Hemorrhoids, which are also called piles, is a condition of weakened and swollen veins in the anus or lower rectum. They often go unnoticed and usually clear up after a few days, but can also cause long-lasting discomfort of the rectum such as pain, itching, and bleeding.

Hemorrhoids can be divided into two types: Internal hemorrhoids lie inside the anus or lower rectum; external hemorrhoids lie outside the anal opening. Both can be present at the same time. Sometimes a blood clot forms in an external hemorrhoid and inflammation and a painful lump develops. This condition is called a thrombosed hemorrhoid.

Hemorrhoids are a very common medical complaint. More than 75% of Americans have hemorrhoids at some point in their lives, typically after age 30. Men are more likely than women to suffer from hemorrhoids that are serious enough to require professional treatment.

During a bowel movement, veins in the anus are protected from damage by expanding to drain blood away from the area. The veins are normally somewhat elastic, and they snap back to their regular size after defecation is finished.

However, repeated straining due to constipation or hardened stools causes the veins to be swollen and stretched out of shape. The swelling also triggers nerves in the area, causing itchiness and a sensation of fulless in the bowel. In addition, straining may cause the rupture of blood vessels and bleeding at the anus.

Causes & symptoms

Aging, obesity, pregnancy, chronic constipation or chronic diarrhea, excessive use of enemas or laxatives, straining during bowel movements, and spending too much time on the toilet are all factors that can contribute to the development of hemorrhoids. In some people there is also a genetic tendency to have fragile veins that are prone to developing hemorrhoids and varicose veins.

The most common symptom of internal hemorrhoids is bright red blood in the toilet bowl or on one’s feces or toilet paper. When hemorrhoids remain inside the anus they are almost never painful, but they can protrude outside the anus and become irritated and sore. Such hemorrhoids are called prolapsed hemorrhoids.

These sometimes move back into the anal canal on their own or can be pushed back inside; however, they may remain permanently outside the anus until treated by a doctor. Small external hemorrhoids usually do not produce symptoms. Larger ones, however, can be painful and interfere with sitting, walking, defecating, and cleaning the anal area after a bowel movement.

Hemorrhoids infographic


Diagnosis of hemorrhoids begins with a visual examination of the anus, followed by an internal manual examination. The doctor may also insert an anoscope, a small tube with a light that can be used to view the anal canal. More serious problems may be ruled out using a sigmoidoscope or colonoscope to inspect the colon.


An herbal sitz bath using witch hazel, Hamamelis virginiana, may shrink hemorrhoids and ease discomfort. A strong infusion should be prepared by adding a gallon of boiling water to eight ounces of the dry herb, and then letting this mixture steep overnight. The infusion can be used several times as a 15-minute soak.

Witch hazel can also be wiped directly over external hemorrhoids. In addition, an ointment formulated of plantain, Plantago spp. and yarrow, Achillea millefolium, will reportedly reduce pain and swelling.

Chinese herbal medicine may be formulated to treat Spleen Qi deficiency or heat in the lower burner. Hemp seeds are recommended for constipation. Daily helpings of foods that soften the stools and make them easier to pass are recommended by traditional Chinese medicine (TCM); examples of these include carrots, broccoli, dried persimmons and unripe figs. Acupuncture and acupressure are also recommended.

Homeopathy offers a gentle treatment solution for hemorrhoids. It is, therefore, especially appropriate for use during pregnancy. Suggested remedies include Aeschulus hippocastanum 30c, Hamamelis virginiana 6c, and Calcarea fluorica 6c. Homeopathic and herbal rectal suppositories are available.

Allopathic treatment

Hemorrhoids can often be dealt with effectively by dietary and lifestyle changes. Avoiding constipation is important; therefore adding fiber to the diet is recommended. Bulk laxatives and fiber supplements such as Metamucil or Citrucel may be suggested. After each bowel movement, wiping with a moistened tissue or pad sold for that purpose helps lessen irritation.

A warm sitz bath for about 10 or 15 minutes two to four times a day can ease hemorrhoid pain. A cool compress or ice pack to reduce swelling is also recommended. Many people find temporary relief using over-the-counter hemorrhoid creams and foams. These products, however, are not receommended during pregnancy.

When painful hemorrhoids do not respond to homebased remedies, professional medical treatment is necessary. Rubber band ligation is probably the most widely used of the many treatments for internal hemorrhoids. It is also the least costly for the patient.

This procedure is performed on an outpatient basis. An applicator is used to place one or two small rubber bands around the base of the hemorrhoid, cutting off the blood supply. After 3 to 10 days in the bands, the hemorrhoid falls off, leaving a sore that heals in a week or two.

Because internal hemorrhoids are located in a part of the anus that is not sensitive to pain, anesthesia is unnecessary and the procedure is painless in most cases. The procedure may need to be repeated a few weeks later. After five years, 15–20% of patients experience a recurrence of internal hemorrhoids, but in most cases all that is needed is another banding.

External hemorrhoids, and some prolapsed internal hemorrhoids, are removed by conventional surgery in a hospital. Depending on the circumstances, this procedure may require anesthesia. Full healing takes two to four weeks, but most people are able to resume normal activities at the end of a week. Hemorrhoids seldom return after surgery.

Expected results

Hemorrhoids are rarely life-threatening. Most clear up after a few days without medical treatment. However, because colorectal cancer and other digestive system diseases can cause anal bleeding and other hemorrhoid symptoms, people should always consult a healthcare practitioner when hemorrhoid symptoms occur.


A high-fiber diet, daily exercise, and losing excess weight are recommended to maintain healthy digestion and elimination. To prevent hemorrhoids by strengthening the veins of the anus, rectum, and colon and increasing circulation, blackberries, blueberries, cherries and vitamin C are recommended.

Tinctures of butcher’s broom (Ruscus aculeatus), and horse chestnut (Aesculus hippocastanum), plant pigments (called flavonoids) found in fruit and fruit products, tea, and soy also are recommended. It should be noted that horse chestnut, along with commercial hemorrhoid preparations, is contraindicated during pregnancy.

Drinking water with a high-fiber meal or supplement will cause the stools to be softer and easier to pass, reducing straining. Constipation should be avoided, and good toilet habits should be cultivated. Promptly responding to the urge to defecate will help encourage regular bowel movements. Defecation should be done without rushing or straining.

A squatting position over the toilet or having the feet raised on a small bench or footstool will also improve elimination. Reading, working or watching television are discouraged, because they entail prolonged sitting on the toilet, which increases the strain placed on the anal and rectal veins. Perfumed soaps or toilet waters may irritate the anal area and should be avoided, as should excessive cleansing, rubbing, or wiping.