Better Me

Getting to the Bottom of Hemorrhoids

Ah, hemorrhoids. Even if you didn’t know how to spell the word correctly, you have certainly heard a joke or two about them. But for those who’ve ever had hemorrhoids, they are no laughing matter.

So rather than being the butt (no pun intended) of many jokes, what exactly are hemorrhoids, who gets them and how can you prevent them? Bradford Keeler, MD, a general surgeon who specializes in colon and rectal surgeries at Banner Health Clinic in Loveland, CO, gets to the bottom of hemorrhoids.

What Are Hemorrhoids?

Hemorrhoids are swollen veins in the anal canal that can develop inside the rectum (internal) or under the skin around the anus (external). When they get irritated or enlarged, they can cause problems such as bleeding, itching and pain.

Types of Hemorrhoids

As mentioned above, there are two sets of hemorrhoidal veins: internal and external.

Internal hemorrhoids

Internal hemorrhoids are roughly 2-3 centimeters (about an inch) inside the anal canal and are relatively painless. You usually won’t even notice them until straining while passing a stool. This can cause the vessels to dilate and then tear and cause bleeding.

Sometimes internal hemorrhoids can enlarge enough that they bulge out of the anus (prolapsed or protruding) and can cause itching. Usually these prolapsed hemorrhoids go back inside the anal canal on their own, or they can be gently pushed back into place. Rarely, however, an internal hemorrhoid can get stuck in a prolapsed position and cause pain.

External hemorrhoids

External hemorrhoids share sensation with the skin and are therefore visible. When irritated and dilated, they can sometimes develop thrombosis. Despite their appearance, thrombosed hemorrhoids are usually not serious, but they can be painful. When the thrombosis resolves or is removed, there can be residual external skin tags that can be a challenge for daily hygiene.

“In general, visible tissue with pain is an external hemorrhoid problem, bleeding with no pain is an internal hemorrhoid problem,” Dr. Keeler said.

Who’s Most Likely to Get Them?

If you’ve had to deal with them, you aren’t alone. It’s estimated that they affect about 1 in 5 Americans, and about half of adults older than age 50 will have them.

“Technically, every person has hemorrhoids, but only some people will have problematic hemorrhoids,” Dr. Keeler said. “Between 50-75% of people will have some type of hemorrhoidal irritation in their lifetime, but only 5% will need surgery.”

Hemorrhoids can be caused by several things, including:

  • straining on the toilet
  • heavy lifting
  • chronic constipation
  • urinary retention issues
  • chronic cough
  • obesity
  • age
  • pregnancy
  • anal sex

Treatment Options

“Fortunately, most hemorrhoid problems can be treated with avoidance of constipation by using daily fiber and not straining with bowel movements,” Dr. Keeler said.

To ease discomfort, Dr. Keeler suggests the following:

  • Take a sitz bath, a warm soak in the tub or place a warm washcloth to the area
  • Avoid straining during bowel movements
  • Use over-the-counter creams, ointments or pads containing hydrocortisone or witch hazel to help reduce swelling and skin irritation

“Creams and ointments work fine for external hemorrhoids, but internal hemorrhoid problems necessitate a suppository of an internal application device similar to a low-pressure enema,” Dr. Keeler said. “Prescription strength medications usually add steroids as a higher strength anti-inflammatory to try and shrink the dilated hemorrhoidal tissue.”

Surgical Interventions

In roughly 5% of cases, surgery may be necessary when there is a lack of response from home treatments, over the counter treatments, or there is continued bleeding problems.

“Operative excision of hemorrhoids is a permanent treatment of that hemorrhoidal column, but there are other hemorrhoids present that can become a problem in the future,” Dr. Keeler said. “Excision of all the hemorrhoidal tissue is not done as this can cause anal stenosis due to extensive scarring. Only the problematic hemorrhoids are treated."

The Key to Avoiding Hemorrhoid Problems

The key to avoiding hemorrhoidal issues is maintaining a regular bowel movement with a soft stool. This can be helped in the following ways:

  • Eat plenty of foods rich in fiber
  • Drink plenty of fluids
  • Don’t wait to go No. 2
  • Stay active
  • Maintain a healthy body weight
  • Avoid traumatic insertion of objects into the anal canal
  • Use stool softeners and regulators, as necessary

“Regular use of laxatives should be avoided as the body can become dependent on these medications and create even bigger problems,” Dr. Keeler added.

When Should You Seek Medical Attention?

While rare, if your symptoms continue after a week of home care, or if you are experiencing rectal bleeding, you should see your doctor.

“Passing blood in your stool is most often from a hemorrhoid, but it can be from other problems including colon, rectal or anal cancer,” Dr. Keeler said. “You should not assume blood passing from the anal canal is not a big deal. This is particularly true for people over the age of 40, but these types of cancers are becoming more common in younger people. It is imperative that a health care provider is made aware of any bouts of passing blood from your anus.”

Big Takeaway

Although hemorrhoids aren’t a joke for those who have them, they are easily treated and very preventable. While you may feel embarrassed by them, don’t wait to consult a doctor. Early interventions can ease discomfort and reduce complications.

If you are experiencing uncomfortable or painful hemorrhoids, schedule an appointment with your primary care provider. To find a specialist near you, visit

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