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Patient Information

Hemorrhoids — or swollen blood vessels in the anus and lower rectum — are very common in adults. External hemorrhoids are located under the skin, while internal hemorrhoids are located inside the rectum.

WakeMed’s colorectal surgery experts can help patients deal with and treat both types of hemorrhoids.

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What Are the Symptoms and Risk Factors of Hemorrhoids?

External hemorrhoids can cause:

  • Bleeding
  • Pain, irritation, or discomfort in the anal area
  • Swelling in the anal area
  • Itching in the anal area, called pruritus ani

Because internal hemorrhoids are located inside the rectum, they will rarely cause pain on their own, but they can cause similar symptoms of bleeding and pain during bowel movements, or when they protrude out of the anus or develop a blood clot. Some patients will notice drops of bright red blood on toilet paper after wiping.

The risk of hemorrhoids increases as people get older, and the tissues around the rectum and anus weaken.

Because they develop from pressure in the lower rectum, other causes include straining during bowel movements, chronic constipation or diarrhea, obesity, and pregnancy.

How Are Hemorrhoids Diagnosed?

If the symptoms above don’t go away after a week, it’s a good idea to see your doctor. 

Typically, a doctor can diagnose hemorrhoids through a simple visual examination and discussion of symptoms. A digital rectal examination may also be performed, in which the doctor inserts a lubricated, gloved finger into the rectum to feel for any abnormalities. Analscopy is usually performed to visualize internal hemorrhoids.

How Are Hemorrhoids Treated?

Generally non-surgical treatments will be recommended first, and many hemorrhoids will go away within four to six weeks with the proper home care. The goal is to make stool soft and formed.

Patients will be encouraged to drink fluids, eat high-fiber foods, and exercise regularly. Patients should avoid straining during bowel movements, and long periods of sitting — both of which can increase pressure in the anal and rectal area. Warm tub baths or a sitz bath can also speed up the healing process.

What Does Surgical Treatment Involve? 

When hemorrhoids are not responding to home care, or are causing intense pain, there are surgical options to remove them.

WakeMed’s colorectal surgeons have extensive experience with surgical procedures including:

  • Hemorrhoid banding: A small rubber band is placed over the hemorrhoid, which cuts off the blood supply. Both the hemorrhoid and the band will fall off within a few days.
  • Stapled hemorrhoidectomy: The hemorrhoid is stapled, and tissue is removed. This procedure can be used for internal hemorrhoids only.
  • Excisional hemorrhoidectomy: If other methods are not successful, the hemorrhoid can be removed under anesthesia. This method is painful and may take up to two weeks for recovery.

Learn more about what to expect from colorectal surgery.