Hemorrhoids are a common condition involving the swelling and inflammation of veins located in the lower rectum and around the anus. This swelling occurs when there is increased pressure on the veins, often due to straining during a bowel movement or prolonged sitting, affecting about half of all people by age 50. The resulting discomfort can vary significantly depending on the location and severity of the affected tissue.
The Spectrum of Hemorrhoid Discomfort
The most frequent experience of hemorrhoids is persistent, fluctuating discomfort rather than sharp pain. External hemorrhoids, located under the skin where numerous pain-sensing nerves exist, frequently present as a dull ache or general soreness. This feeling often worsens when pressure is applied, such as during prolonged sitting or following a bowel movement. Intense itching, known medically as pruritus ani, and a noticeable burning sensation often result from irritation or the leakage of mucus. Internal hemorrhoids that have enlarged can create a feeling of pressure or fullness in the rectum, sometimes described as feeling like one is sitting on a small object. The veins become tender to the touch due to tissue swelling.
When Pain Becomes Acute or Severe
A sudden shift from general discomfort to intense, constant pain often signifies an acute complication, most frequently a thrombosed external hemorrhoid. This occurs when a blood clot forms inside the swollen vein, causing rapid pressure and inflammation. The pain is typically sharp, throbbing, and severe, making sitting, walking, or even moving difficult. This discomfort usually develops abruptly, often reaching its peak intensity within the first 48 to 72 hours. A thrombosed hemorrhoid is often palpable as a hard, tender lump near the anal opening, sometimes appearing bluish or purplish due to the trapped blood. While internal hemorrhoids generally cause less pain, they can cause severe pain if they prolapse (protrude outside the anus) and become “strangulated.” Strangulation happens when the anal muscles constrict and cut off the blood supply to the prolapsed tissue, requiring immediate medical attention.
Quick Strategies for Pain Relief
Several home strategies can provide rapid symptom relief. Soaking the anal area in a warm water bath, known as a sitz bath, for 10 to 20 minutes several times a day helps soothe irritation and reduce muscle spasms. The warm water promotes blood flow and offers immediate comfort for the burning and aching sensations. Topical treatments are effective, with many over-the-counter creams and wipes containing ingredients like witch hazel or hydrocortisone. Witch hazel provides a mild astringent effect that reduces swelling and burning, while hydrocortisone decreases inflammation and itching. To address the root cause of pain during bowel movements, incorporating a stool softener or increasing dietary fiber is important to ensure soft, easy-to-pass stools that prevent straining. Gentle hygiene is paramount, which involves cleaning the area with soft, moist wipes or water and avoiding the use of dry, abrasive toilet paper.