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What Causes Hemorrhoids & How to Prevent Them

"Over 50% of adults will have a hemorrhoid at some point during their life."

Today’s topic is a little personal, but it’s important. If you’ve ever had the experience of visiting the bathroom and finding blood in the toilet, or on the toilet tissue after a bowel movement, you know it can be disconcerting — even scary. In this post, Dr. Keller Wortham, MD, will explain hemorrhoids, one of the main reasons this happens, and as always share some tips to manage and prevent them.

Video Highlights

  • 01:42: What is a Hemorrhoid?
  • 02:35: Symptoms & Categories of Hemorrhoids
  • 04:27: Diagnosing Hemorrhoids
  • 05:21: Treating Hemorrhoids
  • 07:53: Preventing Hemorrhoids
  • 09:54: Wrap-Up

If you’ve ever had the experience we described above, you’re far from alone. In fact, many people have had this experience. And while it is true that blood in your stool can be caused by some serious conditions like inflammatory bowel disease orcolon cancer, most of the time it’s caused by hemorrhoids — especially if there is no pain or other symptoms accompanying it. Over 50% of adults will have a hemorrhoid at some point during their life. It’s not a pleasant club to be part of, but neither is it an uncommon one. 

What is a Hemorrhoid?

A hemorrhoid is, basically like avaricose vein, located in the anus. There are a lot of blood vessels around the anus, and if you are exerting certain pressures down there or if you have certain other underlying conditions, the veins can basically weaken and bulge, just like varicose veins might do in the legs, resulting in a hemorrhoid. And that hemorrhoid then can bleed during a bowel movement, causing that bright red blood, either in the toilet bowl or on the toilet paper. 

Symptoms & Categories of Hemorrhoids

In addition to the blood you might see, which can sometimes seem like a lot, there may be a few other symptoms to help you recognize the problem. Usually, hemorrhoids are quite painless. However, they can sometimes change in size. So there may be an actual bulge that you feel — maybe it feels like it's throbbing, or slightly tender — and then it could go away. You might also experience some itching, burning, or discomfort when you're having a bowel movement. 

The experience you have will probably be determined by the type of hemorrhoid you have. There are really two classes of hemorrhoids, because the blood supply around the anus is actually two-fold. You have an internal blood supply and a more external blood supply. So you have two areas where the veins can become varicose. 

Internal Hemorrhoids

Internal hemorrhoids tend to not be noticeable because they're actually happening inside of the rectum. These can still cause that bleeding, but you don't tend to feel a bulge, unless the hemorrhoid begins to protrude from the rectum. It sounds pretty gross, but that can happen. But if it’s not happening, you probably won’t feel or notice this type of hemorrhoid. They don't cause much pain because there's not a lot of nerve supply in the internal area of that vasculature. 

External Hemorrhoids

This is the second category, and these ones are certainly more noticeable. You might feel the bulge when you're wiping, and you might have more tenderness or more itchiness because the nerve supply there is more present. 

Diagnosing Hemorrhoids

Thankfully, you can handle both these types of hemorrhoids more or less the same way. The first step is always to get a diagnosis because, as we mentioned, there are other and more serious causes of blood in the stool. You want to make sure you rule out any serious conditions like colon cancer or inflammatory bowel disease, so go ahead and bring it up with your doctor. 

It's very easy to make the diagnosis. Basically, a physical exam can help rule out other conditions. Then, a digital rectal exam (which is the medical term for the doctor feeling the inside of the rectum with a finger) will generally determine whether hemorrhoids are the problem. If for some reason that doesn't determine it, sometimes you might need something a little more involved — a procedure called an anoscope which is a little plastic tube inserted into the anus that allows the doctor to visualize what's going on. In rare cases, a sigmoidoscopy, which employs a camera to look further inside, might be required. Additionally, a colonoscopy can help rule out those other conditions we talked about.

Treating Hemorrhoids

As soon as a diagnosis is made, you can begin to talk about treatment. And treatment will depend on how bad the symptoms are for you. Unfortunately, once you get a hemorrhoid, it's usually yours to keep. It doesn’t go away. However, that doesn't mean that you can't manage it. 

If your symptoms are mild, managing them is largely about ahealthy, nutritious diet, and bowel habits such as: 

  • Add Fiber to Your Diet.Fiber is what bulks up your stool, making it easier to pass, and preventsconstipation. You can getdietary fiber through fruits and vegetables, whole grains, or dietary supplements. These include products like Metamucil, Fenefiber, and other similar supplements.
  • Stay Hydrated.Water helps your stool stay soft, so you're not getting constipated and having to push. 

Additionally, if you're experiencing some sensitivity down there, you can try some home remedies to help calm the area:

  • Sitz bath. This is a German term that basically means you sit down in a bathtub with some warm water and someEpsom salts. It can be very relieving if you are experiencing tenderness or itching in the anal area. 
  • Over the Counter Products.There are plenty of over-the-counter products that you can try, often involving some kind of witch hazel or a topical numbing cream that helps reduce the itching, pain, or other sensations.

If that's not doing it, see your doctor. There are some prescriptions that you can get, such as a topical steroid which is basically an anti-inflammatory. It can really calm things down if you're experiencing what’s called a hemorrhoid flare-up. 

There is also an option for surgical removal of hemorrhoids if they become really uncomfortable, happen too frequently, or just really disrupt your bowel habits. There are many ways to remove a hemorrhoid: it can be done with staples, banding, and surgical incision. So if it is becoming a serious problem, your primary care doctor might refer you to a surgical specialist who can take care of them. 

Preventing Hemorrhoids

As always, our favorite topic is prevention. So how do you prevent hemorrhoids from happening? Well, there are some risk factors that you can look at, some of which you have control over and others you don’t. Risk factors include:

  • Genetics. If you have a family history of hemorrhoids, it puts you in a higher risk of getting them. 
  • Pregnancy. If you're a woman and you choose to get pregnant, that definitely increases your risk of hemorrhoids. There are some things you can do during pregnancy to help reduce the risks. But both pregnancy and delivery of the baby can increase your risk for hemorrhoids. 
  • Sedentary jobs. If you sit a lot at a desk all day, or you’re a truck driver or Uber driver, you're sitting all day long, and this can change the blood flow in your bowels and lower extremities. It can build up force within the vessels down there, and that can lead to an increased risk of hemorrhoids. 

Fortunately, there are steps you can take to prevent developing or reduce the risk of developing hemorrhoids, such as: 

  • Not straining when you have a bowel movement. So if you're someone who feels like you have to strain a lot — whether because your stool isn't soft enough, or you're waiting too long to go — you may want to look at making some changes. That could mean making sure to go when you need to, or making sure you’re getting enough fiber in your diet and staying hydrated. 
  • Maintain ahealthy body weight andexercise. A healthy body weight is going to reduce your risk of hemorrhoids, and exercise helps keep blood flowing the way it should. It helps your bowels move appropriately so you don't get constipated and don't end up straining. 


In conclusion, hemorrhoids can and do happen to many of us but there are steps you can take to minimize the risk as well as the symptoms. Try to implement these simple practices: don’t strain on the toilet, don’t hold it if you have to go, take steps to maintain a healthy body weight, add fiber to your diet, and stay hydrated.

If it does happen, and you have that frightening experience of looking down in the toilet bowl and seeing blood, don't freak out. Chances are, it's not as serious as you think. Go to your doctor and get it evaluated. Hopefully, they’ll confirm that it’s hemorrhoids and help you manage it. And if it is something serious, they can point you in the right direction. We hope you enjoyed this weird but important discussion.

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