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By Mary Elizabeth Gillis

When a regular trip to the bathroom becomes a painful event, it can be alarming. For some people, it might also be embarrassing to talk about. But, the fact is a large percentage of Americans have issues they notice during bowel movements, such as sensitivity, swelling and bleeding. The cause is often hemorrhoids.

Hemorrhoids are painful masses caused by stretched and swollen veins around the pelvis. They are blood-filled, bulbous sacs that can be hidden inside or protrude to the outside of the rectum.

It hurts to sit down. It hurts to stand up. It hurts to use the bathroom. The area can be itchy, irritated and sometimes bloody.

Because they can be caused by a wide variety of factors, everyone is at risk to get them.

“Hemorrhoids aren’t associated with a particular gender, ethnicity or race; anyone is prone,” Mudlar Dalloul, Director of Labor and Delivery at SUNY Downstate told TODAY. “But those who experience constant pressure in their abdomen have an increased likelihood of the disease.”

While the exact number of individuals who suffer from hemorrhoids (also called piles) is unknown, a 2019 study published in Clinical Gastroenterology and Hepatology reports hemorrhoids account for upwards of four million outpatient office and emergency room visits per year. This is more than other gastrointestinal conditions including diverticulitis, irritable bowel syndrome and colon cancer.

Who gets hemorrhoids?

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There are several factors that lead to flare ups such as being overweight, lifting heavy object and excessive coughing associated with asthma or other lung conditions. All put undue strain on the stomach.

Pregnant women also have to be careful.

“As the fetus grows, so does the pressure within a women’s abdomen. This then puts strain on the pelvis causing the hemorrhoids,” Gloria Bachmann, a professor of obstetrics, gynecology and medicine at Rutgers University told TODAY. “Most of the time, she’ll see and feel the [external] lump.”

What happens to hemorrhoids?

The hemorrhoid, or enlarged vein, is dark blue because there’s a clot inside the blood vessel, Bachmann added, but not to worry. The clot isn’t dangerous because it’s self-contained. There’s no risk of the clot traveling to the heart or lungs and the hemorrhoids, if managed properly, will not affect the birth.

In severe cases, if the pressure is not alleviated, an infection can occur. Hemorrhoids sometimes tear—whether due to pregnancy or other causes.

"An open lesion can result in the form of an abscess," Dalloul warns. "This is especially true if the area is not clean to begin with. When this happens, the abscess will need to be surgically removed and antibiotics prescribed to fight the infection."

Fortunately, most cases, if caught early, are easily treated.

How to treat hemorrhoids

An over the counter cream such as Preparation H can help ease burning and itching. Keeping the area warm will maintain blood flow that has otherwise stalled. Heat, followed by a cold ice compress, reduces swelling while sitting on cushioned surfaces helps keep hemorrhoids from getting bigger.

Prevention through diet and exercise is also important. Maintain a healthy weight, stay active and make certain to have regular bowel movements by eating foods high in fiber, staying hydrated and taking stool softeners to avoid constipation.

And don't ignore the warning signs. It's time to go to the doctor if the hemorrhoids are accompanied by any bleeding or changes in stool.

"Rectal bleeding and blackish stool—both are indicators of internal bleeding,” Bachmann said. “Severe discomfort to the point you can’t sit down and constantly needing pain medication are also signs something is up."