Hemorrhoids are enlarged and swollen (also called varicose) veins around the outside of the anus or in the lower rectum. The rectum is the last part of the bowel and leads to the anus, the opening at the end of the bowel where fecal matter leaves the body.
Everyone has hemorrhoidal tissue in this area, made up of blood vessels, connective tissue, and some muscle. These “cushions” don’t always become enlarged or distended, but as we age, this phenomenon becomes more common — causing what we call hemorrhoids, also known as piles.
Hemorrhoids can be associated with various conditions, and it's thought that they're most often related to straining to pass a bowel movement. Lifting heavy objects, along with other activities that can cause straining, may also lead to hemorrhoids. Increased pressure during pregnancy, and being overweight, are other contributing factors.
Hemorrhoids may be painful and particularly bothersome if they are recurrent, but they're rarely serious, and symptoms usually go away within a few days. There are plenty of effective ways to treat them, as well as options for the less common types of hemorrhoids that may be more problematic.
Types of Hemorrhoids: Internal and External
Hemorrhoids are either internal or external.
Internal hemorrhoids These hemorrhoids develop inside the rectum (the part of the large bowel leading to the anus) and are not usually visible to the naked eye. Internal hemorrhoids generally don't hurt, but they often bleed painlessly.
In some cases, internal hemorrhoids may protrude through the anus and can be seen, which is known as prolapse. When this happens, they will usually shrink back inside the rectum on their own or can be pushed back in. (1)
External hemorrhoids These hemorrhoids develop under the skin around the outside of the anus. These are the most uncomfortable hemorrhoids and can be itchy or painful, and may feel lumpy. When a blood clot forms within an external hemorrhoid, this is known as a thrombosed hemorrhoid, which can result in severe, ongoing pain. (1) Sometimes clots dissolve on their own, but if they don’t, your doctor can remove the clot, a procedure that’s most effective if done within 72 hours after the clot forms. (2)
Common Questions & Answers
Signs and Symptoms of Hemorrhoids
Seeing blood in your toilet bowl after a bowel movement is no doubt alarming, and it’s one of the main symptoms of hemorrhoids. Other symptoms include:
- Bright red blood on toilet paper or in your stool after a bowel movement
- Itching in the anal area
- Pain in the anal area, especially when sitting
- Pain during bowel movements
- One or more hard, painful lumps around the anus
If you experience any of these hemorrhoid symptoms, avoid excess straining, rubbing, or cleaning around the anus, which can make irritation and itching worse, and can even lead to bleeding. In addition, try to pat the area dry instead of wiping it.
Causes and Risk Factors of Hemorrhoids
Several conditions and habits are thought to cause hemorrhoids.
- Chronic constipation or diarrhea
- Straining too hard during bowel movements
- Sitting on the toilet for a long time
Straining, constipation, and prolonged sitting can all affect the blood flow in the area, causing blood to not move at its expected rate (known as pooling) within the vessels, leading to hemorrhoids.
Factors that raise your risk of hemorrhoids:
- Lack of fiber in the diet
- Overweight or obesity can put pressure on the hemorrhoidal tissue.
- Aging; the connective tissue in the rectum and anus becomes weaker, potentially resulting in bulging hemorrhoids.
- Pregnancy; as the fetus grows and puts pressure on the abdomen, the veins in the rectum and anus become enlarged. The problem typically goes away after birth.
Hemorrhoids and Pregnancy
Hemorrhoids are common during pregnancy, particularly in the third trimester, when the enlarged uterus puts pressure on the pelvis and the veins near the anus and rectum. The increased level of the hormone progesterone during pregnancy can also contribute to the development of hemorrhoids: Progesterone relaxes the walls of the veins, making them more likely to swell.
Some women get hemorrhoids for the first time when they’re pregnant. But if you’ve had hemorrhoids before, you’re more likely to get them again when you’re pregnant.
Fortunately, hemorrhoids usually aren't harmful to your health or the health of your baby, and they typically go away on their own once you give birth. You can often alleviate symptoms with home care, but check with your doctor first to make sure any treatments are safe to take during your pregnancy.
How Are Hemorrhoids Diagnosed?
Your doctor will ask you to describe your symptoms and will take your medical history. They may also look for skin irritation, lumps or swelling, external hemorrhoids, prolapsed internal hemorrhoids, skin tags (excess skin left when the blood clot in a thrombosed hemorrhoid is absorbed by the body), and anal fissures (small tears in the anus that can lead to itching and bleeding). (3)
Your doctor may also check for blood in the stool, examine the muscle tone of your anus, and perform a rectal exam to diagnose internal hemorrhoids. This is done in the doctor's office with a gloved, lubricated finger (an exam of the lower rectum called a digital rectal examination) and an anoscope (a lighted tube that’s inserted a few inches into the anus to help the doctor see any problems inside the lining of the rectum). (3) Your doctor may also recommend additional tests to rule out other causes of bleeding, especially if you are older than 40.
Duration of Hemorrhoids
You can often treat hemorrhoids yourself at home, and symptoms should ease within a week. But if they don't, or if you have rectal bleeding, you should see your doctor, according to the National Institute of Diabetes and Digestive and Kidney Diseases. (4) Bleeding from the rectum could possibly be a sign of digestive tract problems and bowel diseases, such as ulcerative colitis, Crohn’s disease, or anal or colorectal cancer, so it’s important to treat it seriously, especially if you are over 40. (5)
Treatment and Medication Options for Hemorrhoids
Fortunately, most hemorrhoids can be treated at home or with simple medical procedures in a doctor’s office, depending on the type of hemorrhoid and the severity of your symptoms.
At-Home Hemorrhoid Treatment and Remedies
Avoiding constipation is key in treating hemorrhoids. And diet and lifestyle changes, especially consuming more fiber, may help reduce hemorrhoid symptoms. A fiber supplement, like Metamucil (psyllium), and stool softeners, like Citrucel (methylcellulose), can help prevent constipation. But avoid laxatives, which can cause diarrhea and worsen hemorrhoid symptoms.
To ease the discomfort caused by hemorrhoids, you can do several things on your own at home.
- Take a sitz bath. This is a warm shallow bath that specifically targets the area; most drugstores sell a plastic kit that fits over your toilet.
- Use an ice pack.
- Avoid straining during bowel movements.
- Clean your anus properly and keep it clean after each bowel movement. (6)
- Sit on cushioned surfaces rather than hard ones, to reduce swelling and prevent new hemorrhoids from forming. (6)
- As needed, take over-the-counter pain relievers, such as ibuprofen (Advil, Motrin), acetaminophen (Tylenol), or aspirin. (7)
- Try over-the-counter creams, ointments, or pads containing hydrocortisone or witch hazel. These can relieve swelling, pain, and itching. (Products with hydrocortisone can also cause the skin to thin or weaken and should not be used for more than a week at a time.)
Hemorrhoid Treatment in a Doctor’s Office, With or Without Surgery
Medical procedures may be needed for hemorrhoids that don’t go away with home treatments.
Painful external hemorrhoids can be excised (cut off) during an office visit following a shot of local anesthetic to numb the area.
For internal hemorrhoids, a few office procedures may be considered. In rubber band ligation, the most common hemorrhoid procedure performed in the United States, the doctor places a small rubber band around the base of the hemorrhoid, cutting off the hemorrhoid's blood supply. (6) The hemorrhoid typically shrinks and falls off within about a week, though several quick follow-up visits may be required to completely get rid of the hemorrhoid. (1)
Other procedures include sclerotherapy, in which a chemical injected into the hemorrhoid causes scar tissue to form, shrinking the hemorrhoid; and infrared coagulation, in which an intense beam of infrared light causes the scar tissue to form, cutting off the blood supply and shrinking the hemorrhoid. (4)
If you have a large external hemorrhoid, both internal and external hemorrhoids, or an internal hemorrhoid that’s prolapsed (popped out through the anus), a surgical operation called a hemorrhoidectomy may be necessary, though few patients require this procedure. (1)
During a hemorrhoidectomy, the hemorrhoid and surrounding tissue are removed via a small incision, which is usually closed up with stitches afterward. The procedure is performed in an operating room with either localized or general anesthesia, or a spinal block that numbs the bottom half of the body. The procedure is successful in 95 percent of cases, though patients may experience postoperative pain. (6)
Another option that aims to reduce postoperative pain is a stapled hemorrhoidopexy, in which a device pulls the hemorrhoidal tissue upward and to its normal position, stapling it in place. (The staples fall out over time.) (1)
Learn More About Treatment for Hemorrhoids: Medication, Alternative and Complementary Therapies, Surgery Options, and More
Prevention of Hemorrhoids
Keeping your stool soft and having regular bowel movements is one of the best ways to prevent hemorrhoids.
The following tips may help you prevent constipation.
Get plenty of fiber in your diet. A high-fiber diet can make stool softer and bulkier so that it passes easily. According to the USDA's Dietary Guidelines for Americans, adult men younger than 50 should aim for at least 34 grams (g) of fiber a day, and adult women under 50 should aim for 25 g. For those older than 50, the recommendation is slightly lower: 28 g for men and 22 g for women. (8) But be careful to add fiber to your diet slowly to avoid excessive gas or bloating.
There are a number of easy, healthy ways to incorporate more fiber into your diet. Fiber-filled foods include fruits such as berries, avocados, and pears (especially when you eat the skin). Broccoli, artichokes, and Brussels sprouts are among the vegetables that can up your fiber intake. Whole grains, such as brown rice, quinoa, and oatmeal, are also an important source. Legumes, including lentils, various beans, and green peas, are a great way to get fiber. Nuts and seeds make for a great fiber-filled snack, too.
If you're having trouble getting enough fiber in your regular diet, consider a fiber supplement. (7)
If you experience chronic constipation and suspect that may be contributing to your hemorrhoids, avoid eating too many foods that contain little or no fiber, such as cheese and fast and processed foods.
Drink plenty of water and other fluids. Recommendations for daily water intake vary and depend on the individual, but the Institute of Medicine of the National Academies has set adequate intake levels at 2.7 liters (91 ounces [oz]) for women and approximately 3.7 liters (125 oz) for men. (9) This can come from beverages and food, but caffeinated beverages and alcohol can be dehydrating and should not be counted in reaching this intake goal.
Exercise regularly. Exercise, especially 20 to 30 minutes of moderate aerobic activity a day, can help keep bowel movements regular. (6) And regular exercise may help you lose weight, which may be contributing to the formation of hemorrhoids.
Other tips for preventing hemorrhoids include:
Don’t strain or hold your breath during bowel movements. Straining can put excess pressure on veins and lead directly to hemorrhoid development.
Go to the bathroom as soon as you feel the urge. Letting the urge subside can make your stool harder to pass.
Avoid long periods of sitting. Sitting for too long, especially on the toilet, can stress veins in the anus.
Complications of Hemorrhoids
Hemorrhoid complications are rare. Complications may include:
Anemia Bleeding from chronic hemorrhoids can cause anemia, or not having enough red blood cells. (10) Red blood cells carry oxygen throughout the body, so having anemia can make you feel tired, weak, or short of breath.
Strangulated hemorrhoid In rare situations, swelling may cut off the oxygen supply to a hemorrhoid that has prolapsed, causing a strangulated hemorrhoid. This can be extremely painful and incapacitating, and surgery may be needed to treat it. (11)
Research and Statistics: Who Gets Hemorrhoids?
Hemorrhoids are very common in both men and women, affecting about 1 in 20 Americans. (12) The most common time to get hemorrhoids is between ages 45 and 65. (13) Hemorrhoids are also common in pregnant women.
By age 50, about half of us have experienced hemorrhoid symptoms, such as itching, bleeding, and rectal pain. At any given time, about 10 million Americans — roughly 4 percent of adults — have hemorrhoids. (14) It’s estimated that 75 percent of Americans will have hemorrhoids at some point in their lives. (15)
Related Conditions and Causes of Hemorrhoids
Gastrointestinal problems such as constipation and diarrhea can lead to or worsen hemorrhoids. The prolonged sitting or straining that may occur when you're dealing with these issues puts pressure on the hemorrhoidal tissue.
Hemorrhoids also often develop during pregnancy. This is similarly due to greater pressure in the area but can also be due to an increase in blood volume and as a result of hormonal changes that increase the likelihood of swelling. Constipation during pregnancy is a common cause of hemorrhoids.
Resources We Love
Hemorrhoids can be uncomfortable, both to have and to talk about. But clear, straightforward information can help you deal with them.
Essential Orgs for Hemorrhoid Information
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
In addition to basic info about symptoms, causes, and treatment, the NIDDK website offers recommendations on diet and nutrition — what to eat and what to avoid — as well as links to relevant clinical trials that may be seeking participants.
American Society of Colon and Rectal Surgeons
This site provides a comprehensive review of what hemorrhoids are, what causes them, and how to treat them. In cases when pain is severe and hemorrhoids aren't healing with at-home treatment, in-office treatment by a healthcare provider is necessary. This can involve surgical and nonsurgical options.
The Mayo Clinic offers trusted guidance on symptoms, causes, diagnosis, and treatment of hemorrhoids. You can also find answers to specific questions about home remedies and hemorrhoid treatment during pregnancy.
Favorite Podcast on Hemorrhoids
Each episode of the Cleveland Clinic's Butts and Guts podcast explores a different digestive health issue, including a lively, informative one on hemorrhoids.
Additional reporting by Deborah Shapiro.
Editorial Sources and Fact-Checking
- Hemorrhoids: Expanded Version. American Society of Colon and Rectal Surgeons.
- Hemorrhoids: Diagnosis and Treatment. Mayo Clinic. May 12, 2021.
- Diagnosis of Hemorrhoids. National Institute of Diabetes and Digestive and Kidney Diseases. October 2016.
- Symptoms and Causes of Hemorrhoids. National Institute of Diabetes and Digestive and Kidney Diseases. October 2016.
- Hemorrhoids: Symptoms and Causes. Mayo Clinic. May 12, 2021.
- Hemorrhoids and What to Do About Them. Harvard Health Publishing. February 6, 2019.
- Treatment of Hemorrhoids. National Institute of Diabetes and Digestive and Kidney Diseases. October 2016.
- Dietary Guidelines for Americans, 2020–2025. USDA. December 2020.
- Report Sets Dietary Intake Levels for Water, Salt, and Potassium to Maintain Health and Reduce Chronic Disease Risk. National Academies of Sciences, Engineering, and Medicine. February 11, 2004.
- Hemorrhoids. MedlinePlus. September 19, 2021.
- The Acute Management of Haemorrhoids. Annals of the Royal College of Surgeons of England. October 2014.
- Fox A, Tietze PH, Ramakrishnan K. Anorectal Conditions: Hemorrhoids. FP Essentials. March 2014.
- Lohsiriwat V. Hemorrhoids: From Basic Pathophysiology to Clinical Management. World Journal of Gastroenterology. May 2012.
- Sanchez C, Chinn B. Hemorrhoids. Clinics in Colon and Rectal Surgery. March 2011.
- Lohsiriwat V. Treatment of Hemorrhoids: A Coloproctologist’s View. World Journal of Gastroenterology. August 2015.
- American Academy of Family Physicians. September 2020.
- Mayo Clinic.