Topics covered in this article
- What are hemorrhoids?
- Internal and external hemorrhoids: what is the difference?
- Why hemorrhoids develop
- Main symptoms
- Rectal bleeding: when it may be hemorrhoids and when to investigate
- Thrombosed hemorrhoid: what it is and why it can be so painful
- Risk factors: constipation, pregnancy, sedentary lifestyle, and diet
- Diagnosis and medical evaluation
- Treatment: fiber, hydration, creams, and local care
- Procedures: rubber band ligation, sclerotherapy, and surgery
- How to prevent future flare-ups
- Can hemorrhoids turn into cancer?
- Myths and facts
- Quick FAQ
- Important disclaimer
- References and further reading
What are hemorrhoids?
Hemorrhoids are normal vascular structures located in the anal canal and lower rectum. They help with stool control and are part of normal human anatomy.
The problem occurs when these blood vessels become swollen, inflamed, enlarged, or displaced, leading to symptoms such as bleeding, pain, itching, or a lump near the anus.
Hemorrhoids are very common, but many people delay seeking care because of embarrassment.
Hemorrhoids are not a sign of poor hygiene. They are a common medical condition and can usually be treated effectively.
Internal and external hemorrhoids: what is the difference?
Hemorrhoids are classified according to their location.
Internal hemorrhoids
Internal hemorrhoids develop inside the rectum or anal canal.
They may cause:
- Bright red bleeding during or after bowel movements
- Blood on toilet paper or in the toilet bowl
- A feeling of incomplete evacuation
- Prolapse, when tissue bulges out through the anus
- Discomfort or pressure, often with little pain
Because the inner rectal area has fewer pain-sensitive nerves, internal hemorrhoids may bleed without causing significant pain.
External hemorrhoids
External hemorrhoids develop under the skin around the anus.
They may cause:
- Anal pain
- Itching
- Swelling
- A tender lump near the anus
- Discomfort when sitting
- Irritation after bowel movements
When a blood clot forms inside an external hemorrhoid, it can become very painful. This is known as a thrombosed hemorrhoid.
The distinction between internal and external hemorrhoids matters because treatment options may differ.
Why hemorrhoids develop
Hemorrhoids usually develop when pressure increases in the veins of the anal and rectal area.
Common causes include:
- Constipation
- Straining during bowel movements
- Sitting on the toilet for long periods
- Chronic diarrhea
- Pregnancy
- Obesity
- Sedentary lifestyle
- Low-fiber diet
- Low fluid intake
- Aging and weakening of supportive tissues
One of the most important triggers is repeated straining during bowel movements.
Spending too much time on the toilet, especially while using a phone, can worsen hemorrhoid symptoms.
Main symptoms
Symptoms vary depending on the type and severity of hemorrhoids.
Common symptoms include:
- Bright red blood on toilet paper
- Bright red blood in the toilet bowl
- Pain during bowel movements
- Anal itching
- Burning sensation
- Pressure or heaviness around the anus
- A lump or swelling near the anus
- Mucus discharge or local moisture
- A feeling of incomplete bowel emptying
Symptoms may appear during flare-ups, improve, and then return.
Rectal bleeding should not be ignored, even when hemorrhoids seem to be the most likely cause.
Rectal bleeding: when it may be hemorrhoids and when to investigate
Bleeding from hemorrhoids is often:
- Bright red
- Seen on toilet paper
- Visible in the toilet after a bowel movement
- Associated with straining
- Not usually mixed throughout the stool
However, other conditions can also cause rectal bleeding.
Possible causes include:
- Anal fissure
- Colon polyps
- Inflammatory bowel disease
- Diverticular disease
- Infections
- Colorectal cancer
Medical evaluation is especially important if there is:
- Recurrent bleeding
- Blood mixed with stool
- Very dark or black stools
- Unexplained weight loss
- Anemia
- A recent change in bowel habits
- Persistent abdominal pain
- Family history of colorectal cancer
- Age above the recommended threshold for colorectal cancer screening
Not all rectal bleeding is caused by hemorrhoids. Proper evaluation helps prevent delayed diagnosis of more serious conditions.
Thrombosed hemorrhoid: what it is and why it can be so painful
A thrombosed hemorrhoid occurs when a blood clot forms inside an external hemorrhoid.
This can cause:
- Sudden and intense anal pain
- A hard lump near the anus
- Local swelling
- Significant tenderness to touch
- Difficulty sitting comfortably
Pain is often most intense during the first few days and may gradually improve.
Treatment may involve:
- Pain relief medication
- Stool softening measures
- Warm sitz baths
- Local care
- A minor procedure in selected cases
In some cases, a healthcare professional may recommend a procedure to relieve pain, especially when symptoms are severe and the patient is seen early in the episode.
Sudden severe anal pain should be evaluated because other conditions can cause similar symptoms.
Risk factors: constipation, pregnancy, sedentary lifestyle, and diet
Several factors increase the risk of hemorrhoids or worsen flare-ups.
Constipation
Hard stools require more effort to pass, increasing pressure in the anal region.
Constipation may be associated with:
- Low-fiber diet
- Low fluid intake
- Sedentary lifestyle
- Certain medications
- Ignoring the urge to have a bowel movement
Pregnancy
Hemorrhoids are common during pregnancy and after childbirth.
This happens because of:
- Increased abdominal pressure
- Hormonal changes
- Slower bowel movements
- Constipation
- Pressure from the enlarged uterus
Sedentary lifestyle
Sitting for long periods may contribute to local pressure and worsen symptoms.
Low-fiber diet
A diet low in fiber can lead to dry, hard stools and difficult bowel movements.
Chronic diarrhea
Frequent bowel movements and irritation around the anus can also trigger symptoms.
Improving bowel habits is one of the most important parts of hemorrhoid treatment.
Diagnosis and medical evaluation
Diagnosis usually involves a clinical evaluation.
A healthcare professional may assess:
- Symptoms
- Bowel habits
- Bleeding pattern
- Medical history
- Family history
- Physical examination of the anal area
Depending on the situation, evaluation may include:
- Digital rectal examination
- Anoscopy
- Sigmoidoscopy
- Colonoscopy
Colonoscopy may be recommended depending on age, risk factors, symptoms, and the pattern of bleeding.
Examination of the anal and rectal area is a routine part of medical care and helps avoid incorrect treatment.
Treatment: fiber, hydration, creams, and local care
Treatment depends on symptom severity.
Most mild cases improve with conservative measures.
Increasing fiber intake
Adequate fiber intake helps soften stools and reduce straining.
Good sources of fiber include:
- Fruits
- Vegetables
- Legumes
- Oats
- Beans
- Seeds
- Whole grains
Fiber supplements may be recommended in some cases.
Hydration
Drinking enough water helps prevent hard, dry stools.
Improving toilet habits
Helpful measures include:
- Avoid straining
- Avoid sitting on the toilet for long periods
- Do not delay bowel movements when the urge appears
- Avoid excessive wiping
- Use gentle hygiene measures
Sitz baths
Warm sitz baths may help relieve:
- Pain
- Burning
- Local irritation
- Anal muscle spasm
Creams and medications
Hemorrhoid creams may provide temporary relief during flare-ups.
Some products contain:
- Local anesthetics
- Anti-inflammatory ingredients
- Corticosteroids
- Protective barriers
These medications should not be used for prolonged periods without medical guidance, especially products containing corticosteroids.
Creams may reduce symptoms, but they do not correct the underlying cause if bowel habits remain problematic.
Procedures: rubber band ligation, sclerotherapy, and surgery
When symptoms persist or hemorrhoids are more advanced, procedures may be considered.
Rubber band ligation
Rubber band ligation is commonly used for internal hemorrhoids.
A small band is placed at the base of the hemorrhoid, reducing blood flow until the tissue shrinks and falls off.
Sclerotherapy
Sclerotherapy involves injecting a substance that helps shrink the hemorrhoid.
Infrared coagulation
This method uses heat to reduce blood flow to internal hemorrhoids in selected cases.
Surgery
Surgery may be recommended for:
- Large hemorrhoids
- Significant prolapse
- Recurrent symptoms
- Persistent external hemorrhoids
- Failure of less invasive treatments
- Severe symptoms affecting quality of life
Not every hemorrhoid requires surgery. Many cases improve with lifestyle changes or office-based procedures.
How to prevent future flare-ups
Prevention focuses mainly on reducing pressure in the anal and rectal veins.
Helpful strategies include:
- Eat fiber-rich foods daily
- Drink enough fluids
- Exercise regularly
- Avoid straining during bowel movements
- Avoid sitting on the toilet for long periods
- Treat constipation early
- Treat chronic diarrhea when present
- Maintain a healthy weight
- Limit foods or drinks that worsen symptoms, if specific triggers are noticed
For people with recurrent flare-ups, medical follow-up can help identify the best preventive strategy.
Preventing hemorrhoid symptoms often means preventing excessive pressure during bowel movements.
Can hemorrhoids turn into cancer?
No. Hemorrhoids do not turn into cancer.
The concern is that hemorrhoids and more serious conditions can sometimes cause similar symptoms, especially rectal bleeding.
This is why it is important not to assume that all blood in the stool is caused by hemorrhoids.
Medical evaluation is important if there is:
- Persistent bleeding
- Recurrent bleeding
- Change in bowel habits
- Unexplained weight loss
- Anemia
- Abdominal pain
- Family history of colorectal cancer
Hemorrhoids are benign, but rectal bleeding should be interpreted carefully.
Myths and facts
“Hemorrhoids are always caused by poor hygiene.”
Myth.
“Sitting on the toilet for too long can worsen hemorrhoids.”
Fact.
“All rectal bleeding is caused by hemorrhoids.”
Myth.
“Fiber and hydration can improve hemorrhoid symptoms.”
Fact.
“Hemorrhoids can turn into cancer.”
Myth.
Quick FAQ
Do hemorrhoids go away on their own?
Some mild flare-ups improve with fiber, hydration, and local care. Persistent or recurrent symptoms may need medical treatment.
Is bright red blood on toilet paper always hemorrhoids?
No. Hemorrhoids are common, but fissures, polyps, inflammatory bowel disease, and colorectal cancer can also cause bleeding.
Do hemorrhoid creams cure hemorrhoids?
They may relieve symptoms temporarily, but they do not always address the underlying cause.
Does every external hemorrhoid need surgery?
No. Surgery is usually reserved for persistent, recurrent, severe, or highly symptomatic cases.
Can pregnancy cause hemorrhoids?
Yes. Hemorrhoids are common during pregnancy and after childbirth.
When should I see a doctor?
You should seek medical evaluation if bleeding is recurrent, pain is severe, a lump persists, bowel habits change, weight loss occurs, anemia is present, or symptoms do not improve with basic measures.
Important disclaimer
This content is for educational purposes only and does not replace professional medical advice. Rectal bleeding, severe anal pain, changes in bowel habits, unexplained weight loss, anemia, black stools, or persistent symptoms should be evaluated by a qualified healthcare professional. If there is heavy bleeding, dizziness, severe weakness, or intense anal pain, seek urgent medical care.
References and further reading
- American Society of Colon and Rectal Surgeons (ASCRS). Hemorrhoids: clinical practice guidelines and patient information.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Hemorrhoids: symptoms, causes, and treatment.
- Mayo Clinic. Hemorrhoids: symptoms and causes.
- National Health Service (NHS). Piles, also called haemorrhoids: overview and treatment.
- Cleveland Clinic. Hemorrhoids: causes, symptoms, and treatment.
- American College of Gastroenterology (ACG). Patient information on rectal bleeding and colorectal health.
