Pregnancy, excess body weight, older age, and chronic constipation are top risk factors for hemorrhoids — or swollen, enlarged rectal or anal veins that are itchy, irritating, sensitive, and uncomfortable. Also known as piles, hemorrhoids can be:

• Internal, concealed within the inner lining of your rectum
• External, appearing just beneath the skin around your anus
• Prolapsed, meaning they’re bulging outside of your anus 

Most of the time, these “varicose veins” of the anus and rectum improve with lifestyle changes and at-home care. But what happens when they don’t — or when they intensify?

Board-certified general surgeon Dr. Johnny L. Serrano of Precision Surgery and Advanced Vein Therapy discusses the ins and outs of hemorrhoids, including signs they may need expert care. 

Hemorrhoid causes and symptoms 

Hemorrhoids are small “vascular cushions” in the rectum that help control bowel function. Everyone has them — we’re born with them — but at their baseline level, they’re not noticeable. They only become bothersome when they swell, enlarge, and trigger irritating symptoms.   

Anyone can develop inflamed hemorrhoids, but older adults, people who are overweight, and pregnant women have an increased risk. You’re also more likely to get them if you:

• Have regular bouts of bowel-straining constipation
• Sit on the toilet for long stretches (i.e., reading)
• Don’t consume enough fiber in your daily diet
• Don’t drink enough fluids or are often dehydrated
• Do a lot of heavy lifting (i.e., at the gym, on the job) 

Anal itching or pain, sensitive or protruding lumps around your anus, and rectal bleeding during or after a bowel movement are a few common hemorrhoid symptoms. 

Basic at-home care for hemorrhoids 

Fortunately, most hemorrhoids improve substantially or resolve entirely with a little TLC supported by healthy lifestyle changes. If your hemorrhoids aren’t severe, you can try these simple, at-home remedies first: 

Prompt symptom relief

You can ease the discomfort and itching of mild hemorrhoids with an OTC topical hemorrhoid cream or a suppository containing hydrocortisone. Instead of using toilet paper after a bowel movement, gently pat your bottom clean with soothing wet wipes or witch hazel wipes. 

To further soothe your hemorrhoids and help them heal faster, soak in a warm bath for 10-20 minutes daily.   

Long-term improvement

Long-term hemorrhoid recovery and recurrence prevention typically mean supporting better bowel function to promote regularity and avoid constipation. Drinking plenty of water, getting enough fiber (through diet and/or supplementation), and becoming more physically active can help your hemorrhoids heal.

When hemorrhoids need treatment

Sometimes, hemorrhoids need expert help to heal appropriately — or they require a more targeted medical treatment because of their persistence or increasing severity. These five signs indicate that it’s time to seek expert care for your hemorrhoids:  

1. They’re severe or painful from the start

You don’t have to suffer from hemorrhoids that are intense or painful from the start. While at-home care may help, it’s best to have severely inflamed hemorrhoids checked by an expert. Dr. Serrano can help you obtain faster relief than you might get alone. 

2. They don’t improve after a week of care

If your mild to moderate hemorrhoids don’t resolve or even seem to improve after a week of at-home care, schedule a visit with Dr. Serrano. After an exam and symptom assessment, he can offer next-step treatment options for faster relief. 

3. They continue to intensify or worsen

If your hemorrhoids only seem to be getting worse despite at-home care measures, it’s time to call Dr. Serrano. He can get to the bottom of your worsening symptoms and treat the underlying problem before you develop complications like tissue protrusion or strangulation.  

4. They bleed when you move your bowels

Mild or spotty rectal bleeding is indeed a common occurrence with hemorrhoids, but that doesn’t mean you should treat all rectal bleeding with indifference. If you notice blood before (in your underwear), during (in the toilet), or after (on the toilet paper) a bowel movement, see Dr. Serrano. 

5. You develop bulging tissue from your anus

If an internal hemorrhoid becomes severely inflamed, it may prolapse or push itself outward and protrude from your anus. Always see a doctor if you have tissue bulging from your anus — the sooner, the better.  

Treating problematic hemorrhoids 

If Dr. Serrano determines that your hemorrhoids would benefit from medical treatment, he discusses the pros and cons of your various options and how they apply to your specific case. To resolve your problem, he may recommend:

• Minimally invasive rubber band ligation
• Minimally invasive chemical sclerotherapy 
• Hemorrhoidectomy, or surgical removal

Do you have bothersome hemorrhoids? Our board-certified general surgeon in Glendale, Arizona, is here to help. Call 623-321-5663 today, or click online to schedule a visit with Dr. Serrano at your convenience at Precision Surgery and Advanced Vein Therapy.