Hemorrhoids: Symptoms, Causes, Treatment & When to Go

Introduction

Hemorrhoids are swollen blood vessels and support tissue in the anus or lower rectum ^[1,3]. They are also called piles and may form inside or outside the body ^[6,7].

This guide explains hemorrhoids symptoms, causes, treatment and when to see a doctor. It also covers home care, medical procedures, and warning signs.

Many mild cases improve with home care and better bowel habits ^[2,7]. Still, rectal bleeding should not always be blamed on hemorrhoids ^[5,9].

A medical exam may be needed to rule out another cause ^[5,9]. Seek care for bleeding, severe pain, or symptoms that keep returning.

Overview: What Are Hemorrhoids?

Normal hemorrhoidal tissue supports the lower rectum and anal canal ^[3]. Problems begin when its blood vessels and support tissue become enlarged ^[1,3].

Pressure in the anal area can make this tissue swell and bleed ^[1]. The tissue’s location often affects both symptoms and treatment ^[6,9].

Internal vs. external hemorrhoids

Internal hemorrhoids form inside the rectum near the start of the anal canal ^[1,6]. You usually cannot see or feel them ^[1,7].

Internal hemorrhoids commonly cause painless, bright red bleeding ^[1,6]. The bleeding often appears during or after a bowel movement ^[1].

They rarely cause discomfort unless they become large or prolapse ^[6,7]. Prolapse means that the tissue pushes through the anus.

External hemorrhoids form beneath the skin around the anus ^[6,7]. They are more likely to cause pain, itching, swelling, or irritation ^[6,8].

An external hemorrhoid may also bleed or form a lump ^[6,8]. You may be able to see or feel that lump ^[6].

Some people have both internal hemorrhoids and external hemorrhoids ^[10]. A clinician can identify the type by checking the tissue’s location ^[5,10].

Prolapsed and thrombosed hemorrhoids

A prolapsed hemorrhoid is an internal hemorrhoid that extends through the anus ^[1,6]. It may look like soft tissue that bulges during a bowel movement ^[1,7].

Some prolapsed hemorrhoids move back inside on their own ^[1,3]. Larger ones may remain outside and cause more symptoms ^[1,3].

Doctors grade internal hemorrhoids based on how far they prolapse ^[9]. This grade can help guide treatment choices ^[3,9].

A thrombosed external hemorrhoid contains a blood clot ^[8]. It may cause sudden, severe pain near the anus ^[8].

You may also notice a firm and tender lump ^[8]. The clot often dissolves but may leave loose skin behind ^[8].

How common are hemorrhoids?

Hemorrhoids are very common ^[1,4]. Many adults have bleeding, itching, pain, or prolapse by middle age ^[8,9].

Hemorrhoids are rarely dangerous, but they can return ^[8]. Pain and other symptoms may also disrupt daily life ^[8].

Treating constipation may help reduce hemorrhoid symptoms ^[10]. Avoiding strain and long toilet visits may also help ^[2,6].

Symptoms and Warning Signs

Symptoms often depend on the hemorrhoid’s type and location ^[7,9]. Size, prolapse, and blood clots can also affect discomfort ^[8,9].

Possible hemorrhoid symptoms include:

• Bright red blood after a bowel movement ^[1,6]
• Anal itching or skin irritation ^[6,8]
• Pain or discomfort around the anus ^[6,8]
• Swelling near the anal opening ^[2,6]
• A lump that you can see or feel ^[6,8]
• Tissue that bulges through the anus ^[1,8]
• Bleeding during a bowel movement ^[1,7]

Common internal hemorrhoid symptoms

Painless rectal bleeding is a common sign of internal hemorrhoids ^[1,6]. The blood is often bright red ^[1].

You might see blood on toilet paper or after passing stool ^[1]. Internal hemorrhoids usually do not hurt ^[6,7].

Straining can cause an internal hemorrhoid to prolapse ^[1]. The tissue may then extend through the anal opening ^[1,8].

A prolapse may cause discomfort around the anus ^[1,8]. Large prolapsed hemorrhoids may need an office treatment or surgery ^[3].

Treatment depends on the hemorrhoid’s size and grade ^[3,9]. Symptoms and past treatment results also guide the choice ^[3,9].

Common external hemorrhoid symptoms

External hemorrhoids can cause itching, pain, tenderness, or swelling ^[6,8]. Some external hemorrhoids also bleed ^[6,8].

You may see or feel a lump beneath the skin ^[6]. The skin over that lump may become sore or irritated ^[8].

A blood clot may form inside an external hemorrhoid ^[8]. This is called a thrombosed external hemorrhoid.

A thrombosed hemorrhoid may cause sudden and severe pain ^[8]. It may also create a firm, tender lump ^[8].

Symptoms that may have another cause

Do not assume all anal pain or rectal bleeding comes from hemorrhoids. An exam should check for signs of a more serious disease ^[9].

Other digestive conditions can cause symptoms that look like hemorrhoids ^[5,9]. A doctor may recommend more tests when another condition is possible ^[5].

Further testing may also be needed for colorectal cancer risks ^[5]. It may be advised when a person has missed recommended screening ^[5].

Arrange a medical visit for unexplained or repeated rectal bleeding. Bleeding with other major bowel changes also needs assessment ^[5,9].

Seek prompt care for heavy or ongoing bleeding. Fainting, marked dizziness, confusion, or black stool also need urgent assessment.

Severe anal pain with fever or spreading redness needs prompt care. Such symptoms may have a cause other than simple hemorrhoids.

Causes and Risk Factors

Hemorrhoids are linked to increased pressure around the anus and lower rectum ^[1,8]. This pressure can make normal anal tissue swell or bleed ^[1].

Several health conditions and daily habits can raise that pressure ^[1,8]. A person may have more than one risk factor.

Pressure, constipation, and straining

Constipation can make stool hard or difficult to pass. Straining then raises pressure around the anus ^[1].

Common risk factors include:

• Long-term constipation ^[1]
• Straining during bowel movements ^[1,8]
• Sitting on the toilet for too long ^[1,2]
• Pregnancy and childbirth ^[1,8]
• Excess body weight ^[8]
• Ongoing pressure around the anus ^[1,8]

Long toilet visits may increase pressure on anal tissue ^[1,2]. Phones and books can make these visits longer.

Try to leave the toilet after finishing a bowel movement ^[2]. Do not sit and wait for another urge.

Pregnancy, aging, and daily habits

Pregnancy can increase pressure around the anus ^[1,8]. Childbirth can also raise pressure in that area ^[1,8].

Hemorrhoids may first appear or become worse during pregnancy ^[1]. They are also a common concern by middle age ^[8,9].

Excess body weight is another known risk factor ^[8]. Straining and poor toilet habits can add more pressure ^[1,2].

Changing daily bowel habits may reduce that strain ^[2]. The goal is to pass soft stool without pushing hard.

How to lower the risk of recurrence

Increasing fiber and fluids can reduce hemorrhoid symptoms ^[2,9,10]. These steps can improve stool texture and reduce straining ^[2,9].

High-fiber foods include fruits, vegetables, beans, and whole grains. Fiber supplements are another option ^[2].

Psyllium and methylcellulose are common fiber supplements ^[2]. Ask a clinician if you are unsure which product to use.

Drink water or other nonalcoholic fluids as your clinician recommends ^[2]. Some people may need personal guidance about fluid intake.

Go to the toilet when you feel the need. Avoid pushing hard during a bowel movement ^[2].

Do not remain on the toilet for long periods ^[2]. Leave when you have finished passing stool.

Treating constipation can greatly reduce hemorrhoid symptoms ^[10]. These habits may also lower the chance of repeat symptoms ^[2,6].

Treatment and Diagnosis

Treatment depends on the hemorrhoid’s type, size, and grade ^[3,9]. The level of pain, bleeding, and prolapse also matters ^[3,9].

Most people begin with fiber and better toilet habits ^[2,9]. Short-term care may ease pain, swelling, and itching ^[2].

Persistent internal hemorrhoids may need an office procedure ^[3,10]. Large prolapsed hemorrhoids may require surgery ^[3].

Hemorrhoid home treatment

Hemorrhoid home treatment aims to make stool easier to pass. It also helps reduce strain and anal irritation ^[2].

Useful home steps include:

• Eat more high-fiber foods ^[2]
• Take a fiber supplement when suitable ^[2]
• Drink fluids as your clinician recommends ^[2]
• Use a stool softener when advised ^[2,9]
• Avoid pushing during bowel movements ^[2]
• Limit time spent sitting on the toilet ^[2]
• Soak the anal area in warm water ^[2]
• Use a suitable nonprescription pain medicine ^[2]

A sitz bath is a warm bath for the anal area ^[2]. It may offer short-term relief from pain ^[2].

Doctors may suggest taking a sitz bath several times daily ^[2]. Use comfortably warm water rather than very hot water.

Fiber can help make stool easier to pass ^[2]. Better stool texture may reduce strain and hemorrhoid symptoms ^[2,9,10].

A stool softener may also help some people ^[2,9]. Ask a clinician whether one is right for you.

Over-the-counter options

Nonprescription creams, ointments, and suppositories may ease mild symptoms ^[2]. They may help with pain, swelling, or itching ^[2].

Some products contain hydrocortisone, phenylephrine, or pramoxine ^[10]. These ingredients may reduce pain or itching ^[10].

Over-the-counter hemorrhoid products are usually for short-term use ^[2]. Doctors often recommend using them for about one week ^[2].

Do not keep using them unless a healthcare professional advises it ^[2]. Contact a clinician if symptoms continue after one week ^[2].

Nonprescription pain medicine may also help ^[2]. Options listed by NIDDK include acetaminophen, ibuprofen, naproxen, and aspirin ^[2].

Ask a clinician which choice is safe for you. This is important if you take other medicines or have bleeding.

Home care may ease symptoms without removing enlarged tissue ^[3]. Repeated symptoms may need an exam and a new treatment plan ^[3,5].

How a doctor diagnoses hemorrhoids

The clinician may first inspect the skin around the anus ^[5]. External hemorrhoids can often be seen during this exam ^[5].

A digital rectal exam may also be done ^[5]. The clinician places a gloved and lubricated finger into the rectum ^[5].

This exam helps check for unusual tissue or growths ^[5]. Internal hemorrhoids may be too soft to feel this way ^[5].

An anoscope may be used to view the anal canal ^[5]. An anoscope is a short viewing tool.

A proctoscope or sigmoidoscope may also be used ^[5]. These tools let the clinician examine the rectum or lower colon ^[5].

Colonoscopy examines the whole colon ^[5]. It may be advised when symptoms point to another digestive disease ^[5].

A colonoscopy may also be advised for colorectal cancer risks ^[5]. The same applies when a middle-aged adult has not had recent screening ^[5].

Office procedures and surgery

Office treatments are options for some internal hemorrhoids ^[3,10]. They include rubber band ligation, sclerotherapy, and infrared coagulation ^[3,10].

Rubber band ligation is also called banding. A clinician places a small band around an internal hemorrhoid.

Banding is often used when basic treatment has failed ^[9]. It is a preferred office choice for many grade I to III hemorrhoids ^[9].

Sclerotherapy uses an injection to shrink the hemorrhoidal tissue ^[3,10]. Infrared coagulation treats the tissue with controlled infrared energy ^[10].

Office procedures are often preferred over surgery ^[10]. They may provide similar benefits with fewer problems ^[10].

The best choice depends on bleeding, discomfort, and prolapse ^[3,9]. Other health needs and personal wishes also matter ^[3,9].

Surgery may be needed when office treatments do not work well enough ^[3]. Large grade III or grade IV hemorrhoids may also need surgery ^[3].

These large hemorrhoids often remain outside the anus ^[3]. Surgery can remove the swollen tissue ^[3].

A hemorrhoidectomy is surgery that removes hemorrhoids ^[3]. A clinician should explain the expected results and recovery before treatment.

When to See a Doctor

When to schedule a medical visit

Contact a clinician if symptoms continue after one week of home care ^[2]. Make an appointment if symptoms keep coming back.

You should also seek care when symptoms disrupt daily life. A new lump or worsening prolapse also deserves an exam.

Sudden severe pain may be due to a thrombosed external hemorrhoid ^[8]. A firm and tender lump may appear with it ^[8].

Seek medical advice for:

• New or unexplained rectal bleeding
• Bleeding that continues or returns
• Pain or swelling that becomes worse
• A lump that does not improve
• Tissue that remains outside the anus
• Symptoms lasting beyond one week of home care ^[2]
• Known colorectal cancer risk factors ^[5]
• Overdue colorectal cancer screening ^[5]

Rectal bleeding should not be blamed on hemorrhoids without thought. Other digestive conditions may need to be ruled out ^[5,9].

When rectal bleeding needs urgent care

Seek medical assessment for unexplained rectal bleeding. This is especially important when bowel habits have greatly changed ^[5,9].

Bleeding with stomach pain, weight loss, weakness, or possible anemia needs prompt assessment. Anemia means the blood lacks enough healthy red blood cells.

Get emergency help for heavy or nonstop bleeding. Also seek help for fainting, severe dizziness, or confusion.

Black or tar-like stool needs urgent medical care. It may signal bleeding from another part of the digestive tract.

Severe anal pain with fever needs prompt assessment. Spreading redness around the painful area also needs urgent care.

These symptoms should not be treated as simple hemorrhoids without an exam. A clinician can look for another cause ^[5,9].

What to expect at the appointment

The clinician may ask when your symptoms started. You may also discuss how often they happen.

Be ready to describe the blood’s color and amount. Explain whether bleeding happens during a bowel movement.

The clinician may ask about:

• Constipation, diarrhea, and straining
• Time spent sitting on the toilet
• Pain, itching, swelling, or prolapse
• Current medicines and supplements
• Pregnancy or recent childbirth
• Personal and family health history
• Colorectal cancer risk factors
• Past colorectal cancer screening

The clinician may inspect the anus and perform a digital rectal exam ^[5]. Anoscopy may be used to view internal tissue ^[5].

Some people may need sigmoidoscopy or colonoscopy ^[5]. The choice depends on symptoms, exam results, and cancer risks ^[5].

Conclusion

Many mild hemorrhoid symptoms improve with home care ^[2,7]. Helpful steps include fiber, fluids, warm baths, and better toilet habits ^[2,7].

Increasing fiber and fluids can make stool easier to pass ^[2,9,10]. This can reduce straining and ease hemorrhoid symptoms ^[2,9,10].

Over-the-counter products may give short-term symptom relief ^[2]. Use them for about one week unless a clinician says otherwise ^[2].

Internal hemorrhoids often cause painless bright red bleeding ^[1,6]. External hemorrhoids more often cause pain, itching, swelling, or a lump ^[6,8].

Office procedures can treat persistent internal hemorrhoids ^[3,10]. Large prolapsed or treatment-resistant hemorrhoids may require surgery ^[3].

Rectal bleeding and severe pain can have other causes ^[5,9]. Seek care for symptoms that persist, return, or become severe.