When it comes to issues regarding our rear ends, far too many of us feel ashamed to talk about them, even when they’re common concerns or problems. Take, for instance, hemorrhoids. According to the National Institute of Diabetes and Digestive and Kidney Diseases, “Hemorrhoids are common in both men and women and affect about 1 in 20 Americans. About half of adults older than age 50 have hemorrhoids.”
While hemorrhoids may be an unpleasant thing to experience, you’re certainly not alone if you have them, especially if you’re a pregnant woman. Moreover, there are ways to prevent getting hemorrhoids, as well as methods to care for them.
We spoke to two medical experts about hemorrhoids, and why they’re nothing to be embarrassed about.
What, Exactly, Are Hemorrhoids?
In layman’s terms, hemorrhoids are “naturally occurring veins found inside and outside of the anus,” explains Megan Fawbush, NP-C, of Piedmont Colorectal Associates. In fact, we are all born with hemorrhoids, “regardless of whether each of us has ever been aware of their presence,” she adds.
Matthew Schultzel, DO, of General and Colorectal Surgical Specialists of San Diego, describes hemorrhoids as a vein, not unlike the ones in your legs or fingertips, but in this case, it is a varicose vein of the anus. These veins, he explains, “are very thin and lack the muscular walls that arteries have.”
There are also internal and external hemorrhoids, which are differentiated between being inside of the anal canal versus being outside of the anal canal. “Internal hemorrhoids are lined with mucosa and external hemorrhoids are skin covered. Although internal hemorrhoids originate inside the anal canal, when enlarged and symptomatic, these veins can dilate and evert or protrude from the anal opening,” Fawbush says.
Hemorrhoids Symptoms & Signs
While symptoms and their severity may vary from person to person, Fawbush says that the most common signs that you “have” hemorrhoids are perianal itching, burning sensations, rectal bleeding and difficulty cleaning after bowel movements.
These signs are more often related to internal hemorrhoids, even though there may be external symptoms. “This is often due to even small amounts of drainage from inflamed, dilated internal hemorrhoids that irritates the perianal skin,” she explains.
Some of the other possible signs and symptoms to be aware of, Schultzel says, are anal pressure (feeling like you always need to go) or there’s a protrusion pushing out from inside the anus.
If you are experiencing any of these symptoms, it’s important that you talk to your doctor. They will be able to diagnosis whether these are hemorrhoids or something else. Schultzel notes that these symptoms can be indicators for other major issues, including anal fissures or certain cancers.
Hemorrhoid symptoms can last anywhere from a few days to a few weeks, Schultzel says, but treatment(s) can lessen this.
What Causes Hemorrhoids?
Since we are all born with these veins, everyone is susceptible to developing hemorrhoidal symptoms,” Fawbush says, adding, “However, there are certain things that will make the symptoms more likely to occur.”
These can include constipation, straining while going to the bathroom, diarrhea, prolonged sitting or standing, heavy lifting, a lack of fiber in your diet, and/or pregnancy. (All of these things, Schultzel explains, puts the vein in the anus under pressure.)
“Many pregnant women will develop some degree of hemorrhoidal symptoms either during the pregnancy, especially later stages, or during delivery due to pushing,” Fawbush says. But, as Schultzel points out, women who have c-sections can also experience hemorrhoids.
Fawbush says that some women, “especially during or after pregnancy, can have excess skin around the anus that is difficult to cleanse and traps some of this moisture, exacerbating symptoms.” And while these symptoms will often improve quickly, “it is not uncommon for women to have continued, yet intermittent symptoms,” she says.
“Other women may find that they have residual, excess skin around the anus permanently,” Fawbush says, “which is often asymptomatic but can cause irritation due to difficulty cleaning.”
How Can You Prevent Getting Hemorrhoids?
There are simple steps anyone can take to avoid the unpleasantries that can be accompanied by a hemorrhoid flare-up. Schultzel recommends that anyone, whether or not you have hemorrhoids, be aware of their bathroom behaviors. You should avoid straining while you’re having a bowel movement, as well as staying on the toilet for too long.
In addition to what you do (or don’t do) in the bathroom, he says to drink at least 6-8 glasses of water per day to regulate you, as well as taking fiber supplements. Keep your stress levels low, and if you can, alternate between sitting and standing at work “to alleviate pressure and give you comfort,” he says.
Fawbush also recommends avoiding excessive heavy lifting or anything that increases abdominal pressure. “While we often cannot completely avoid the risk, addressing your symptoms early, while the hemorrhoids are only mildly dilated/symptomatic, may mean that the treatment options are easier and more successful,” she says.
If you do have hemorrhoids, there are treatments depending on the severity of your symptoms. The common at-home treatments include topical hemorrhoids creams, aloe vera wipes and warm baths, with or without Epsom salt.
“If OTC creams/wipes, or home remedies are not enough, your healthcare provider can often prescribe a stronger version of the steroid based hemorrhoid cream or suppositories,” Fawbush says, “These can be used episodically but should not be used for a prolonged period of time.”
For those with more difficult hemorrhoids, there are treatments such as rubber-band ligation, which can be done by a proctology specialist. Minimally invasive, Schultzel explains that the banding is done when a scope is placed in the anus and a rubber band is applied to the neck of the hemorrhoid. The band “chokes off the blood supply,” causing it to shrivel up so that you can pass it. While you may experience mild discomfort during the procedure, unlike surgery you can return to most activities as normal.
Surgery comes into the picture, Fawbush says, “When topical and office-based therapies are not providing a level of symptom control that the patient desires. Surgery is usually reserved for the more advanced hemorrhoidal stages and typically requires a 2-4 week recovery period.”
However, as Fawbush points out, these treatments do not “get rid” of hemorrhoids, as that is not possible. “The goal is to reduce the size of the hemorrhoids to a level that does not cause the patient symptoms.” She adds, “Even with successful treatment, recurrence of symptoms is possible and this should not discourage treatment.”
Why You Shouldn’t Have to Suffer from Hemorrhoids
Whether it’s due to embarrassment, denial, or any other reason for avoidance, Schultzel that sometimes people can go years without treating their hemorrhoid systems, and they really shouldn’t have to.
“Having hemorrhoids doesn’t sound glamorous, or beautiful, feminine or sexy. But the truth is, many women develop some degree of these type of symptoms during their lives,” Fawbush adds.
Suffering in silence certainly won’t make your symptoms go away, Fawbush says, “And there are often easy treatment options to reduce or even eliminate the symptoms.” For a basic assessment you should visit your primary care provider can establish the diagnosis and they may even be able to begin basic, initial treatment.
“For persistent symptoms or treatment beyond topical creams/suppositories, scheduling an appt with a proctologist is best,” Fawbush says, “Proctology specialists talk about these subjects so often, we usually have developed a great way to make even the most awkward topics seem totally normal.”