Should all hemorrhoids be treated?

Ask the Doctor

Q. I had a colonoscopy recently and it detected hemorrhoids. I don't have any symptoms. Should I be doing something to get rid of them?

A. Like you, approximately 40% of people with hemorrhoids have none of the common symptoms—bleeding, anal itching, and pain. Their hemorrhoids may be found on a routine physical examination or during a test done for other reasons, such as a colonoscopy for colon cancer screening.

Hemorrhoids arise from blood vessels in the anal canal. Think of them as varicose veins of the rectum. External hemorrhoids can be seen or felt as a bulge on the outside of the rectum, whereas internal hemorrhoids, which you may have, are hidden inside. Hemorrhoids get more common as we age. They also tend to occur in people who are constipated or strain to have a bowel movement, or who sit for prolonged periods. Sometimes they occur in people who have diarrhea or during or after pregnancy.

Some people with hemorrhoids notice bright red blood when they have a bowel movement. If you develop rectal bleeding, it's important to let your doctor know. While hemorrhoids are a common reason for rectal bleeding, there are other, more serious causes of rectal bleeding that should always be ruled out.

Dietary changes can help prevent hemorrhoids from becoming symptomatic and can lessen any symptoms you may develop. Increasing the fiber in your diet and eating plenty of fruits and vegetables are good first steps. There are stool softeners and laxatives that you could take, but since your hemorrhoids are not causing you trouble, I would advise sticking to a healthy, high-fiber diet as your best bet to keep things that way. It is not generally recommended that people with asymptomatic hemorrhoids have them surgically removed.