Hemorrhoids are bundles of blood vessels all humans have in the anal area. While you can treat most hemorrhoids with self-care, hemorrhoids can cause symptoms such as bleeding or pain that may require treatment from a doctor.

“We only need to intervene for hemorrhoids if they’re causing problems,” said Dr. Stephanie Carr, colorectal surgeon at Marshfield Clinic Health System.

Hemorrhoid causes

Hemorrhoids are caused when the blood vessels around the anus are put under increased pressure, leading them to swell or become inflamed.

Common causes of hemorrhoids include:

• Straining during bowel movements
• Sitting on the toilet for long periods of time
• Constipation
• Diarrhea
• Pregnancy
• Aging
• Obesity
• Lifting

Hemorrhoids symptoms

Hemorrhoids are broken up into external and internal hemorrhoids, both of which can cause different symptoms.

External hemorrhoids can get large and can sometimes be hard to clean after a bowel movement.

External hemorrhoids can also be painful if a blood clot gets stuck inside of the blood vessel, which is called a thrombosed external hemorrhoid.

The most common problems with internal hemorrhoids are bleeding or the tissue coming in and out of the anus, which is called prolapse.

If you experience any of these symptoms, you should see a doctor right away.

“A lot of people think any problem with the anal area is due to hemorrhoids,” Dr. Carr said. “But there are actually many different things that can cause pain and bleeding in that area.”

For example, a doctor may recommend a colonoscopy or rectal exam to rule out cancer or other pathology.

Hemorrhoids treatment starts with bowel habits

Improving bowel habits are a simple and easy way people can reduce hemorrhoid symptoms.

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Dr. Carr recommends that all patients take a fiber supplement. She recommends men take 30 grams and women take 25 grams of fiber each day.

“Even just five extra grams of fiber a day will often improve the regularity and consistency of bowel movements,” Dr. Carr said. “It will help with diarrhea or constipation.”

She also encourages people to spend as little time on the toilet as possible. While sitting on the toilet, Dr. Carr also encourages people not to strain.

“For some people, it’s helpful to get their knees above their hips, like a squatting position,” Dr. Carr said. “That’s a more natural position to have a bowel movement. I tell all my patients that toilets are pretty new inventions and our bodies weren’t designed to sit like that for a bowel movement.”

Medications for hemorrhoids treatment

While bowel movements are the best place to start, sometimes it is not enough.

There are some over-the-counter creams that can help in the short-term. However, Dr. Carr does not recommend these creams for long-term use.

“Certainly, if someone has ongoing bleeding, they should be evaluated to rule out a cancer,” said Dr. Carr.

There are also some topical steroids that a doctor can prescribe to patients who have mild or intermittent hemorrhoid symptoms.

Hemorrhoid surgery or procedures

For people who have regular symptoms or hemorrhoids have been a problem for years, there are multiple hemorrhoid treatment options a doctor can provide including:

• Rubber band ligation: A surgeon places a rubber band around the internal hemorrhoid, cutting off its blood supply. The hemorrhoid will fall off in a few days. This a rather painless procedure that does not require time off work.
• Injection: Bleeding hemorrhoids can be treated with an injection to stop the bleeding during an office appointment. This is a good option for people on blood thinners who cannot undergo other procedures. This is a rather painless procedure that does not require time off work.
• Surgical hemorrhoidectomy: A surgeon removes the hemorrhoid tissue in the operating room during an outpatient surgery. Due to the pain, patients typically need to take two weeks off work.

“People can have their hemorrhoids come back even after surgery,” Dr. Carr said. “If they don’t change their habits, it will take many years, but if they continue to strain or spend a long time on the toilet, they will come back.”