What are Hemorrhoids: Symptoms, Causes & Treatment?

When the veins in the lining around the anus or in lower rectum become swollen, the condition called Hemorrhoids develop. Hemorrhoids are also called piles and they can occur internally or externally. In internal Hemorrhoids, the veins become swollen within the rectum or anus and in external Hemorrhoids; swollen veins develop outside of the anus. The external Hemorrhoids are most common and cause more trouble for the patient. When the patient has Hemorrhoids, he/she experiences severe itching, pain, and difficulty in sitting. Fortunately, best Hemorrhoid treatments are available along with natural remedies and lifestyle changes.

It has been observed that around 50% of adults experience the Hemorrhoids symptoms by 50 years of age.

Here, we discuss the symptoms, causes, risk factors, complications, diagnosis and treatment for Hemorrhoids to give a complete overview and understanding to our readers:

What are the symptoms of Hemorrhoids?

Following are some common signs and symptoms of Hemorrhoids:

  • Pain, discomfort, itching or irritation in/around the anal area
  • Swelling around the anus
  • Painless bleeding during a bowel movement in which the patient may notices bright red blood in small amounts in the toilet or on the toilet tissue
  • Lump near the anus or that bulges out from the anus and can be painful

The specific Hemorrhoids symptoms depend on the location, either internal or external.

Internal Hemorrhoids: The patient can’t see and feel these Hemorrhoids as they lie inside the rectum. They rarely cause any discomfort but during straining for passing a stool can damage their surface and cause them to bleed. The straining can also push the Hemorrhoid towards the anal opening and such condition is called prolapsed or protruding Hemorrhoid causing irritation and pain.

External Hemorrhoids: These develop on the skin outside the anus and when they irritated, they may cause itching or bleeding.

Thrombosed Hemorrhoids: When blood collects in the external Hemorrhoids, a clot (thrombus) is formed and patient experiences severe swelling, pain, inflammation and eventually it becomes a hard lump near the anus.

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What causes Hemorrhoids?

Although experts are not sure what actually causes the condition some possible factors include:

  • Some patients inherit this condition from their parents or other family members,

During the condition of Hemorrhoids, pressure builds up in the lower rectum that affects the blood flow and makes the veins swell. This pressure building and swelling happen due to the following reasons:

  • When a person is obese or pregnant
  • It also comes from pushing during a bowel movement
  • Due to straining, when a person does hard physical activity like lifting something heavy
  • When a person sits or stands for long time duration
  • When a person experienced diarrhea or chronic constipation that doesn’t completely clear up

What are the risk factors for Hemorrhoids?

Following are the factors that can increase the risk of getting Hemorrhoids:

  • Genetics, from parent to child
  • Being obese
  • Consistent lifting something heavy
  • Other constant strain on the body
  • Standing too much for long period of time
  • Diarrhea, that doesn’t treat completely
  • Consistent anal sexual intercourse
  • Pregnancy

Are there any complications of Hemorrhoids?

Yes, there are some complications of Hemorrhoids, but they are very rare.

  1. The first complication is anemia that occurs due to chronic blood loss from Hemorrhoids.
  2. The second complication is strangulated Hemorrhoid that occurs when the blood supply to an internal Hemorrhoid cuts off and it becomes strangulated (constricted) and causes severe pain.

How to diagnose Hemorrhoids?

In some cases, visual examination is only needed to diagnose Hemorrhoids. In some other cases, if gastroenterologist needs to confirm the diagnosis, further tests are performed that include Digital Rectal Exam in which the physician inserts a gloved and lubricated finger into the rectum. If the physician feels any abnormality during the Digital Rectal Exam, an additional test called Flexible Sigmoidoscopy is recommended.

The Flexible Sigmoidoscopy procedure involves visual examination of the rectum by using a flexible, lighted tube, called sigmoidoscope having a video camera. The physician can view the inside of the rectum and the Hemorrhoid closely and clearly.

internal and external hemorrhoids

What treatment is available for Hemorrhoids?

Fortunately, Hemorrhoids can be treated and cured with different available treatment options that can be classified into two main categories: home treatment and medical treatment. We will discuss home treatment in our coming posts. But, here we give you a brief overview of the medical treatment for Hemorrhoids.


If the symptoms of Hemorrhoids are mild, these can be treated with medications. The gastroenterologist prescribes over-the-counter creams, ointments, pads or suppositories. These medications and products contain ingredients such as hydrocortisone and lidocaine that relieve itching and pain temporarily. The patient should use over-the-counter steroid cream as per doctor’s suggestion because it can cause harmful effects on the skin.

External Hemorrhoid Thrombectomy:

During the external Hemorrhoid thrombectomy, the physician removes the clot that has formed in the condition of thrombosed Hemorrhoids. The clot is removed by making a simple incision and then it is drained. The procedure gives prompt relief as well as more effective results if it is done within 72 hours after the clot is developed.

Minimally Invasive Treatment Options:

If the Hemorrhoids are painful and persistently bleeds, the physician recommends one of the various other minimally invasive Hemorrhoid pain treatment procedures that are available. These procedures can be performed in doctor’s office as an outpatient setting and usually, they don’t require anesthesia. Here, are these minimally invasive treatments for Hemorrhoids:

Rubber Band Ligation:

This procedure proves to be effective for the majority of the patients. In this procedure, the doctor places one or two tiny rubber bands around the base of the internal Hemorrhoid that cuts off the circulation. Within a week, the Hemorrhoid becomes weak and falls away. The patient may feel uncomfortable with Hemorrhoid banding and within 2-4 hours after the procedure, bleeding may begin but it isn’t severe. Very rarely, complications can also occur.

Injection (Sclerotherapy):

In this procedure, the doctor injects a chemical solution into the Hemorrhoid that causes it to shrink. Although, the patient feels little to no pain during the procedure the rubber band ligation is more effective than this.


This procedure may involve different techniques that use laser, heat or infrared light to harden and shrunken the small size, bleeding internal Hemorrhoids. The coagulation procedure has few side effects and the patient feels little discomfort immediately after the procedure. There is a chance that Hemorrhoids can recur with coagulation procedure than rubber band technique.

Surgical Treatment Options:

If the patient doesn’t get relief from Hemorrhoids symptoms with all the treatment options or when the Hemorrhoids are large, the physician recommends surgical treatment. Two surgical procedures, listed below, are currently being performed:

Hemorrhoidectomy (Hemorrhoid removal):

During this surgical procedure, the doctor removes the excessive Hemorrhoid tissue that causes the bleeding by using various techniques. The surgery can be done with local anesthesia combined with sedation, spinal or general anesthesia.

The patient may feel pain after the surgery that can be managed with medications. Hemorrhoidectomy is the effective and best treatment option for severe and recurring Hemorrhoids.

Stapled Hemorrhoidectomy (Hemorrhoid stapling):

This procedure is also called stapled Hemorrhoidopexy or Hemorrhoid stapling that is typically used to treat internal Hemorrhoids. It involves blocking the flow of blood to the Hemorrhoidal tissue.

As compared to Hemorrhoidectomy, the Hemorrhoid stapling involves less pain and allows less recovery time. However, stapling procedure has a high risk of causing recurrent Hemorrhoids and rectal prolapse (a condition in which part of rectum come through the anus).

The doctor can better determine the right surgical treatment for Hemorrhoids for each patient.

hemorrhoid veins

The board-certified gastroenterologist, Dr. Bharat Dasani has been practicing gastroenterology for over 15 years at GI Endoscopy Practice in Riverdale, NJ. The physician provides the best treatment for Hemorrhoids in NJ while customizing it according to the needs and conditions of each individual patient.

If you’re experiencing the symptoms of Hemorrhoids, you can schedule an online appointment, simply by visiting our website or calling 973.248.1550 for an immediate response.


The information presented in this article is intended to help the patients and their families who look for general information about hemorrhoids. A gastroenterologist is a right person to answer any specific questions. 

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