Hemorrhoids are enlarged veins in the anus or lower rectum. They often go unnoticed and usually clear up after a few days, but can cause long-lasting discomfort, bleeding and be excruciatingly painful. Hemorrhoids develop when excessive pressure or other factors cause the veins within these cushions to swell and stretch.
Nearly everyone has hemorrhoids at some time. They can develop at any age, but the incidence increases after age 30.
Hemorrhoids involve the blood vessels that line the anus. Pressure on the walls of the rectum weakens the muscles that support the hemorrhoidal vessels. They then become enlarged and lose their support and result in a sac-like protrusion inside the rectal canal (called internal hemorrhoids) .
If the internal hemorrhoid pushes out of the anal opening, this hemorrhoid is called a prolapsed hemorrhoid. Sometimes, blood can pool in an external hemorrhoid, forming a clot (thrombus).

Causes

• Rushing to complete a bowel movement. Hurrying can lead to excessive straining and increase pressure on rectal veins.
• Persistent diarrhea or constipation, which may cause straining and increase pressure on veins in the anal canal.

 
• Constipation and chronic straining often due to a diet low in vegetables, fruits, and other fiber sources.
• Being overweight. Excess weight, especially in the abdomen and pelvis, may increase pressure on pelvic veins.
• Genetic factors may play a role.
• Pregnancy and labor. Hormonal changes during pregnancy increase blood flow to the pelvis and relax supportive tissues while the growing fetus causes increased pressure on blood vessels.
• Sitting for long periods of time
• Medical conditions. For example, long-term heart and liver disease may cause blood to pool in the abdomen and pelvic area, enlarging the veins.
• Tumors in the pelvic area. These occur very rarely.

Symptoms

The primary symptom is a swelling or a soft lump at the anus, sometimes accompanied by pain and itching. You may pass some mucus after a bowel movement. You may also feel that you need to pass more stool. You might also notice streaks of bright red blood on the toilet paper after straining to pass a stool

Treatment

Hemorrhoids can often be effectively dealt with by dietary and lifestyle changes. Softening the feces and avoiding constipation by adding fiber to one's diet is important, because hard feces lead to straining during defecation

• Eat a high-fiber diet. Good choices are fruits and vegetables, oat and bran cereal, whole-grain bread, and brown rice.
• Increase dietary fiber and fluids (6-8 glasses water a day if not contraindicated).
• Always take laxatives recommended by your doctor and try to take only the natural sources, such as Psyllium based products.
• Laxatives are not to be taken for a period greater than 2 weeks, and if you have constipation for longer than 2 weeks notify your physicians.
• To reduce pain and swelling, apply an over-the-counter hemorrhoid medicine. Follow the directions on the label.
• Sit in a tub of comfortably hot water for 20 minutes, 3 times a day.
• If a hemorrhoid is very painful and swollen, apply an ice pack to the anal area.
• Clean the anal area gently with soft, moist toilet paper after each bowel movement.
• You may do normal activities if you are not in pain. Avoid sitting or standing for long periods of time. If the hemorrhoid is painful, lie down as much as possible.
• Lose weight if you are overweight.
• Hemorrhoidal creams, foams and suppositories containing hydrocortisone (e.g. Anusol HC) may be prescribed to reduce the swelling, burning and itching.
• In some patients with problematic hemorrhoids, a surgeon may be consulted.
  Surgical methods to remove or reduce the hemorrhoids include rubber band ligation (a rubber band placed around the dilated veins to cut off circulation), sclerotherapy (hemorrhoids injected with chemical solution), Laser or infrared light coagulation (burn the hemorrhoids), and hemorrhoidectomy.