Bleeding Hemorrhoids: Causes, Symptoms, and Treatment

Hemorrhoids are the swollen blood vessels present in and around the rectum. Most people do not come to know they are suffering from hemorrhoids until they start bleeding, get uncomfortable, or develop pain. They are of two types:

• Internal hemorrhoids: These hemorrhoids develop in the rectum.
• External Hemorrhoids: These hemorrhoids develop around the anal opening in the skin.

Hemorrhoids bleed due to straining during the bowel movement. Other triggers include diarrhea, constipation, and sitting and standing for a long time. Bleeding hemorrhoids can also occur after lifting heavy items during pregnancy.

Hemorrhoids can be treated at home and in some severe cases, surgery may be needed.

Hemorrhoidal tissue is present in the anal canal of every individual, which consists of blood vessels, connective tissue, and muscles. On sneezing, straining, or exerting, the hemorrhoidal tissue swells up.⁽¹⁾ It prevents the feces from leaving the body. Mostly the tissue returns to its normal size, but in some, it may remain enlarged and this leads to hemorrhoids.

Hemorrhoids bleed in the following cases:

• With diarrhea or constipation
• After a bowel movement
• During pregnancy
• When lifting heavy objects
• Sitting and standing for a long time
• Blood clots blocking the blood supply

Hemorrhoids remain inside the anal canal and only sometimes bulge outside the body. Both internal and external hemorrhoids can bleed. However the external is more painful.

The most common symptom of a hemorrhoid is bleeding from the rectum.⁽²⁾ There may be streaks of bright red blood in the:

• Tissue after wiping
• In the toilet bowl
• In the stool

If dark red blood is present, a doctor should be notified as there can be a problem up the gastrointestinal tract.

Thrombosed Hemorrhoid

When a blood clot develops inside a hemorrhoid, it is known as a thrombosed hemorrhoid. As the swelling increase, the pressure from the surrounding tissues and stool can make hemorrhoids rupture and bleed at the end of the stool and may also be extremely painful.

A doctors advise is necessary if there is:

• Excessive pain
• Continuous bleeding from the hemorrhoid
• Drops of blood in the toilet bowl
• Bluish lump on the anus

A thrombosed hemorrhoid may need urgent treatment as it can compress and damage the surrounding blood vessel.

The treatment of hemorrhoids depends on the severity of the symptoms, the size of the hemorrhoid, and whether or not a person has already taken treatment for the condition.

The treatment for hemorrhoid that can be done at the doctor’s office include:⁽¹⁾

• Rubber Band Ligation: It involves placing a small rubber band at the base of an internal hemorrhoid that cuts off the blood supply. This makes the hemorrhoids fall off in 5-7 days.
• Sclerotherapy: It involves injecting chemicals into the hemorrhoids making them shrink. Scarring occurs in the blood vessels, stopping the flow of blood through them.
• Cryotherapy: This therapy freezes the blood vessels, scarring the tissue, thereby blocking the blood flow.
• Infrared Photocoagulation: In this option, the laser is used to damage the hemorrhoidal tissue. This causes it to shrink and slough off.

For those with large and bulky hemorrhoids, more invasive surgery may be needed. The procedures mainly aim to tie off the bleeding blood vessels so that the bleeding stops. The surgery includes:

• Hemorrhoidectomy: In this procedure, the area is numbed with anesthesia and the hemorrhoid is cut away. General anesthesia may be needed for large hemorrhoids.
• Stapled Hemorrhoidectomy: In this, a hemorrhoid is stapled inside the anus.
• Hemorrhoid Artery Ligation: In this, the arteries supplying blood to the hemorrhoids are stitched. This causes it to shrink.

Home remedies might not help in resolving bleeding hemorrhoids but can be helpful in relieving the symptoms.

Some of the home remedies include:

Sitz Bath: A Sitz bath can be helpful in relieving pain and irritation in the hemorrhoids. It is a small plastic tub that can fit on the toilet seat and can be filled with warm water.

Ice: Applying ice to the swollen area can help in relieving swelling and reducing pain and inflammation.

Good Toilet Habits: Good toilet habits include:

• Using the bathroom during the urge
• Avoiding excess wiping
• Avoiding excess staining or pushing
• Limiting toilet time to 3-5 minutes

Water Intake: Increasing water intake helps in softening stool and making the stool easier to pass. This will cause lesser staring at stool and give time for hemorrhoids to heal.

Over-the-Counter Medications: OTC treatments include suppositories, stool softeners, and rectal ointments. These help in providing relief from irritation and pain.

Bleeding from the hemorrhoids can be prevented by keeping the bowel movements regular, by increasing fiber intake exercising, and drinking plenty of water. A doctor should be consulted if the bleeding is excessive and include clots.