How to Treat Bleeding Hemorrhoids
Medically reviewed by Robert Burakoff, MD
Hemorrhoids occur when pressure from straining causes veins in the rectum and anus to swell and bulge. About 40% of people with hemorrhoids have no symptoms. For those with internal hemorrhoids, bleeding is the most common sign.
Most of the time, hemorrhoids can be treated at home. Serious cases may require in-office procedures like electrocautery or surgeries like a hemorrhoidectomy.
This article describes the causes and symptoms of hemorrhoids. It also explains when it is time to see a healthcare provider along with the various treatment options.
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What Are the Causes of Bleeding Hemorrhoids?
The anal canal is lined with hemorrhoidal tissues that consist of muscles, connective tissues, and a network of blood vessels. Whenever pressure is exerted on these tissues, such as when you are passing a stool, the tissues will swell.
In most cases, the tissues will return to their normal size after the pressure eases. However, when excessive or prolonged pressure is placed, the vessels inside the tissues can bulge and cause an abnormal pile, known as a hemorrhoid.
Common causes of hemorrhoids include:
Straining on the toilet
Straining while lifting heavy objects or sneezing loudly
Sitting for a long time
Constipation
Diarrhea
Pregnancy
Bleeding can occur as a passing stool nicks a blood vessel in the swollen pile. The same can occur with straining, causing the thinned walls of a blood vessel to spontaneously burst and bleed.
What Are the Symptoms of Bleeding Hemorrhoids?
Hemorrhoids can be internal (situated inside the anal canal or lower rectum) or external (situated outside of the anal canal). In some cases, an internal hemorrhoid can bulge outside of the anal canal, causing a prolapsed hemorrhoid.
Bleeding is common with internal hemorrhoids. The bleeding is generally painless and causes streaks of bright red blood:
On toilet paper when wiping
On the outside of a stool
In drops in the toilet bowl
Dark red blood is a sign of bleeding higher up in the digestive tract. These are far more concerning and require immediate medical attention.
Thrombosed Hemorrhoids
External hemorrhoids are more likely to be painful but less likely to bleed. However, bleeding can occur if there is a thrombosed hemorrhoid. This is a type of hemorrhoid caused when a blood clot obstructs a vein in or around the anal canal.
When these hemorrhoids bleed, the blood will usually be darker because the blood inside will have pooled and oxidized. You may also notice tiny clots on toilet paper or stools.
When to See a Healthcare Provider
While rectal bleeding is a common symptom of hemorrhoids, it can also be a symptom of other conditions, including ones that may be more serious.
As such, you should contact your healthcare provider if:
Bleeding is persistent or worsening
Bleeding involves darker blood or clots
Your symptoms don't respond to home treatment within a week
When Immediate Care Is Needed
Seek immediate medical care if you experience the following signs or symptoms:
Severe rectal bleeding
Severe anal or rectal pain
Fever with chills
Heart palpitation
Cold sweats
Pallor (pale skin)
Dizziness, lightheadedness, or fainting
Severe abdominal pain
Bloody or tarry stools
Medical Treatments for Bleeding Hemorrhoids
Hemorrhoids usually respond well to conservative treatment, but severe cases may require treatment by a healthcare provider. The treatment will be based on the size of the hemorrhoid, the severity of your symptoms, and how much the condition interferes with your daily life.
If bleeding is the main concern, medications may be of little help other than to ease pain. In such cases, an in-office or surgical procedure may be needed.
In-Office Procedures
In-office procedures aim to shrink the hemorrhoid by creating scar tissue that cuts off its blood supply. Options include:
Rubber band ligation: This involves the placement of a rubber band around the base of the hemorrhoid. Within about a week, the banded section shrivels and falls off, leaving scar tissue.
Sclerotherapy: This involves an injection of a chemical into blood vessels to scar them.
Infrared photocoagulation: This uses an intense beam of infrared light to scar blood vessels.
Electrocautery: This involves an electrical current to scar blood vessels.
Cryotherapy: This involves the application of liquid nitrogen to scar blood vessels.
Surgery
Hemorrhoid surgery is generally performed on an outpatient basis with local or regional anesthesia. Options include:
Hemorrhoidectomy: This is the surgical removal of large external hemorrhoids and prolapsed hemorrhoids that do not respond to other conservative treatments.
Hemorrhoid stapling: This procedure uses a special stapling tool to remove internal hemorrhoids and pull a prolapsed hemorrhoid back into place inside the rectum.
Hemorrhoid artery ligation: This surgery cuts off blood flow by applying a stitch around the artery servicing the hemorrhoid. Another series of stitches can pull the prolapsed hemorrhoid back into place inside the rectum.
Ways to Treat Bleeding Hemorrhoids at Home
Hemorrhoids often respond well to self-care treatments. This may involve diet and lifestyle changes, simple home remedies, and over-the-counter (OTC) medications.
Lifestyle and Diet
Diet plays a central role in treating hemorrhoidal bleeding by preventing constipation and keeping stools soft. This mainly involves eating foods rich in fiber (such as whole grains and fresh fruits and vegetables) and avoiding foods that constipate (such as fried foods, processed meats, commercial baked goods, and cheese).
Studies suggest that increasing your fiber intake can reduce hemorrhoidal bleeding by as much as 50%.
Increasing your fluid intake is also important as dehydration is a leading cause of constipation. Most adults should aim to drink at least eight 8-ounce glasses of fluids per day. Plain water is best.
Brisk walking and other moderate aerobic exercises performed 20 to 30 minutes a day can also help prevent constipation by stimulating bowel movements.
Home Remedies
One of the most effective ways to ease hemorrhoidal pain is with a sitz bath. A sitz bath is a shallow pan you sit in that usually fits over the seat of your toilet. Sitting in lukewarm water can promote circulation and aid with the healing of inflamed and damaged tissues.
Sitting in a bathtub filled with a few inches of lukewarm water can also work.
For severe pain and swelling, try applying a cold compress to your anus for 10 to 15 minutes several times a day. This helps shrink blood vessels, reducing swelling and helping stem minor bleeding.
OTC Medications
Over-the-counter hemorrhoid treatments are also effective in easing symptoms by either shrinking tissues or numbing pain. They are intended for short-term use and are available as creams, ointments, pads, and suppositories.
Options include:
Witch hazel: A topical astringent that reduces inflammation
Lidocaine: A topical anesthetic used to ease pain and itching
Hydrocortisone: A topical steroid used to ease inflammation
Phenylephrine: A topical decongestant that may help shrink blood vessels
Reducing inflammation and shrinking blood vessels may also help stem minor bleeding.
Related: Hemorrhoid Treatments: Home Remedies, OTC Medicine, and More
Ways to Prevent Bleeding Hemorrhoids
Hemorrhoids can't always be prevented, but practicing the following measures may help reduce the risk or stop them from getting worse.
Preventive measures include:
Eating a high-fiber diet with plenty of non-caffeinated, nonalcoholic liquids
Avoiding straining, such as during a bowel movement or heavy lifting
Avoiding sitting on the toilet for long periods
Using the toilet as soon as you feel the urge (don't hold it in)
Establishing a regular bowel routine, such as using the toilet at the same time each day
Using a pillow to avoid sitting on hard surfaces
Exercising regularly to stimulate bowel movement
Summary
Bleeding is a common symptom of internal hemorrhoids. It is usually painless and causes bright red streaks of blood on stools or toilet paper. Hemorrhoids tend to respond well to home remedies, but severe cases may require medical treatments, including surgery.
See a healthcare provider if hemorrhoidal bleeding persists or worsens. If the bleeding is severe or accompanied by fever and other symptoms, seek immediate medical care.
Read the original article on Verywell Health.
