on the toilet for extended periods of time, which reduces blood circulation
- low fiber diet, which results in small, hard stools that can be difficult to pass
- PREGNANCY, which pressures the pelvic floor and can affect perineal blood flow
- INFLAMMATORY BOWEL DISEASE (IBD)
The doctor can diagnose hemorrhoids via physical examination of the anal area, including DIGITAL RECTAL EXAMINATION (DRE) or anoscopy, when symptoms are mild. Treatment attempts to shrink and soothe the irritated tissues. Topical preparations containing an anesthetic agent and hydrocortisone can provide prompt, short-term relief. A SITZ BATH, or simply soaking in the bathtub, relaxes the anal sphincter enough to calm the spasms that prolapsed or thrombosed (clotted) hemorrhoids cause.
Dietary changes (such as increased fiber and fluids) combined with frequent physical activity (such as walking) help to reduce constipation, which relieves straining and pressure on the anorectal area. The doctor can ligate (band off), cauterize, freeze, or excise (cut out) hemorrhoids that fail to respond to conservative treatment approaches. In the vast majority of people, appropriate treatment and lifestyle modifications end symptoms.