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Hemorrhoid tissues are a network of blood vessels located near the anal canal that play an important role during bowel movements. When you have a bowel movement, these blood vessels swell and enlarge to cushion the anal canal as your body eliminates waste. After the bowel movement, the hemorrhoid tissues stop swelling and return to their normal size.
Hemorrhoids can remain swollen or inflamed if there is too much pressure on the anal canal. This can cause discomfort and pain.
Symptoms of swollen hemorrhoids include:
 Itching around the anus
 Bleeding during bowel movement
 Paining or a burning sensation
 Protrusion of tissue from the anus
The increase in pressure on the anal canal is often caused by chronic constipation, straining during bowel movements, diarrhea, strenuous exercising or heavy lifting, aging, or pregnancy and childbirth.
Swelling of the hemorrhoids can occur both inside and outside the anal canal. When hemorrhoids remain swollen inside the anal canal, they are called internal hemorrhoids . And when swollen hemorrhoids develop outside the anal open, they are called external hemorrhoids .
Internal hemorrhoids often form in clusters around the wall of the anal canal. Most of the time they are painless. Due to straining or pressure from hard stool, they may prolapse , or stick out of the anus. They may reduce , or go back inside the body once the bowel movement ends. They might also discharge mucus.
External hemorrhoids are located beneath the skin of the anal opening. These tissues are usually painless unless they thrombose , or form a blood clot. A thrombosed external hemorrhoid looks like a hard, bluish bump and can cause sharp, severe pain.
The clot may disappear on its own with time and leave a “skin tag”, tissue stretched by the clot.
Other Medical Problems May Be Responsible For Your Symptoms. Below are common problems that cause similar symptoms as hemorrhoids.
 A fissure is a small tear or crack in the lining of the anus. Hard bowel movements, diarrhea, or inflammation in the rectal area can cause a fissure. Fissures can bleed and cause painful bowel movements.
 An abscess is an infected gland in the anal canal. The area swells and often causes pain.
 A fistula is a pathway that may form when an anal abscess drains. This pathway may remain even after the abscess has disappeared. Fistulas are usually not painful, but they can cause drainage where the pathway comes in contact with skin.

In order to learn about your symptoms and rule out alternative medical causes, your doctor will perform an evaluation.
This will include a patient history and exam. Your doctor will ask questions about bowel habits, diet, how often you exercise, and your medications. During your physical exam, you will be asked to lie on an exam table while your doctor looks for signs of swollen hemorrhoids. Your doctor will perform a visual exam is used to examine the outer anal skin. A digital rectal exam is used to look for hemorrhoids or other problems in the anal canal. This is done using a lubricated gloved finger. An anoscopic exam is used to examine the anal canal. It uses a special viewing tube called an anoscope.
After completing your physical exam, your doctor may assign a grade to your internal hemorrhoids. This grade depends on the severity of your symptoms.
 Grade I hemorrhoids: They do not protrude from the anus and cause few symptoms. Bleeding may occur.
 Grade II hemorrhoids: They protrude from the anus during bowel movements and reduce after straining.
 Grade III hemorrhoids: They protrude on their own or with straining. They do not reduce by themselves, but can be pushed back into place.
 Grade IV hemorrhoids: They can protrude and cannot be reduced at all. They can be painful and may require treatment.
Diagnostic tests may be performed to rule out other medical causes such as polyps and colorectal cancer. These tests require a fecal occult blood test which looks for blood in stool.
 Sigmoidoscopy: A thin, lighted tube called a sigmoidscope is used to view the rectum and lower colon. The test is performed in the doctor’s office and it only takes a few minutes.
 Colonoscopy: A long, thin, lighted, flexible tube called a colonoscope is used to view the entire colon. Your doctor will perform this test in a hospital. You are given medications to help you relax during the procedure.
 Barium Enema: A radiologist injects a liquid barium solution into the colon. The barium acts as a dye that allows the colon to become easily viewed on x-rays. The test is performed at a hospital or radiology center.
 Virtual CT scan: For those people who cannot tolerate colonoscopy or barium enema, a CT scan in the radiology department may be the answer.
After examining the results of your exam and any tests, your doctor will provide you with treatment options. Often just making small changes in your diet and bowel habits can relieve your symptoms. However, if they are severe, your doctor may advise removing your hemorrhoids. There are many things you can do to relieve your symptoms on your own.
Swelling and pain due to hemorrhoid are often difficult to ignore. Your doctor may prescribe anti-inflammatory medicine to alleviate pain. Following tips below may also help relieve pain and swelling.
 Develop Good Bowel Habits: Each individual has different bowel movements, but use the bathroom when you need to. Mostly importantly, do not ignore the urge to go. This can lead to constipation, hard stools and straining. Only sit as long as needed, do not read while on the toilet. Wipe gently with soft, unscented toilet tissue or baby wipes.
 Take Sitz Baths: A sitz bath includes sitting in a few inches of warm bath water. Soaking for 15 to 20 minutes twice a day can provide great relief from hemorrhoids. It will also help the area stay clean.
 Use Ice Packs: To relieve pain, you can place an ice pack on a thrombosed external hemorrhoid. This will also help reduce the blood clot. Try to use the ice for only 15 to 20 minutes at a time. Wrap the ice in a cloth to prevent skin damage.
 Using laxatives and enemas can help relieve constipation. Only use them if you doctor advised you to. Overthe-counter hemorrhoid ointments and petroleum jelly will also provide relief.
Your doctor may also recommend making small changes in your diet and exercise habits to ease constipation and prevent hemorrhoids.
 Eating A Fiber-Rich Diet: By adding more fiber to your diet, you can help ease constipation. Fiber will make your stools softer and thus easier to pass. Your doctor may suggest using high-fiber supplements or bulking agents. Eating high-fiber foods, such as whole grains, vegetables, fruits, and nuts and legumes, will also help.
 Drinking More Water: Drinking water can also help relieve constipation.

 Exercise Daily: Exercising will help digestion and prevent constipation. Exercise is also good for you.
If your symptoms still do not go away, your doctor may advise removing the hemorrhoid. Depending on location and symptoms, your treatment plan may differ.
Thrombosed External Hemorrhoids
To relieve your pain, your doctor may remove the blood clot. The procedure only takes a few minutes and you can expect a quick recovery. You will be asked to lie or kneel on an exam table. You doctor will inject a local anesthetic into the hemorrhoid. He or she will make a small incision and remove the blood clot. The incision is then left open to heal on its own.
Internal Hemorrhoids
To treat an internal hemorrhoid, your doctor will remove or shrink the tissue. You will be asked to lie or kneel on an exam table. Your doctor will insert an anoscope in order to see the anal canal. Your doctor will then perform one of these methods:
 The banding method uses tight elastic bands placed at the base of the hemorrhoid to cut off blood supply. The hemorrhoid will then fall in about a week.
 Sclerotherapy uses a chemical that is injected into the tissue around the hemorrhoid to shrink the hemorrhoid.
Banding Infrared Coagulation Sclerotherapy
For hemorrhoids that cause severe pain, your doctor may suggest having your hemorrhoid surgically removed. During the procedure, your doctor will use an anoscope to view the anal canal. The swollen hemorrhoids are then removed using surgical tool. Sometimes the incision is closed with sutures and other times with staples.
Hemorrhoidectomy with Sutures
Your doctor uses surgical tools to remove the swollen hemorrhoids.
The incision is closed with sutures. Sometimes the incision is not
closed all the way to allow fluid to drain. This helps the healing process.
Stapled Hemorrhoidopexy
Your doctor uses a special device to remove a ring of tissue from
the anal canal which will cut off blood supply to the hemorrhoid.
This will cause the hemorrhoid to shrink. The ring of tissue is kept
in place with staples.