The anal canal expands to 35 mm without apparent harm when there are no enlarged internal hemorrhoids to constrict it. Anything beyond that size is bound to cause pain. If an individual is tense, he or she may not be able to completely relax the external anal muscle, and may experience pain even from smaller stools.
Eating high-fiber foods can make your stools softer and easier to pass and can help treat and prevent hemorrhoids. Drinking water and other liquids, such as fruit juices and clear soups, can help the fiber in your diet work better.
Internal hemorrhoids usually present with painless, bright red rectal bleeding during or following a bowel movement. The blood typically covers the stool (a condition known as hematochezia), is on the toilet paper, or drips into the toilet bowl. The stool itself is usually normally coloured. Other symptoms may include mucous discharge, a perianal mass if they prolapse through the anus, itchiness, and fecal incontinence. Internal hemorrhoids are usually only painful if they become thrombosed or necrotic.
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Don’t assume rectal bleeding is due to hemorrhoids, especially if you are over 40 years old. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer. If you have bleeding along with a marked change in bowel habits or if your stools change in color or consistency, consult your doctor. These types of stools can signal more extensive bleeding elsewhere in your digestive tract.
^ Jump up to: a b Davis, BR; Lee-Kong, SA; Migaly, J; Feingold, DL; Steele, SR (March 2018). “The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids”. Diseases of the colon and rectum. 61 (3): 284–292. doi:10.1097/DCR.0000000000001030. PMID 29420423.
To regain your piece of mind, follow the instructions provided with the kit — usually a strip of paper that you’ll drop into the toilet — to observe changes. If the test is positive, and your pulse rate happens to be high, your blood pressure low, your appearance pale or you find that you’re short of breath, fatigued or dizzy, you should call 911 at once. These are all symptoms of serious blood loss.
The diagnosis of hemorrhoids is based on a medical history and physical examination. A digital rectal examination and an anoscopy may be the only tests needed at first. Your doctor will decide which tests to use. If hemorrhoids are the obvious cause of rectal bleeding, you are younger than age 50, and you do not have risk factors for colon cancer, you may not need more tests.
When painful hemorrhoids do not respond to home-based remedies, professional medical treatment is necessary. The choice of treatment depends on the type of hemorrhoid, what medical equipment is available, and other considerations.
Feldman M, et al. Diseases of the anorectum. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed May 22, 2016.
In a study of 198 physicians from different specialties, Grucela et al found the rate of correct identification for 7 common, benign anal pathologic conditions (including anal abscess, fissure, and fistula; prolapsed internal hemorrhoid; thrombosed external hemorrhoid; condyloma acuminata; and full-thickness rectal prolapse) was greatest for condylomata and rectal prolapse and was lowest for hemorrhoidal conditions.  There was no correlation between diagnostic accuracy and years of physician experience. The investigators found the overall diagnostic accuracy among the physicians to be 53.5%, with the accuracy for surgeons being 70.4% and that for the rest of the doctors being less than 50%. 
Many people who have hemorrhoids find relief from symptoms through home treatment. If medical treatment is needed, fixative procedures are the most widely used non-surgical treatments. Fixative procedures are only for internal hemorrhoids.
Spending too much time in the toilet is said to be one of the reasons for hemorrhoids. This is mainly from constipation or hard stools that require much straining to be passed.4 A good number of people experience hemorrhoids in relation to constipation or straining. Straining can also result in the prolapse of the hemorrhoid tissues which can be felt near the anus. High anal pressure from straining can result in anal fissures, too.5
Other Drugs: Over-the-counter analgesics such as acetaminophen or topical anesthetics such as lidocaine ointment. Some people find that hamamelis water (witch hazel) effectively reduces anal itching. Note: Laxatives are prohibited.
Celsus (25 BC – AD 14) described ligation and excision procedures, and discussed the possible complications. Galen advocated severing the connection of the arteries to veins, claiming it reduced both pain and the spread of gangrene. The Susruta Samhita (4th–5th century AD) is similar to the words of Hippocrates, but emphasizes wound cleanliness. In the 13th century, European surgeons such as Lanfranc of Milan, Guy de Chauliac, Henri de Mondeville, and John of Ardene made great progress and development of the surgical techniques.
It is obvious that the excessive consumption of salt is one of the causes of hypertension. When your blood pressure increases, the veins in your rectum and anus will be more susceptible to getting inflamed and developing hemorrhoids.
The American Gastroenterological Association suggests that drinking water and eating enough fiber are the two biggest ways to treat hemorrhoid flare-ups. “Fiber has a consistent beneficial effect,” says Janelle Gurguis-Blake, MD. Increased fiber in your diet can cause stools to soften and makes them easier to pass, reducing the pressure on your Boost fiber either by eating high-fiber foods or by taking a fiber supplement (such as Metamucil, Citrucel, or FiberCon), or both. Just make sure that you also drink plenty of fluids. High-fiber foods include broccoli, beans, wheat and oat bran, whole grains, and fruit. (Try these 6 tasty ways to get more fiber in your diet.)
Patients who have failed conservative therapy or who have grade 4 hemorrhoids are candidates for surgery to remove the swollen hemorrhoids and the larger external hemorrhoid skin tags. Options include hemorrhoid removal with laser surgery or hemorrhoidectomy (ectomy=removal) using a scalpel. Another alternative is stapled hemorrhoidectomy, where a special staple gun is positioned to remove the hemorrhoid and surround the tissue with a ring of staples to close the area as well as controlling the bleeding.