Lutheran Medical Center


Anorectal disorders occur at the junction of the anal canal and the rectum. Often times treatment is available in an office setting, but occasionally require more complex treatments.

Learn what hemorrhoids are, what the symptoms are, your surgical options and more.


Hemorrhoids are enlarged or swollen veins in the bottom of the rectum (just above the anus) or the anus. Hemorrhoids are common, occurring in both men and women. Although hemorrhoids do not usually cause serious health problems, they can be annoying and uncomfortable. They are generally caused by chronic constipation or after pregnancy/childbirth. Hemorrhoids can often times be treated with diet changes and regular bowel habits; sometimes hemorrhoids do require surgery to remove them if they are bothersome.

Hemorrhoids that are hidden inside the rectum are called “internal” hemorrhoids. You cannot see them, but they can cause symptoms. Hemorrhoids that you can see or feel are called “external” hemorrhoids.

This figure shows what an external hemorrhoid looks like.

Reproduced with permission from: Patient Information: Hemorrhoids (The Basics). In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA 2012. Copyright © 2012 UpToDate, Inc. For more information visit www.uptodate.com.

Causes of Hemorrhoids

There are many different causes of hemorrhoids, but in general they are caused by increased pressure on the veins in the pelvis and rectal area. This is caused by:

  • Chronic constipation or diarrhea, excess straining to have bowel movements is a common cause of hemorrhoids
  • Pregnancy, due to pressure in the pelvis from the baby in the uterus
  • Obesity
  • Prolonged sitting for most of the day (for example truck drivers or other professions that require sitting for most of the day)

Symptoms of Hemorrhoids

The most common symptoms of hemorrhoids can include the following:

  • Painless rectal bleeding, usually is a small amount
  • Anal itching or pain, due to irritation of the skin surrounding the anus
  • Tissue bulging around the anus, some people can see or feel hemorrhoids on the outside of the anus
  • Leakage of feces or difficulty cleaning after a bowel movement

Hemorrhoids are more common in people who are older and in those who have diarrhea, pelvic tumors, during or after pregnancy, and in people who sit for prolonged periods of time and/or strain (push hard) to have a bowel movement.

  • Rectal bleeding — Many people with hemorrhoids notice bright red blood on the stool, in the toilet, or on the toilet tissue after a bowel movement. The amount of blood is usually small. However, even a small amount of blood in the toilet bowl can cause the water to appear bright red, which can be frightening. Less commonly, bleeding can be heavy. While hemorrhoids are one of the most common reasons for rectal bleeding, there are other, more serious causes. It is not possible to know what is causing rectal bleeding unless you are examined. You should seek medical attention if you see bleeding after a bowel movement.
  • Pain — Hemorrhoids can become painful. If you develop severe pain, call your healthcare provider immediately because this may be a sign of a serious problem.

Testing for Hemorrhoids

In many cases, your doctor can determine if you have hemorrhoids by asking you about your symptoms and doing a physical examination. Some hemorrhoids are visible on the outside (called External Hemorrhoids) and others are deeper inside (called Internal Hemorrhoids), and these are generally not visible on the outside.

The doctor will likely do a digitial rectal examination (using a gloved finger inside your rectum) or may need to do an Anoscopy (by placing a short, lighted, scope into your anus and examining the inside of the anal canal).

If you have rectal bleeding, the doctor will need to determine where the bleeding is coming from. Many times the bleeding can be from hemorrhoids, but it can also be from other medical conditions such as colon or rectal cancer. You may need to have a Colonoscopy or sigmoidoscopy for further testing.

Types of Hemorrhoids

External hemorrhoids are those that are visible on the outside of the anus; they originate in the lower part of the anus. These can become inflammed and the blood inside the veins can become clotted. This is called Thrombosed (or clotted) Hemorrhoids.

Internal Hemorrhoids are generally not visible on the outside because they originate higher up in the anal canal. Internal hemorrhoids more commonly cause bleeding after a bowel movement, in comparison to external hemorrhoids. If internal hemorrhoids become large and severe, they can push out through the anus and may be visible. This can be very painful, especially if the hemorrhoids become trapped by the anal muscle and cannot go back inside.

Classification of Internal Hemorrhoids:

  • Grade 1(minor): present but only visualized by a doctor with ansocopy or colonoscopy, and do not extend out the anus
  • Grade 2: can extend out of the anus with a bowel movement or with straining, but will go back inside spontaneously
  • Grade 3: extend out of the anus with a bowel movement or with straining, but will not go back inside spontaneously, and requires the patient to manually push it back inside. If you have this, you should seek medical attention, but it is not urgent.
  • Grade 4 (severe): extend outside the anus and are not able to be pushed manually back inside. **If you have this, you should seek medical attention immediately as this can cause significant complications.

After Hemorrhoid Surgery:

This is generally a same-day surgery. Most people are able to return to work and other activities in about 1-2 weeks. You may have a small amount of bleeding on the dressing or after having a bowel movement; this can last for a couple weeks. You should contact your doctor if the bleeding is more than a few Tablespoons per day.

You may resume your usual diet immediately after surgery.

**It is very important to not allow yourself to become constipated after surgery.**

  • To avoid constipation or stool impaction, we recommend starting a high fiber diet the morning after surgery (Bran cereal, wheat or rye bread, fresh fruits, and vegetables) and also one tablespoon of Metamucil (or other fiber supplement powder) mixed with 8 ounces of water each morning and evening starting the day after surgery.
  • You should take Dulcolax stool softener (Docusate is the generic name) 100mg tablet twice daily starting on the day before your surgery, and until you are no longer taking pain medication.
  • If you go 48 hours without a bowel movement (BM), you should take 2 tablespoons of Milk of Magnesia every 6 hours until your first BM, and then stop.
  • Call the office if you go more than 2 days without a BM or if you are having abdominal pain or abdominal distension.
  • Drink plenty of water and juice and eat fresh fruits and vegetables.

Learn more about hemorrhoids.

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