About 10 million Americans suffer from hemorrhoids. Hemorrhoids are swollen veins in the rectum or around the anus. They can be internal or external. External hemorrhoids more commonly cause symptoms of pain and itching when irritated. Internal hemorrhoids generally are painless but can cause bleeding. "They can cause bright red rectal bleeding, but if you have bleeding, don't assume it's hemorrhoids. Colorectal cancer can also cause rectal bleeding, so you need to see your doctor to rule out cancer or other serious causes of rectal bleeding. Sometimes internal hemorrhoids can protrude outside of the anus. Protruding (or prolapsed) hemorrhoids can become painful if irritated.

Other hemorrhoid symptoms include mucus drainage. A blood clot that forms within a hemorrhoid, called a thrombosed hemorrhoid, can be extremely painful.

Key to Prevention: Stop Straining

For many people, hemorrhoids are caused by straining during bowel movements, especially with constipation. Pregnancy, lack of exercise, immobility, age, certain medical conditions, and medications are among other causes of constipation and hemorrhoids.

Your best strategy to prevent constipation -- and the hemorrhoids that come with it -- is through lifestyle changes that include adding more fiber to your diet, drinking plenty of water, and exercise.

Adding fiber to your diet is recommended, but not until things are moving again. If you add fiber to someone already constipated, all you'll get is constipation with more fiber. First the stool needs to be made soft. Prunes have a natural laxative. Some people just need a stool softener like Colace. After that is taken care of, increase fiber intake gradually, along with fluid intake. If you increase fiber without increasing fluid, you will have bloating and gas. Dietary fiber includes fresh fruits, vegetables, and whole grains. You can also use fiber supplements like Metamucil, Citrucel, and Benefiber. Fiber helps to soften stool and increase stool bulk.

You need seven servings of fruits and vegetables, adequate fluid, and 30 to 60 minutes of exercise each day.

Treating hemorrhoids with medication won't make them go away, but it alleviates symptoms. Basic medical treatments are a variation of witch hazel, such as Preparation H or Tucks pads. Witch hazel dehydrates and shrinks them but doesn't make them go away. Tucks pads, which have a lot of witch hazel, may a preference. You tuck them in the vicinity.

When hemorrhoids are painful, don't use dry toilet paper. It's like using sandpaper. Using hypo-allergenic baby wipes or flushable Cottonelle is advised. If itching is a problem, diaper ointment can provide relief.

Good hygiene is also very important since fecal matter or mucus drainage irritates the skin and hemorrhoid area. Too much wiping can worsen discomfort, so the American Gastroenterological Association suggests that a bath or shower can be used as an alternative to wiping after a bowel movement.

Ointments containing lidocaine, hydrocortisone creams and suppositories, as well as warm sitz baths can also provide hemorrhoid relief.

Various non-surgical treatments are available to remove internal hemorrhoids. Hemorrhoids are graded according to severity from I to IV. Surgery is used on grade IV hemorrhoids and sometimes on grade III. Non-surgical procedures are typically performed in a doctor's office without anesthesia and can be used to treat hemorrhoids from grades I to III. They include:

    Injection sclerotherapy:
This treatment is sometimes used for smaller bleeding hemorrhoids. The doctor injects a special solution to shrink the hemorrhoidal tissue. Success rates vary.

    Rubber band ligation:
Several sessions may be required for rubber band ligation, which is used for larger internal hemorrhoids or those that fail to respond to injection sclerotherapy. A rubber band is put round the hemorrhoid to choke off its blood supply. The hemorrhoid eventually falls off on its own. Recurrence may be as high as 68% after four or five years, but symptoms usually respond to repeat procedures. Pain following the procedure is generally minor and can be relieved with sitz baths and pain medications. Complications are minimal, and patients can return to normal activities the same day.

    Infrared photocoagulation:
Some doctors use infrared photocoagulation to treat small internal hemorrhoids, hemorrhoids that cannot be treated with rubber band ligation because of pain sensitivity, or hemorrhoids that are not cured with rubber band ligation. A probe focuses infrared radiation on the hemorrhoid, burning it. The procedure requires multiple treatments, and the recurrence rate can be high.

Surgical hemorrhoidectomy is performed when more conservative treatments fail. Tissue that includes blood vessels is excised, so there is bleeding. Most patients can go home the same day, but the need for catheterization may require an overnight stay.

Stapled hemorrhoidectomy was introduced in 1998 as an alternative to traditional surgical hemorrhoidectomy. A stapling device is used to attach the hemorrhoid to rectal muscle. It's advocated as a less painful alternative for grades I through III. When appropriately done, it's as effective as hemorrhoidectomy. But the long-term outcomes regarding recurrence are unknown.

Patients can expect pain that makes it difficult to sit after surgery. But they can resume normal activities in a few days, and some do so immediately. Complications can include impacted stool, especially in elderly patients, or infection. It's important for patients to use a stool softener, or it could require another trip to surgery.

While surgery is generally reserved for internal hemorrhoids, thrombosed external hemorrhoids may require prompt attention.

To avoid surgery. make lifestyle changes and use over-the-counter remedies to soothe hemorrhoids.