Hemorrhoids are abnormally swollen veins in the rectum and anus. They are much like varicose veins you might see on a person's legs. When bulging hemorrhoidal veins are irritated, they cause surrounding membranes to swell, burn, itch, become very painful, and bleed. Hemorrhoids are caused by too much pressure in the rectum, forcing blood to stretch and bulge the walls of the veins, sometimes rupturing them. Listed below are the most frequent causes of hemorrhoids:

• Constant sitting
• Straining with bowel movements (from constipation or hard stools)
• Diarrhea
• Sitting on the toilet for a long time
• Severe coughing
• Childbirth
• Heavy Lifting

There are two kinds of hemorrhoids: internal and external

• Internal hemorrhoids usually don't hurt or itch; you can't feel them because they are deep inside the rectum. Internal hemorrhoids are pretty harmless. But since their bleeding could mask blood from a dangerous source like colorectal cancer, they should be treated.
• External hemorrhoids cause most of the symptoms we commonly hear about --- pain, burning, and itching. If an external hemorrhoid becomes strangulated (cut off from blood supply), a clot can form in it and become an excruciatingly painful thrombosed hemorrhoid. Because of these unpleasant symptoms, external hemorrhoids get the most treatment attention.

Once the rectal veins have been stretched out and hemorrhoids created, they are difficult to get rid of completely and tend to recur with less straining than it took to cause them in the first place. Fortunately, good habits and simple medical treatment usually control hemorrhoids well, and surgery is only recommended in unusually severe cases.

Avoiding the causes listed in Basics will prevent most cases of hemorrhoids, but this advice is sometimes hard to follow. For example, how can you avoid sitting all day if you have a seated job? And most of us would like to avoid coughing, diarrhea, and childbirth, but that's pretty much impossible, isn't it? Here are some practical hints to help:

• If your main job activity is seated, always stand or walk during your breaks. Make it a point to stand and walk at least 5 minutes every hour and try to shift frequently in your chair to avoid direct rectal pressure.
• Always exhale as you strain or lift. Don't hold your breath.
• Control coughing, diarrhea and constipation with early treatment since hemorrhoids may soon follow.
• Make a rule: No reading or other relaxing activity while on the toilet. If bowel movements take longer than 3-5 minutes, something is wrong. If you want to keep hemorrhoids away, maintaining good bowel habits and softer stools should be your highest priority (see Treatment section).

If these preventive measures fail, you must take action right away! Hemorrhoids are one condition that can be mild in the morning and become intolerable by nightfall.

Aggressive treatment using the above techniques should improve hemorrhoids within days, but they may need 2-4 weeks of treatment to completely calm down. If they have not resolved to your satisfaction in that time, consult a physician. Other medical problems such as inflammatory bowel disease or bowel infection can cause hemorrhoid-like symptoms. So if the problem does not clear up promptly with basic OTC treatment, see your doctor.