Hemorrhoids are caused by increased pressure in the veins of the anus. The most common cause is straining during bowel movements. Constipation, prolonged sitting during bowel movements, and anal infection are contributing factors. Internal hemorrhoids occur near the beginning of the anal canal, and external hemorrhoids occur at the anal opening. Hemorrhoids may protrude outside the anus. They are very common, especially during pregnancy and after childbirth. The incidence is 2 out of 1000 people.

• rectal bleeding
• rectal bleeding after bowel movements
• bright red blood in the stool
• pain during bowel movements
• anal itching

Rectal examination may be sufficient to diagnose hemorrhoids.

• stool guaiac shows the presence of blood.

Tests that reveal hemorrhoids include:

• sigmoidoscopy
• anoscopy
• proctoscopy

Mild cases are controlled by drinking fluids, adhering to a high-fiber diet, and the use of stool bulking agents, such as Metamucil. Corticosteroid creams help reduce pain and swelling. Procedural treatments consist of rubber band ligation, or surgical hemorrhoidectomy. These procedures are generally indicated in patients with severe hemorrhoidal disease, with pain or bleeding, who have not responded to conservative therapy.

Most treatments are effective, but recurrence is possible if a high-fiber diet with adequate fluids is not adhered to after treatment.

Hemorrhoids can become thrombosed-the blood in the enlarged veins clots, and the tissue surrounding the hemorrhoids necroses (dies). Thrombosed hemorrhoids generally require surgical hemorrhoidectomy.

Iron deficiency anemia can result from prolonged loss of blood. Significant bleeding from hemorrhoids is unusual, however.

Call for an appointment with your health care provider if hemorrhoid symptoms do not improve with home treatment.

Avoiding contributing factors and eating a high fiber diet may help to prevent the development of hemorrhoids.