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WHAT IS IT?
Hemorrhoids-swollen veins inside or outside the anus-often called “varicose veins of the anus and rectum”-are one of the most common health problems. Fifty to 75 percent of all Americans get hemorrhoids in their lifetimes. Although hemorrhoids can appear at any age, people usually tend to get them after age 30. They are also more common among pregnant women.Hemorrhoids can be uncomfortable and sometimes painful but are pretty harmless. They never lead to serious disease. Be aware, though, that some hemorrhoid symptoms such as bleeding can be similar to those of more serious problems like colon cancer. If you notice bleeding from the anus or other symptoms, don’t rely on over-the-counter medications to clear them up. Be sure to see a doctor at the first sign of bleeding or if your hemorrhoids don’t go away.
Most of the time, hemorrhoid pain and itching lingers for a few days. Often, symptoms come back. But hemorrhoids usually improve with better bowel habits and home treatment. You should know, too, that other anorectal problems-like fissures, abscesses, and general irritation and itching-are often confused for hemorrhoids.
WHAT IS HAPPENING?
The blood vessels lining the anus sometimes become enlarged, often from forcing bowel movements during bouts of constipation. The result may be a hemorrhoid, a swollen vein in your anus. These veins are thin-walled and rupture easily if you pass a hard stool.
Hemorrhoids can be either internal or external. Internal hemorrhoids are inside the anus, although they can sometimes thrust out from the opening. They tend to bleed but are usually painless. External hemorrhoids, also known as piles, develop under the skin at the entrance to the anus. As an external hemorrhoid swells, the overlying skin stretches. If blood in the hemorrhoid clots, you might feel severe pain.
WHAT CAUSES IT?
The exact cause of hemorrhoids is unknown. One factor may be our normal upright posture, which can put enough pressure on the veins of the rectum to make them bulge. Other factors are known to contribute, some of which you can’t do anything about but many that you can control.

THINGS YOU CAN’T CHANGE

Age
It is unclear why, but your risk gets higher as you get older.

Family history
In some families, many members have problems with hemorrhoids, perhaps because they have inherited a weakness in the walls of the rectal veins.

Pregnancy
Pressure on the rectal veins from a growing fetus, as well as hormonal changes during pregnancy, can lead to hemorrhoids.

Loss of anal muscle tone
You lose anal muscle tone naturally as you age. But rectal surgery or episiotomy (cutting the opening of the birth canal to widen it for childbirth) can also weaken the anus.

THINGS YOU CAN CHANGE

Laxative or enema abuse
If you use laxatives or enemas too often, it can lead to faulty bowel function, which increases the risk of hemorrhoids.

Chronic constipation or diarrhea
The most common cause of hemorrhoids is straining to move your bowels because of constipation or diarrhea, both of which can be related to your diet.

Prolonged standing or sitting
Standing or sitting for long periods of time puts pressure on the veins in the rectum.

Obesity
Extra weight can put additional pressure on the rectal veins.

Physical strain
Work that requires lifting, especially of heavy objects, can put strain on your rectal veins.

Breathing
Holding your breath during physical exertion puts pressure on the veins in the rectum. (If you grunt when you lift something heavy, you’re holding your breath.)

Unhealthy bowel habits
Spending a long time on the toilet or not allowing enough time for a bowel movement- both are unhealthy habits that can lead to hemorrhoids.
WHAT YOU CAN DO FOR YOURSELF
You can make many easy changes in your lifestyle to prevent hemorrhoids, or to keep them from coming back. Even when these changes don’t work, home treatment can almost always control the problem and ease your symptoms.

To prevent hemorrhoids:
Eat plenty of high-fiber foods (fruits, vegetables, beans, bran cereals, and whole grain bread) to produce soft, easily passed stools. Increase fiber in your diet slowly so that you don’t get diarrhea. (If you are pregnant, consult your doctor before changing your diet.)
Drink lots of liquids such as water or fruit and vegetable juices (at least eight glasses a day).
Don’t strain during bowel movements.
Make a regular time in your daily routine for your bowel movement(s). Don’t sit on the toilet for more than five to ten minutes at a time.
Take frequent breaks if you have a sit-down job. Long stretches of sitting reduce blood flow around the anus and may lead to hemorrhoids.
Get as much exercise as possible. Walking is great because it helps reduce constipation.
Try ginger; some people find it helps reduce hemorrhoid inflammation and pain. Add a little ginger to soup or make tea using ginger.
To treat hemorrhoids:
Sit in warm (not hot) water for 10 to 15 minutes many times a day. Called a sitz bath, this is especially useful right after a bowel movement.
Bathe regularly to keep the anal area clean, but be gentle. Too much scrubbing, especially with soap, can worsen burning and irritation.
Dab petroleum jelly just inside the anus to ease bowel movements and make them less painful.
Soak a cotton pad in witch hazel and apply for temporary relief.
Wipe gently. Dampen your toilet paper first, or use cotton balls or alcohol-free baby wipes.
To ease pain, apply a cold compress many times a day.
Resist the urge to scratch hemorrhoids; you’ll make the pain and itching worse.
Ask your doctor about hemorrhoidal creams or suppositories to relieve pain and itching.
WHAT YOUR DOCTOR CAN DO FOR YOU
Your doctor can perform a rectal exam to find out if you have hemorrhoids. If you do have hemorrhoids, you should drink lots of water and get plenty of fiber in your diet. If you change your diet but are still constipated, your doctor can prescribe a special type of laxative called a stool softener. Avoid other laxatives; they may become habit-forming.

Your doctor may also suggest a suppository or ointment containing hydrocortisone to relieve pain, itching, and swelling if you have internal hemorrhoids. But use these drugs only for a short course. If you take them for too long, they can thin the anal skin and make the area more prone to injury.

If your hemorrhoids don’t clear up on their own, your doctor may suggest one of the following outpatient treatments:

Rubber band ligation
This in-office treatment is widely used for protruding or bleeding internal hemorrhoids. The doctor slips a small rubber band around the base of the hemorrhoid. The band cuts off the hemorrhoid’s blood supply so it shrivels up. This procedure can be slightly uncomfortable and several treatments may be needed.

Sclerotherapy
The doctor injects a chemical solution around the blood vessel to shrink internal hemorrhoids. This treatment works well, above all for small bleeding hemorrhoids. Repeat treatments may be needed every few months or years.

Infrared photocoagulation
One of the newest outpatient procedures, photocoagulation removes internal hemorrhoids by burning them with infrared light.

Laser coagulation
All but the most severe internal hemorrhoids can be treated with this safe, effective, and painless method. An electric current is applied to the hemorrhoid to shut down its blood supply so it shrinks up. Some people choose this treatment because no recovery time is needed; they can return home or to work right afterward.

Hemorrhoidectomy
More severe internal or external hemorrhoids may need this surgery, in which a surgeon cuts away hemorrhoids with a scalpel. The surgeon may or may not close the wound after removing the hemorrhoid. Pain may last for two weeks after surgery. Hemorrhoidectomy is the most effective way to permanently remove hemorrhoids.