Hemorrhoids (HEM-or-roids), sometimes called piles, are enlarged veins in the rectum, which is the lower portion of the digestive tract. They are similar to varicose veins of the legs. Hemorrhoids may bleed and cause pain.

Where Do People Get Hemorrhoids?

Hemorrhoids occur in two places. When they are located in the upper part of the rectum, the hemorrhoids are called internal hemorrhoids. In the lower part of the rectum, they are called external hemorrhoids.

Hemorrhoids are said to be prolapsed if they have slipped down from their usual position and extend outside of the anal * opening.

What Causes Hemorrhoids?

Hemorrhoids have a number of different causes. They occur often in women who are pregnant or who have just given birth. People with chronic constipation are at risk for hemorrhoids because of added pressure to the anorectal (pertaining to the anus and rectum) area when they pass stools (solid waste matter, feces) that are hard and dry. Among other causes are sitting for long periods, diets low in fiber, and obesity.

What Are the Symptoms of Hemorrhoids?

Pain during bowel movements and blood in the stool are the usual symptoms that accompany hemorrhoids. Sometimes there is a discharge of mucus, and there may also be itching, burning, or pain in the area. The enlarged vein in the rectum sometimes develops a clot, which can be very painful. People with hemorrhoids sometimes develop iron deficiency anemia * from the bleeding that occurs.

How Are Hemorrhoids Diagnosed and Treated?

The doctor first examines the anal area through a viewing tube called an anoscope to rule out other conditions that cause similar symptoms. For mild cases of hemorrhoids, doctors may recommend the following:

When the hemorrhoids are internal, they can be removed in the doctor's office by a simple procedure. Tiny rubber bands are wrapped tightly around the hemorrhoids. Following this procedure, the hemorrhoids wither away and drop off without causing pain.

Rubber band ligation is probably the most widely used treatment for internal hemorrhoids. An applicator is used to place one or two small rubber bands around the base of the hemorrhoid, cutting off its blood supply (figures A and B).

Rubber band ligation is probably the most widely used treatment for internal hemorrhoids. An applicator is used to place one or two small rubber bands around the base of the hemorrhoid, cutting off its blood supply (figures A and B). After 3–10 days, the rubber bands and the hemorrhoid fall off, leaving a scab that disappears within a week or two.
Illustration by Electronic Illustrators Group. © 2016 Cengage Learning®.

Dietary fiber (also called bulk or roughage) is important for digestive health. The average adult eats about 15 grams of fiber per day, yet recommendations are for 25 grams per day for women and 38 grams per day for men.

There are two different types of fiber: soluble and insoluble. Consuming both types of dietary fiber promotes healthy digestion.

Eating at least five servings of fruits and vegetables each day, as well as at least six servings of whole-grain products per day, will meet the recommended fiber requirements.

To reach dietary fiber goals each day, avoid regular wheat (white) products and white rice in favor of whole grains. Whole grains include whole wheat, quinoa, brown rice, farro, barley, millet, and corn. Seeds and nuts count as well, including chia, flax, hemp, teff, pumpkin, and pomegranate seeds.

Internal hemorrhoids that stay prolapsed (outside the body), or external hemorrhoids that have clotted, are often removed surgically. This method of removal is usually done on an outpatient * basis with local anesthesia * .

See also Constipation • Varicose Veins


Books and Articles

Courage, Katherine Harmon. “Fiber-Famished Gut Microbes Linked to Poor Health.” Scientific American, March 23, 2015. http://www.scientificamerican.com/article/fiber-famished-gut-microbes-linked-to-poor-health1 (accessed July 16, 2015).


Harvard School of Public Health. “Fiber.” http://www.hsph.harvard.edu/nutritionsource/carbohydrates/fiber (accessed July 16, 2015).

MedlinePlus. “Hemorrhoids.” U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000292.htm (accessed June 9, 2016).


American Gastroenterological Association. 4930 Del Ray Ave., Bethesda, MD 20814. Telephone: 301-654-2055. Website: http://www.gastro.org (accessed July 16, 2015).

National Institute of Diabetes and Digestive and Kidney Diseases. 9000 Rockville Pk., Bethesda, MD 20892-2560. Telephone: 301-496-3583. Website: http://www.niddk.nih.gov (accessed March 28, 2016).

* anal refers to the anus, the opening at the end of the digestive system through which waste leaves the body.

* anemia (uh-NEE-me-uh) is a blood condition in which there is decreased hemoglobin in the blood and, usually, fewer than normal numbers of red blood cells.

* outpatient is a medical procedure that is conducted in a doctor's office or hospital but does not require an overnight stay in a hospital bed.

* local anesthesia (an-es-THEEzha) means using medicine to block or numb pain in one part of the body while the patient remains awake. General anesthesia blocks pain over the entire body while the patient sleeps.

* inflammation (in-fla-MAY-shun) is the body's reaction to irritation, infection, or injury that often involves swelling, pain, redness, and warmth.

* acute describes an infection or other illness that comes on suddenly and usually does not last very long.

* chronic (KRAH-nik) means lasting a long time or recurring frequently.

* autoimmune (AW-toe-im-YOON) refers to disorders that result from the body's immune system attacking body cells.

Disclaimer:   This information is not a tool for self-diagnosis or a substitute for professional care.

(MLA 8th Edition)