Let’s talk about hemorrhoids. Hemorrhoids, also known as piles, are blood vessels near the surface of the skin in the rectum or anus that have become too full of blood and stretched like a small — and often painful — balloon. Nine million adults in the U.S. suffer from hemorrhoids, but they are rarely discussed. I hope that this article reaches some of those nine million.
Hemorrhoids are most common in adults aged 45-65 years and can be caused by increased pressure on the abdomen resulting from prolonged straining, sitting, coughing, constipation, or pregnancy.
External hemorrhoids are found near the anus where the skin has plenty of pain receptors, thus causing significant discomfort. Blood pooling in the stretched vessel can thrombose, or clot. Thrombosed hemorrhoids are purplish and feel like tender, hard lumps around the anus. [Internal hemorrhoids usually cause no pain and are not the subject of this article. In this article, “hemorrhoids” will refer only to external hemorrhoids.]
The symptoms of hemorrhoids include: anal itching, bright red blood from the rectum, and pain—especially during bowel movements, cleaning after bowel movements, or with sitting. While hemorrhoids are frequently self-diagnosed, if in doubt, please make an appointment with your doctor or nurse practitioner. We see hemorrhoids all the time (9 million!) and are trained to differentiate them from other conditions with similar symptoms (such as skin tags, anal warts, anal fissures, perianal abscesses, or cancer).
If you are sure you have a hemorrhoid, here are some things you can try at home:
- Keep your bowel movements soft to avoid straining. Increase the fiber in your diet by eating more whole vegetables, fruits and whole grains. Try bran cereal or oats. Additionally, you may want to try a fiber supplement such as psyllium powder (the key ingredient in Metamucil). Fiber works by drawing more water into the stool, thus making it softer in consistency. Fiber supplements are dry (unlike whole foods) and won’t work if you don’t drink plenty of water. You can tell you’re getting “plenty of water” if your urine is pale yellow to clear instead of dark yellow. You may find you want an over-the-counter stool softener such as docusate sodium (Colace) capsules. If so, most folks benefit from 100 mg of docusate twice a day. Not only can softer stools ease the symptoms of hemorrhoids, they can prevent them in the first place.
- Don’t use soap. When I spoke with Peter Cataldo, MD, a colorectal surgeon at the UVM Medical Center, about hemorrhoids he stressed this as an important home-care lesson: Avoid using soap or scented wipes around your anus, especially if you have itching in the area. Clean the skin with plain water only. Many people make the mistake of over-cleaning, which irritates the skin around the anus. Try cleaning after bowel movements with water instead of toilet tissue or wipes, either spraying with water (warm or cool—whatever feels best) from a spray bottle, or simply pouring water over the area using a plastic cup or pitcher. Use your other hand to gently clean around the hemorrhoid(s). This may sound disgusting, but it is a common method of personal hygiene around the world. Of course, wash your hands after with warm water and soap.
- Try simple medicines. Daily soaks in warm water with or without plain, unscented Epsom salts can be soothing and reduce swelling. Try to avoid sitting on hard surfaces, though. Either recline in the bathtub, or try a sitz bath. Over-the-counter products such as Preparation H or Tucks pads definitely can help. You can even make your own Tucks-type pads:
Dissolve 2/3 cup plain unscented Epsom salts in a pint of boiling water. Let water cool, then add a pint of mineral oil to the cooled Epsom salt water. Alternatively, you can try mixing 1 cup witch hazel with 2/3 cup water, and (optional) 1 tablespoon of glycerin. With either mixture, shake well and pour into a small, clean jar full of cotton balls or squares of clean flannel (pieces of old, clean shirts). Keep this jar in the refrigerator and bring it with you to the bathroom. Place a cool cotton ball or square of fabric between the buttocks for temporary pain relief. You may also want to line your underwear with a moisture barrier such as a panty liner or pad.
Hemorrhoids usually become less painful after several weeks or months with proper care and efforts at prevention. If your home care is not successful, or you have many recurrences, see your doctor or nurse practitioner. There are several office procedures and, in more severe cases, minor surgeries, that can help.
Caroline Adams, MD, born and raised in Berkeley, California, is a family medicine resident at the University of Vermont Medical Center. She attended Tulane University School of Medicine where she was inducted into the Gold Humanism Honor Society, organized community garden projects and ran a caregiver support group at a New Orleans retirement community. Her interests include doctor-patient communication, movement therapies, chronic pain and addiction medicine, and addressing health disparities.