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JAMA Patient Page
December 24/31, 2014

Hemorrhoids

JAMA. 2014;312(24):2698. doi:10.1001/jama.2014.281

Hemorrhoids are bulging blood vessels in or near the rectum or anus.

Hemorrhoids are so common that most people have them at some point in their lives. They may develop inside the anus (but can protrude outside) or develop outside the anus and be covered by skin. Although hemorrhoids can be painful, they rarely cause long-term health problems and are not associated with cancer. They sometimes result in blood in the stool, but this can also occur with colon or rectal cancer.

Symptoms

It is common for people with hemorrhoids never to see a doctor for them because of embarrassment or fear or lack of knowledge about treatment. Symptoms include bright red drops of blood on toilet tissue or in the toilet; protruding, swollen blood vessels from the anus; a hard, painful lump near the anus; pain during bowel movements; and itching and irritation.

Causes

In general, anything that puts pressure on the veins in the lower body can lead to hemorrhoids, including straining during a bowel movement; sitting on the toilet for long periods; constipation or diarrhea; being overweight; pregnancy; and age, which causes tissues to become weaker.

Diagnosis

A doctor diagnoses hemorrhoids by examining the area around the anus and rectum and may use an anoscope to look inside the rectum.

Treatment

Often hemorrhoids can be treated with simple methods at home, such as sitting in a warm bath for 10 to 15 minutes or using over-the-counter medications or prescription corticosteroid creams.

If these treatments do not work, hemorrhoids may need to be treated by a doctor. Most commonly this can be done in an office setting. In more advanced cases, the hemorrhoids may need to be removed by a hemorrhoidectomy, an operation done to remove hemorrhoids. This is typically done as an outpatient procedure but might require anesthesia or even an overnight hospital stay.

Office-based procedures include

  • Sclerotherapy: the hemorrhoid is injected with a chemical, causing it to shrink and fall off.

  • Rubber band ligation (RBL): a rubber band is tied around the hemorrhoid, cutting off the blood supply. The hemorrhoid falls off after a few days.

  • Infrared photocoagulation: a laser is used to remove the hemorrhoid. This surgery is more expensive than RBL, and most studies show similar results.

Operating room procedures include

  • Stapled hemorrhoidectomy: the hemorrhoid is lifted up and stapled, cutting off the blood supply.

  • Excisional hemorrhoidectomy: the hemorrhoid is removed using a sharp instrument or specialized energy device.

To heal following surgery or to prevent hemorrhoids from recurring, any underlying constipation should be treated by using stool softeners and laxatives, drinking plenty of liquids, eating foods that are high in fiber, and/or taking a fiber supplement.

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Article Information
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: McQuaid KR. Gastrointestinal disorders. In: Papadakis MA, McPhee SJ, Rabow MW, Berger TG, eds. Current Medical Diagnosis & Treatment 2014. New York, NY: McGraw-Hill; 2013:chap 15.

Topic: Digestive System

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