Hemorrhoids: Causes, Symptoms, and Treatment

Hemorrhoids are a common but uncomfortable disorder of the anus and rectum that affect millions of Americans nationwide.

Though they are rarely life-threatening or medically dangerous, they have a way of unpleasantly disrupting some of the most routine behaviors of our lives.

Having hemorrhoids can make it more painful to do things like sit, move around, and have a bowel movement.

They can also lead to the appearance of bright red blood after passing a stool. 

Even brief hemorrhoid episodes can cause discomfort.

While most hemorrhoids clear up on their own after just a few days, you’ll want to see a healthcare provider for cases that last longer than a week or that involve anal bleeding or pain. 

For all of these reasons, you may be interested in ways to treat, manage, and prevent hemorrhoids.

In this article, I’ll explain the two different types of hemorrhoids, as well as their associated symptoms.

I’ll discuss some potential causes of hemorrhoids and the main risk factors associated with them.

I’ll also overview how hemorrhoids are diagnosed and when to see a healthcare provider.

What Are Hemorrhoids?

Hemorrhoids are swollen or irritated veins or blood vessels in and around the anus and rectum. 

The area immediately surrounding the anus and lower rectum is made up of pillowy tissue.

This tissue helps to cushion and support the muscles of the anal canal and contains a network of veins. 

Sometimes, the blood flow through these veins can become disrupted, causing blood to pool and the entire area to swell and form lumps called hemorrhoids. 

This swelling can push hemorrhoids into the path of bowel movements.

When a hard stool meets a swollen hemorrhoid, the friction and pressure between them can cause further damage or inflammation to the hemorrhoid itself can even begin to rupture or bleed.

How Common Are Hemorrhoids?

Hemorrhoids affect people of all genders and are estimated to affect 50% of people older than 50, which makes them very common.

By some researchers’ estimates, 3 out of 4 Americans will have hemorrhoids at some point in their lives.

People may be more likely to get hemorrhoids if their parents had them, too, which suggests there may be some genetic component behind their pervasiveness.

Symptoms

There are several classic symptoms that, when taken together, may indicate you have hemorrhoids.

These include:

• Painless bright red blood from the rectum
• Anal itching
• Anal aches or pain, especially while sitting
• Pain during bowel movements
• One or more hard tender lumps near the anus
• Pain or irritation around the anus

Types

While all hemorrhoids occur on or around the anus, doctors classify them into two distinct types based on the exact region where they appear.

These two types are internal and external hemorrhoids. 

External Hemorrhoids

External hemorrhoids appear under the skin around the anus. 

Because external hemorrhoids occur underneath sensitive skin in an area that is prone to chafing, these inflamed lumps tend to be the source of the physical discomfort that many people associate with hemorrhoids.

This includes anal itching and anal pain, especially when sitting. 

Sometimes, a vein inside an external hemorrhoid experiences a blood clot that can cause the hemorrhoid to become especially hard, swollen, and tender, which can be sharp and painful.

This is called a thrombosed external hemorrhoid.

When these hemorrhoids recede, they can leave behind a growth of extra skin called a skin tag.

Internal hemorrhoids

Internal hemorrhoids occur in the inner lining of the anus and in the very lowest part of the rectum.

This is an area lined with mucous membranes, rather than skin.

For this reason, internal hemorrhoids aren’t accompanied by the kind of pain or painful skin irritation that can come with external hemorrhoids.

In fact, most internal hemorrhoids are not painful.

Instead, they are most noticeable indirectly: in cases when hard stool passing through your anus causes these lumps to rupture and bleed bright red blood that might then show up on toilet paper.

Occasionally, though, an internal hemorrhoid might swell to the point where it falls through your anal opening, which is called prolapse.

These prolapsed internal hemorrhoids may cause more pain and discomfort.

Causes

The exact technical reasons why hemorrhoids appear in some people and not in others are not yet completely understood.

This includes the possible role of genetics.

Still, we know that in more general terms, hemorrhoids are caused by disruption to blood circulation within the anus’s cushioning tissues.

Sometimes this blood flow is disrupted because the anal tissue itself becomes damaged, deformed, or stressed.

And sometimes there are changes to your body’s blood circulation more generally.

The end result is that blood pools in the anal cushions, enlarging the blood vessels and causing hemorrhoids.

Some of the major causes of hemorrhoids include:

• Straining during bowel movements
• Sitting on the toilet for long periods of time
• Chronic constipation or diarrhea
• A low-fiber diet
• Aging, and the weakening of the supporting tissues in your anus and rectum that comes with aging
• Pregnancy
• Lifting heavy object

Risk Factors

Some of the risk factors for hemorrhoids cannot be changed.

Others can be addressed preventatively to lower your likelihood of getting hemorrhoids.

Some of the biggest risk factors for hemorrhoids include:

• Bowel movement patterns: straining during bowel movements, sitting on the toilet for long periods of time; having chronic constipation or diarrhea

• Diet and exercise: having a low-fiber diet; not drinking enough fluids; often lifting heavy objects

• Body changes: being pregnant; being older than 50; weight gain; depression

Diagnosis

In general, you’ll want to talk to a healthcare provider if you’re experiencing severe or worsening anal pain, as well as any anal bleeding.

Even if you think that anal bleeding is from a low-grade internal hemorrhoid, you’ll still want to talk to a healthcare provider to rule out any more serious causes.

Diagnosing hemorrhoids is usually a straightforward process.

Usually it begins with your healthcare provider asking questions about symptoms and medical history.

From there, your healthcare provider will then perform a physical exam.

This will involve checking the area around your anus for any lumps, swelling, blood clots, or prolapses, as well as any skin irritation or skin tags. 

Your healthcare provider may also perform a digital rectal exam.

This involves probing with a gloved finger to check for any tenderness, blood, or masses that could be an internal hemorrhoid. 

To get a clearer, better-illuminated look at any suspected internal hemorrhoids, your healthcare provider may also use certain special tools to get a look at the lower rectum.

These include an endoscope or a proctoscope. 

In some cases, routine colonoscopies or flexible sigmoidoscopies can also alert gastroenterologists to the presence of internal hemorrhoids, even before patients begin to experience any symptoms.

Management and Treatment Options

For many people, hemorrhoid symptoms go away within a few days.

You can support this healing process and reduce discomfort by reducing stress on the affected area.

Common home remedies for managing and treating hemorrhoids include:

• Eating high-fiber foods
• Avoiding spicy foods
• Drinking lots of fluids
• Avoiding caffeine and alcohol
• Taking a stool softener or fiber supplement
• Trying not to strain during bowel movements
• Avoiding long sitting periods on the toilet
• Applying anal lubricants like mineral oil to help stool pass more easily

For external hemorrhoids, in particular, you also can take over the counter pain relievers to relieve discomfort.

Over-the-counter hemorrhoid creams, wipes, or suppositories (pain-relieving medications inserted into your rectum) can also help to relieve pain and itching.

Warm baths, sitz baths (baths in which you are sitting in just a few inches of warm water), and ice packs may also provide relief for external hemorrhoids, as well as prolapsed internal hemorrhoids.

If hemorrhoid symptoms persist after a week of these home remedies, you should follow up with your healthcare provider to explore additional treatment.

They will also want to see you if your anal bleeding becomes more severe, or if the pain becomes more intense or excruciating.

For especially large or painful hemorrhoids, you may be referred to a specialist like a gastroenterologist, proctologist, or colorectal surgeon.

Today these specialists have a wide array of treatment procedures at their disposal. 

Many of these procedures aim to shrink the hemorrhoid by cutting off the blood supply to its outermost areas, while also promoting scar tissue formation to hold future hemorrhoid growth in check.

This can be accomplished using special rubber bands, fluid injections, or electric currents.

In cases of prolapsed hemorrhoids, doctors will also make sure to push the hemorrhoid fully back inside the anus.

These can be performed without the need for general anesthesia or hospital stays.

In rarer cases, doctors may perform a more complete surgical removal procedure (called a hemorrhoidectomy), which usually involves a longer recovery time but also rarely involve hospital stays.

Prevention

Many approaches to hemorrhoid prevention involve reducing strain on the anal cushions during bowel movements.

Constipation is a major reason why people strain more and spend longer on the toilet, which is why hemorrhoid prevention strategies often involve trying to reduce this condition.

A high-fiber diet, as well as fiber supplements, can help to make stools softer and easier to pass.

Drinking lots of water and other hydrating fluids is another way to reduce constipation.

You might also consider reducing your intake of dehydrating substances like alcohol and caffeine if you find yourself frequently experiencing hemorrhoids.

Try not to wait too long before going to the bathroom for a bowel movement; doing so can increase constipation and the amount of time you spend on the toilet.

And lastly, try to reduce distractions that make you spend more time in the bathroom during a bowel movement; these can include reading or playing with your phone.

Did you know you can get affordable primary care with the K Health app?
Download K Health to check your symptoms, explore conditions and treatments, and, if needed, text with a healthcare provider in minutes. K Health’s AI-powered app is based on 20 years of clinical data.