Tom knew there was an issue, but he was embarrassed to talk about it.

The problem? Lately, going to the bathroom filled Tom with dread. He had been constipated and knew that was causing a strain on his system. But he was experiencing a lot of pain when eliminating. He tried a few laxatives, which seemed to bring some relief.

However, the pain from eliminating wouldn’t go completely away. After a week or so, he started wondering if it might be something serious, particularly when he noticed some blood in his stool and on the toilet paper.

Finally, his problem reached a point where Tom couldn’t take the pain and the sleepless nights worrying about what his condition might be. Embarrassment be damned, it was time to see a doctor.

That’s when he found out the cause of his trouble – hemorrhoids.

The Source of Hemorrhoid Pain

Hemorrhoids are painful, swollen and inflamed veins located in the anus and lower rectum. They may be found in the rectum or can develop under the skin around the anus (a condition known as external hemorrhoids).


Hemorrhoids can develop in a number of ways, including increased pressure on the veins caused by bowel movement straining; pregnancy-related issues; sitting for long periods on the toilet, putting strain on the anal opening; chronic constipation or diarrhea; from obesity; eating a low-fiber diet, which causes larger stools and constipation; and finally, hemorrhoids can be caused by anal intercourse, which can damage and tear the delicate fibers in the rectum and anus.

Older people are more susceptible to hemorrhoids because the tissues surrounding the veins in the anus and rectum often stretch and weaken as part of the normal aging process. Half of adults age 50 and older have to deal with the bleeding, discomfort and itching caused by hemorrhoids.

While hemorrhoids are painful and annoying, they can be treated with over-the-counter remedies. Combined with some minor lifestyle changes, most people will not be long-term sufferers.

Symptoms of Hemorrhoids

Hemorrhoid symptoms may include the following:

1. Bowel movement bleeding -- Small amounts of bright red blood may appear on the toilet tissue, signaling the presence of hemorrhoids.
2. Extreme itching -- The area in and around the anus develops an uncontrollable itch and irritation.
3. Pain -- Hemorrhoids can cause elimination pain and sometimes manifest while sitting.
4. Swelling -- The irritated area around the anus can swell from repeated scratching. There also may be a painful lump in the area.
5. Leakage -- The sphincter may not close properly from the swelling, causing fecal leakage.

Like in real estate, whether hemorrhoids pose a major or minor irritation depends largely on their location, location, location. Internal hemorrhoids are cushioned somewhat by the rectum and usually only cause discomfort if a large stool passes over them, causing the muscles to strain to pass it. This can irritate the hemorrhoid and cause bleeding and irritation.

External hemorrhoids pose their own unique problems. Sometimes the irritation becomes so great that blood pools in the hemorrhoid, forming a clot (known as a thrombus) that can swell and cause severe pain and inflammation.

Other Conditions Possible

Any rectal bleeding can be a sign of trouble beyond hemorrhoids. Underlying conditions that can cause bleeding include colorectal cancer and anal cancer. That’s why a doctor should examine persistent bleeding.

During the exam, the doctor will perform tests to rule out more serious conditions that can be attributed to bleeding. Of particular interest are any changes in bowel habits and the color of the stools -- black, maroon or tarry stools are not a good sign. Passing blood clots or having blood mixed in the with the stool are signs of serious problems and should be addressed by a medical professional because they may signal issues within the digestive tract.

Of course, large amounts of bleeding accompanied by dizziness or fainting indicate an emergency situation, and the patient should seek immediate attention.

Although they aren’t common, there can be complications from hemorrhoids. These include anemia, caused by chronic blood loss and resulting in weakness and fatigue, and a condition called a strangulated hemorrhoid, in which blood supply to the internal hemorrhoid is cut off, causing tissue death (gangrene) and extreme pain.


Help with Hemorrhoids

A doctor can confirm a diagnosis of external hemorrhoids with visual confirmation. Tests for internal hemorrhoids include:

1. Examination looking for abnormalities – The doctor will perform a digital rectal exam. This involves inserting a gloved, lubricated finger into the rectum, trying to feel for any unusual bulges or growths. This is usually the first test and acts as the precursor to more extensive examinations.
2. Visual confirmation -- Many internal hemorrhoids are too soft to be felt, so visual confirmation is needed. This is done with an anoscope, proctoscopy or sigmoidoscopy. All involve thin wires inserted into the rectal area and an examination of that body part as well as further along the intestinal tract. The goal is to spot any hemorrhoids and any other bowel issues that may cause problems.

If the entire colon needs to be examined, the doctor may recommend a colonoscopy, an involved procedure that requires extensive prep and usually is performed under sedation. This is usually recommended if the doctor suspects some underlying issue may cause hemorrhoids, such as colorectal cancer. Colonoscopies are painless and should be performed as part of a regular health maintenance screening.

Most hemorrhoids can be treated with medications and lifestyle changes, like getting more exercise and increasing fiber intake. But there may be a need for more extensive medications and surgery.

There are some over-the-counter ointments, creams, pads and suppositories that can help with hemorrhoid relief. Most of them contain hydrocortisone, a substance that helps relieve itching and pain. However, these over-the-counter medications should only be used for a limited time because they can thin the skin and create their own inflammation and rashes.


An external hemorrhoid will likely be removed with an incision or other minimally invasive procedure. These can usually be done right in the doctor’s office with local anesthesia. These procedures include:

1. Rubber band ligation - This involves placing tiny rubber bands at the base of a hemorrhoid to cut off its circulation. This causes it to wither and fall away on its own. It can be uncomfortable if the hemorrhoid is irritated and may cause some minor bleeding.
2. Sclerotherapy - This is an injection of a chemical solution directly into the hemorrhoid tissue to shrink it. The injection isn’t painful but may not totally get rid of the hemorrhoid.
3. Coagulation - This uses infrared light or laser heat applied directly to the hemorrhoid, causing it to harden and shrivel. It does have a higher rate of hemorrhoids recurring than rubber band treatment.

Surgery is recommended if the other procedures don’t produce results or if the hemorrhoids are particularly large. The surgical procedures range from snipping or stapling the hemorrhoid to removing the surrounding tissues. The surgery can be done on an outpatient or inpatient basis.

Whatever treatment for the condition is chosen, it is a good idea to include more fiber in the diet and begin a light to moderate exercise program. This will help reduce bulky stools and stimulate the system to pass waste material more quickly and efficiently, both helpful in avoiding serious hemorrhoid complications.

As for Tom, the over-the-counter treatments worked. He’s back on the job, sleeping well and looking forward to the big game.