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Hemorrhoids Happen: Here's what you need to know


Andrea Richard for Greater Baltimore Medical Center

January 13, 2021
Hemorrhoids are swollen veins in the anus and lower rectum. When inflamed, they can have an impact on routine activities. For many, a flare-up of “piles,” which hemorrhoids also are called, can be embarrassing to talk about — even with a doctor.

But while getting them is common — an estimated 75% of adults get them according to the National Institute of Diabetes and Digestive and Kidney Diseases — it’s important to not neglect them and understand when medical attention is necessary.

“Now that everybody has devices, they're spending a lot more time on the toilet,” says Joseph DiRocco, M.D., MBA, FACS, medical director of gastrointestinal oncology at the Greater Baltimore Medical Center.

“I know my kids think that's the place to hide when they want to watch videos on the internet,” Dr. DiRocco says. “Some people have magazines or a library in the bathroom, but the longer you spend on the toilet, the more likely you’ll get hemorrhoids.”

So what is considered too long to sit on the toilet?

Sitting in the bathroom beyond the time it takes to do a bowel movement is too long. Sitting in this position can cause pressure that leads to swelling and blood clotting in veins of the anus and buttocks.

The old expression “crap or get off the pot” — that was probably originated by a colorectal surgeon, says Dr. DiRocco, who is a practicing colorectal surgeon.

In addition, chronically straining is a cause and should be avoided, he says. Straining, constipation and frequent diarrhea can increase the likelihood of developing hemorrhoids. For those who already have hemorrhoids, all three can exacerbate your symptoms.

Internal and external hemorrhoids: What's the difference?

There are internal hemorrhoids and external hemorrhoids.

“We're born with them, and we die with them,” Dr. DiRocco says. “They can cause symptoms and cause difficulty for people. Sometimes people can have enlarged hemorrhoids and have no symptoms whatsoever.”

The symptoms of internal hemorrhoids and external hemorrhoids are different.

External hemorrhoids, located around the anus, can swell and protrude, causing discomfort and pain. In addition, they can cause moisture leading to burning and itching. Painless bleeding can be a symptom, too.

Internal hemorrhoids are deep inside the rectum where there are fewer nerves, so the pain is less severe. A main indication is finding blood in the stool and on toilet paper.

What are the causes?

When increased pressure occurs in the abdomen and pelvic region, hemorrhoids can flare up.

Pregnancy can lead to increased blood flow in the pelvic area and can lead to large hemorrhoids. Obesity or excess weight causes extra pressure on blood vessels and constricts veins surrounding the anus and colon, which can lead to hemorrhoids.
  • Exercises such as squatting and heavy weight lifting can be culprits.
  • Frequent loose stools, constipation, eating a low-fiber diet, and the aforementioned straining and sitting on the toilet for too long can cause hemorrhoids.
  • Aging weakens the connective tissue between the anus and rectum making older people more susceptible to hemorrhoids. Though hemorrhoids are most common in adults aged 45 to 65, they can appear at any age, even in children.
  • A strong family history is another factor.
  • Sometimes the causes are unknown.

When to see a doctor

Bleeding, recurrent or persistent pain or itching in the area needs to be addressed, says Dr. DiRocco. If you’ve tried over-the-counter remedies for a week without relief, call your doctor. If stool is maroon-colored or black, which could indicate bleeding, call your doctor. If rectal bleeding will not stop and you feel faint or dizzy, call 911, as you might need a trip to the emergency room.

Prevention and healing

Listen to the body. Increasing dietary fiber and fluids is essential in combating this condition.

Fiber bulks up the stool and makes it easier to pass through the intestines, so there's less effort required to have a bowel movement. Fluids prevent stool from drying out and becoming more difficult to pass.

Additionally, make sure you are moving around throughout the day. Sedentary living exacerbates hemorrhoids. Boost your activity level. Even walking can make a difference.

Comprehensive hemorrhoid treatment

At Greater Baltimore Medical Center, physicians customize treatment plans to the individual patient. There are simple nonsurgical options such as creams, and surgeries are performed on site. Urgent appointments are available for painful conditions.

Rubber band ligation, also called banding, is an effective and quick procedure for internal hemorrhoids. It takes less than a minute and typically does not require any pain medicine or time off of work.

External hemorrhoid surgery can be done safely in the office with local anesthesia. A numbing medicine is applied at the time of surgery, which can numb the area for up to three days. “And that's been a real blessing for a lot of patients, because the initial day or two after having surgery certainly is the most sensitive time,” Dr. DiRocco says, “and being able to have the area numb until you have your first bowel movement makes a big difference.”

For information about hemorrhoid diagnostic tests and treatments, visit
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