DR. HOOK- Pain in the... Hemorrhoids make it hard to sit

Hemorrhoids afflict about 4 percent of American adults, affecting men and women about the same. It's most common in folks between 45-65 years old. The hemorrhoid veins are internal or external in the anus. When swollen, they cause symptoms such as itching, bleeding, and pain when thrombosed. And they bulge out.

Risk factors: chronic constipation is probably the biggest, but some studies say no. Chronic straining with bowel movements, diarrhea, pregnancy, getting older, sitting all the time, and pelvic tumors are also suggested culprits.

Painless bleeding with a bowel movement towards the end of the stool is a sign. The blood is bright red, not dark. Drops of blood in the toilet water and toilet paper can occur.  If there's no thrombosis, it usually doesn't hurt. Hurting with bowel movement is associated more with anal fissures. Other causes of bright red blood can be from the colon, such as a polyp, tumor, AVM, IBD, or infection.

Itching and irritation are the most common symptoms, and wiping extra hard to get clean makes it worse. The irritation can lead to fecal incontinence because of rectal leakage from prolapsed internal hemorrhoids, skin irritation, and swelling.

Skin tags aren't hemorrhoids but can be a remnant of a previous thrombosed hemorrhoid. If they're really big, it could be a sign of Crohn's disease. Also, these skin tags can make it hard to clean up after a bowel movement, so that can lead to soiling of underwear.

Thrombosis is a blood clot inside the hemorrhoid vein, leading to a tender lump. Looking at it, you can see a black spot– that's the clot. This irritates the perianal skin's nerves– ouch! If becomes gangrenous, surgery is urgently needed.

Other things that can mimic hemorrhoids are warts, rectal prolapse, anal cancer, fissues, and Crohn's disease. So anoscopy, flex-sig, or colonoscopy might be indicated for proper diagnosis.

Of course, see your doctor if you've got them. Simple measures to help prevent hemorrhoids include a high fiber diet with a lot of water to reduce straining with bowel movement. Tucks pads and Sitz baths soothe hemorrhoids. Over-the-counter creams and suppositories like Anusol and Preparation H can reduce hemorrhoidal swelling, and a short course of topical hydrocortisone can reduce the itch.

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.