Diarrhea and Bleeding
Hemorrhoids (also called piles) are swollen blood vessels in the anus and rectum that become engorged from increased pressure, similar to what occurs in varicose veins in the legs. Hemorrhoids can either be internal (inside the anus) or external (under the skin around the anus). Hemorrhoids are the most common cause of minor rectal bleeding, and are typically not associated with pain. Bleeding from hemorrhoids is usually associated with bowel movements, or it may also stain the toilet paper with blood. The exact cause of bleeding from hemorrhoids is not known, but it often seems to be related to constipation, diarrhea, sitting or standing for long periods, obesity, heavy lifting and pregnancy. Symptoms from hemorrhoids may run in some families. Hemorrhoids are also more common as we get older. Fortunately, this very common condition does not lead to cancer.
Hemorrhoid flare-up: Symptoms, treatment and prevention
Many people who experience hemorrhoids do not have symptoms all the time. Oftentimes people feel just fine, and then something might cause hemorrhoids to flare up. Most hemorrhoid remedies are intended to shorten the duration of flare-ups and decrease their severity.
What is a hemorrhoid?
Hemorrhoids occur when the veins in the anus and rectum become enlarged and inflamed, causing pain, bleeding and discomfort. Fortunately, there are many ways to treat hemorrhoid flare-ups.
Symptoms and signs of hemorrhoids
Hemorrhoids can cause anal itching and pain, anal bleeding or bright red blood in the stool. Hemorrhoids sometimes become so large that they can be felt as lumps around the anus. Those lumps can be soft or hard, painful or painless. Usually, the larger they are, the more painful they become. Seek medical care if you experience worsening symptoms, including severe anal pain or bleeding from your rectum. This is especially important if you have pain or discomfort in your abdomen, diarrhea or fever. These could be signs of other health conditions.
Do hemorrhoids itch?
Hemorrhoids can itch in some cases. You may experience hemorrhoids that itch frequently during flare-ups. Internal hemorrhoids less commonly cause itching.
How to stop hemorrhoids from bleeding
Drinking enough water and getting enough fiber in your diet can soften stools, making them easier to pass. This can help ease pressure on the veins and reduce bleeding. Sitz baths can also be helpful for symptoms in some cases. It’s also important to try to avoid straining during a bowel movement. Over-the-counter hemorrhoid treatments, such as creams, wipes and suppositories containing hydrocortisone, witch hazel, phenylephrine and zinc oxide, can also be helpful. Lidocaine cream may help with pain and itching. Bleeding may also be a sign of other health conditions and should be evaluated by your healthcare provider.
Hemorrhoid with fissure
Sometimes hemorrhoids can be accompanied by a fissure, a tear in the skin around the anus that is often painful and may bleed. A hemorrhoid is not the same thing as a fissure. You can have hemorrhoids without a fissure, and a fissure without hemorrhoids. Fissures may be soothed with some hemorrhoid remedies but certain products may cause them to sting or burn. Blood in the stool or in the toilet bowl can be alarming to see. Hemorrhoids can cause blood in the stool, but this can also be a sign of anal fissure, infection or even cancer. See your healthcare provider if you notice blood in your stool.
Hemorrhoid vs. skin tag
It may seem like you have a skin tag from a hemorrhoid because hemorrhoids can appear like skin tags, which are small flaps of skin that look and feel like a bump.
Thrombosed hemorrhoid
Internal and external hemorrhoids can become thrombosed, meaning the blood inside the vein forms a clot and becomes hard and painful. At this point, your healthcare provider may recommend surgery to remove the clot and relieve the symptoms of hemorrhoids.
Postpartum hemorrhoid
Hemorrhoids commonly occur during or after pregnancy. Treatment for hemorrhoids following pregnancy is the same as for nonpregnancy-related hemorrhoids. Increasing liquids and fiber in your diet and using simple, over-the-counter remedies are usually effective hemorrhoid treatments for most people. If you are pregnant and experiencing hemorrhoids, ask your healthcare provider about safe possible options for treatment.
Are hemorrhoids dangerous?
Hemorrhoids are not usually dangerous, but infection and other complications can occur. Infected hemorrhoids should be evaluated and treated by your healthcare provider, as infection can become life-threatening. Hemorrhoids may cause very uncomfortable symptoms of swelling, pain, itching or bleeding that also may require medical attention. In more severe cases, hemorrhoids may require surgery.
Can hemorrhoids bleed without a bowel movement?
Yes, hemorrhoids can bleed without a bowel movement. Hemorrhoids may bleed due to prolonged sitting, lifting a heavy object, clothes rubbing against the hemorrhoid, and anal sex.
Can hemorrhoids cause constipation?
Hemorrhoids don’t usually cause constipation. Rather, constipation can cause hemorrhoids. But if someone avoids using the toilet because of their hemorrhoids, this can lead to constipation. Increasing fluids and fiber in the diet can be helpful for both constipation and hemorrhoids.
Hemorrhoid medicine and treatment
- Acetaminophen for pain
- Hydrocortisone, for its anti-inflammatory and anti-itching effects
- Ibuprofen for pain and inflammation
- Lidocaine for pain
- Phenylephrine, which causes the constriction (shrinking) of blood vessels
- Witch hazel, an astringent for temporary relief from itching
- Zinc oxide, which prevents the hemorrhoids from rubbing against clothing or skin folds
Most people never need to see a healthcare provider for their hemorrhoids because over-the-counter remedies are often effective. It’s important to note that pain relievers, such as acetaminophen (Tylenol) and ibuprofen (Advil), should be taken as directed. Some topical medications, such as hydrocortisone, should only be used for a short duration because of potential thinning of the anal mucosa with long-term use.
Another effective remedy is a sitz bath, a shallow basin that fits inside the toilet and provides a comfortable place to bathe hemorrhoids in warm water.
Hemorrhoid flare-ups are a common problem. Fortunately, many people find relief from their flare-ups with the help of treatment and lifestyle changes. See your healthcare provider if you have any concerns about your hemorrhoids.
What is Diarrhea and Bleeding?
To evaluate minor rectal bleeding, your doctor may perform a digital rectal examination. In addition, an endoscopic procedure such as anoscopy, flexible sigmoidoscopy or colonoscopy may be recommended.
Minor rectal bleeding refers to the passage of a few drops of bright red (fresh) blood from the rectum, which may appear on the stool, on the toilet paper or in the toilet bowl.
This brochure addresses minor rectal bleeding that occurs from time to time. Continuous passage of significantly greater amounts of blood from the rectum or stools that appear black, tarry or maroon in color can be caused by other diseases that will not be discussed here. Call your doctor immediately if these more serious conditions occur. Because there are several possible causes for minor rectal bleeding, a complete evaluation and early diagnosis by your doctor is very important. Rectal bleeding, whether it is minor or not, can be a symptom of colon cancer, a type of cancer that can be cured if detected early.
What are hemorrhoids?
Hemorrhoids (also called piles) are swollen blood vessels in the anus and rectum that become engorged from increased pressure, similar to what occurs in varicose veins in the legs. Hemorrhoids can either be internal (inside the anus) or external (under the skin around the anus). Hemorrhoids are the most common cause of minor rectal bleeding, and are typically not associated with pain. Bleeding from hemorrhoids is usually associated with bowel movements, or it may also stain the toilet paper with blood. The exact cause of bleeding from hemorrhoids is not known, but it often seems to be related to constipation, diarrhea, sitting or standing for long periods, obesity, heavy lifting and pregnancy. Symptoms from hemorrhoids may run in some families. Hemorrhoids are also more common as we get older. Fortunately, this very common condition does not lead to cancer.
Hemorrhoids and rectal polyps are common causes of minor rectal bleeding.
How are hemorrhoids treated?
Medical treatment of hemorrhoids includes treatment of any underlying constipation, taking warm baths and applying an over-the-counter cream or suppository that may contain hydrocortisone. If medical treatment fails there are a number of ways to reduce the size or eliminate internal hemorrhoids. Each method varies in its success rate, risks and recovery time. Your doctor will discuss these options with you. Rubber band ligation is the most common outpatient procedure for hemorrhoids in the United States. It involves placing rubber bands around the base of an internal hemorrhoid to cut off its blood supply. This causes the hemorrhoid to shrink, and in a few days both the hemorrhoid and the rubber band fall off during a bowel movement. Possible complications include pain, bleeding and infection. After band ligation, your doctor may prescribe medications, including pain medication and stool softeners, before sending you home. Contact your doctor immediately if you notice severe pain, fever or significant rectal bleeding. Laser or infrared coagulation and sclerotherapy (injection of medicine directly into the hemorrhoids) are also office-based treatment procedures, although they are less common. Surgery to remove hemorrhoids may be required in severe cases or if symptoms persist despite rubber band ligation, coagulation or sclerotherapy.
What are anal fissures?
Tears that occur in the lining of the anus are called anal fissures. This condition is most commonly caused by constipation and passing hard stools, although it may also result from diarrhea or inflammation in the anus. In addition to causing bleeding from the rectum, anal fissures may also cause a lot of pain during and immediately after bowel movements. Most fissures are treated successfully with simple remedies such as fiber supplements, stool softeners (if constipation is the cause) and warm baths. Your doctor may also prescribe a cream to soothe the inflamed area. Other options for fissures that do not heal with medication include treatment to relax the muscles around the anus (sphincters) or surgery.
In a colonoscopy, the physician passes the endoscope through your rectum and into the colon to examine the tissue of the colon wall for abnormalities such as polyps.
What is proctitis?
Proctitis refers to inflammation of the lining of the rectum. It can be caused by previous radiation therapy for various cancers, medications, infections or a limited form of inflammatory bowel disease (IBD). It may cause the sensation that you didn’t completely empty your bowels after a bowel movement, and may give you the frequent urge to have a bowel movement. Other symptoms include passing mucus through the rectum, rectal bleeding and pain in the area of the anus and rectum. Treatment for proctitis depends on the cause. Your doctor will discuss the appropriate course of action with you.
What are colon polyps?
Polyps are benign growths within the lining of the large bowel. Although most do not cause symptoms, some polyps located in the lower colon and rectum may cause minor bleeding. It is important to remove these polyps because some of them may later turn into colon cancer if left untreated.
What is colon cancer?
Colon cancer refers to cancer that starts in the large intestine. It can affect both men and women of all ethnic backgrounds and is the second most common cause of cancer deaths in the United States. Fortunately, it is generally a slow-growing cancer that can be cured if detected early. Most colon cancers develop from colon polyps over a period of several years. Therefore, removing colon polyps reduces the risk for colon cancer. Anal cancer is less common but curable when diagnosed early.
Most colon cancers develop from colon polyps over a period of several years. Therefore, removing colon polyps reduces the risk for colon cancer.
What are rectal ulcers?
Solitary rectal ulcer syndrome is an uncommon condition that can affect both men and women, and is associated with long-standing constipation and prolonged straining during bowel movement. In this condition, an area in the rectum (typically in the form of a single ulcer) leads to passing blood and mucus from the rectum. Treatment involves fiber supplements to relieve constipation. For those with significant symptoms, surgery may be required.
How is minor rectal bleeding evaluated?
Your doctor may examine the anus visually to look for anal fissures, cancer or external hemorrhoids, or the doctor may perform an internal examination with a gloved, lubricated finger to feel for abnormalities in the lower rectum and anal canal.If indicated, your doctor may also perform a procedure called colonoscopy. In this procedure, a flexible, lighted tube about the thickness of your finger is inserted into the anus to examine the entire colon. Sedative medications are typically given for colonoscopy to make you sleepy and decrease any discomfort. As an alternative, to evaluate your bleeding, your doctor may recommend a flexible sigmoidoscopy, which uses a shorter tube with a camera to examine the lower colon and rectum. To examine only the lower rectum and anal canal, an anoscope may be used. This very short (3 to 4 inch) tube is especially useful when your doctor suspects hemorrhoids, anal cancer or anal fissures.
What can I do to prevent further rectal bleeding?
This depends on the cause of the rectal bleeding. You should talk to your doctor about specific management options.
