Overview

Hemorrhoids are swollen veins in the lower portion of the rectum or anus. If you have hemorrhoids you may experience anal pain or itching, pain during a bowel movement, and/or bleeding. Common causes include straining during a bowel movement, constipation, sitting for long periods of time, and pregnancy.

There are two types of hemorrhoids:

External hemorrhoids are dilated veins covered by the skin near the anal opening. They may be felt as bumps or lumps near the outside of the anus, and become painful when they are swollen with blood. They can sometimes be confused with skin tags which are extra pieces of skin near the anus.

Internal hemorrhoids are dilated veins that form inside the rectum and above the anal opening, and are therefore “internal”. However, in some situations they may enlarge and protrude (prolapse) out of the anus. Internal hemorrhoids typically cause bleeding when symptomatic.

Most hemorrhoids resolve spontaneously, or with simple measures. These measures include avoidance of straining, and treatment of hard stools or constipation with increased fluids, addition of increased fiber in the diet or taken as fiber supplements and stool softeners or lubricants. There are multiple over-the-counter creams and suppositories which can reduce symptoms of itching and pain.

In some circumstances, hemorrhoids that do not resolve or bleed repeatedly need other type of treatment. These include:
Rubber band ligation: Small rubber bands are placed around the hemorrhoids.
Infrared coagulation: A small probe is inserted in the rectum and heat is applied to destroy a hemorrhoid.
Surgery: Removal of the dilated, stretched veins by a surgeon.

An anal fissure is a tear in the lining of the anal canal. It often occurs after the passage of a hard bowel movement. An anal fissure typically causes pain, especially with a bowel movement. Sometimes, bleeding occurs as well.

Most anal fissures will heal on their own within a few weeks if the stools are kept soft (possibly with stool softeners, laxatives, and fiber supplements) and the area is not repeatedly re-injured.

Other measures may include: Sitz baths, medicated creams and/or suppositories to relieve pain and inflammation. Occasionally, the use of nitroglycerine/nifedipine/diltiazem ointment applied to the area will be necessary. Rarely, injection of botulinum toxin, Botox®, may be helpful. Surgery may be necessary if symptoms persist.