Hemorrhoids may cause:

• Rectal bleeding. You may see bright red blood on the toilet paper or in the toilet after a bowel movement. You may see blood on the stool.
• Itching. Hemorrhoids often seep mucus. It can irritate the skin and cause itching.
• Discomfort. You may still feel the urge to pass stool right after having a bowel movement.
• Pain.
  • When a vein within an external hemorrhoid gets irritated, blood may clot under the skin, forming a hard, bluish lump. This is known as a thrombosed, or clotted, hemorrhoid. Thrombosed hemorrhoids can be very painful.
  • Large internal hemorrhoids that bulge from the anus may be painful if they're squeezed by the anal muscles. They may be very painful if the blood supply to the hemorrhoid is cut off.

For some people, hemorrhoids may cause a little discomfort for a limited time. Other people have recurrent bouts of discomfort when hemorrhoids flare up. Some people struggle with hemorrhoid pain, discomfort, and itching much of their lives. The degree (Figure 2) and duration of discomfort depend on where the hemorrhoids are.

Hemorrhoids frequently develop during pregnancy because of extra pressure on veins (from the enlarged uterus).

During labour, hemorrhoids may start or get worse because of the intense straining and pressure on the anal area while pushing to deliver the baby.

External hemorrhoids

Because external hemorrhoids may not cause any symptoms, you may not be aware that you have hemorrhoids.

When a vein within an external hemorrhoid gets irritated, blood may clot under the skin, forming a hard, bluish lump. This is known as a thrombosed, or clotted, hemorrhoid. Thrombosed hemorrhoids can be very painful.

Internal hemorrhoids

Small internal hemorrhoids may not grow larger if bowel habits or other factors change to lower pressure on the veins in the bowel.

Large internal hemorrhoids may bulge from the anus. After bowel movements, you may have to push them back through the anus. At worst, large internal hemorrhoids stick out all the time.

In rare cases, hemorrhoids may bulge through the anus and swell. Muscles that control the opening and closing of the anus may cut off a hemorrhoid's blood supply (strangulated hemorrhoid). This may cause the hemorrhoid tissues to die. If this happens, you will feel severe rectal pain and may see blood and pus at the anus. You will need urgent surgery to prevent further complications, such as death of the affected tissue and infection.

Figure 2 - Internal hemorrhoids: First- to fourth-degree

A first-degree internal hemorrhoid bulges into the anal canal during bowel movements.

A second-degree internal hemorrhoid bulges from the anus during bowel movements, then goes back inside by itself.

A third-degree hemorrhoid bulges from the anus during bowel movements and must be pushed back in with a finger. A fourth-degree hemorrhoid protrudes from the anus all the time.

Current as of: October 19, 2023

Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

Common symptoms of hemorrhoids may be a sign of other serious health problems. Colon or rectal cancer and other conditions have many of the same symptoms as hemorrhoids. Call your doctor if you have symptoms like these:

• Stools are black or tarry or change size and shape.
• A lump or bulge that isn't tender and that doesn't go away forms at the anal opening.
• Rectal bleeding becomes heavy or changes colour (such as from bright red to dark red).

If you have hemorrhoids, call your doctor if:

• Moderate rectal pain has not gone away after 3 to 4 days of home treatment.
• Pain or swelling is severe.
• Tissue from inside the body bulges from the anus and does not return to normal after 3 to 7 days of home treatment.
• A lump inside the anus gets bigger or more painful.

Watchful waiting

Watchful waiting is a wait-and-see approach. And in most cases, bleeding caused by hemorrhoids should stop after 2 to 3 days. Continue home treatment to prevent bleeding from starting again. Call your doctor if bleeding:

• Occurs for more than 1 week without improvement.
• Starts again.
• Occurs when there is no reason to expect it.

Your doctor can tell if you have hemorrhoids by asking about your past health and doing a physical exam.

You may not need many tests at first if your doctor thinks that your rectal bleeding is caused by hemorrhoids. Your doctor may just examine your rectum with a gloved finger. Or your doctor may use a short, lighted scope to look inside the rectum.

Rectal bleeding can be a sign of a more serious problem, such as colon, rectal, or anal cancer. So if the first exam doesn't show a clear cause of your problems, your doctor may do tests to check for other causes of bleeding. The doctor may use a lighted scope to look at the lower third of your colon. This is called sigmoidoscopy. Or your doctor may use another kind of scope to look at the entire colon. This is called colonoscopy.

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Most hemorrhoids can be treated with simple changes to diet and bowel habits. Most don't require surgery or other treatment unless the hemorrhoids are very large and painful.

Home treatment

For most external hemorrhoids, home treatment is all you need. The same home treatment can be used for most internal hemorrhoids.

• Slowly add fibre to your meals. Eat foods that have lots of fibre, such as fruits, vegetables, and whole grains.
• Use an over-the-counter ointment for a limited time to stop itching. You also may use a stool softener.
• Try suppositories. They can help relieve irritation and lubricate the anal canal during bowel movements.
• Drink plenty of water.
• Get some exercise every day.

Non-surgical procedures

The goal of these procedures is to reduce the blood supply to the hemorrhoid so it shrinks or goes away. The scar tissue left in its place helps support the anal tissue and helps prevent new hemorrhoids.

These procedures can only be done on internal hemorrhoids. They include:

• Tying off the hemorrhoids with a rubber band. This is called rubber band ligation.
• Using heat, lasers, or electric current to create scar tissue. This is called coagulation therapy.

Surgery

Surgery to remove hemorrhoids is called hemorrhoidectomy. It can be used:

• For large internal hemorrhoids.
• When you have several small hemorrhoids.
• When other treatments haven't controlled bleeding.

Sometimes a combination of treatments (for example, a non-surgical procedure and surgery) is the best way to treat hemorrhoids.

External hemorrhoids usually aren't removed with surgery unless they are very large and uncomfortable. Or they may be removed if you are having surgery on the anal area for another reason, such as for internal hemorrhoids or a tear (anal fissure). If a blood clot forms in the external hemorrhoid, the clot may need to be removed to relieve pain.

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Home treatment may help relieve your symptoms or keep your hemorrhoids from getting worse. It mainly involves having healthy bowel habits.

• Avoid constipation.

  Slowly add fibre to your meals. Eat foods with lots of fibre like fruits, vegetables, and whole grains. And drink plenty of water. These things may help prevent hard stools.

• Avoid making hemorrhoids worse.
  • After bowel movements, blot the anus gently with white toilet paper moistened with water or a cleansing agent. Or you can use baby wipes or other premoistened towels (such as Preparation H or Tucks).
  • Avoid rubbing the anal area. You can rinse off in the shower or on a bidet instead of wiping yourself with toilet paper. After cleansing, gently pat the anal area dry with a soft, absorbent towel or cloth.
  • Don't use soaps that contain perfumes or dyes.
• Relieve pain and itching.
  • Take over-the-counter pain relievers. Acetaminophen (Tylenol) can help with pain. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) and naproxen (Aleve) can help with pain and swelling.
  • Apply ice several times a day for 10 minutes at a time. Then place a warm compress on the anal area for another 10 to 20 minutes.
  • Take a sitz bath. Fill your bathtub with just enough warm water to cover the anal area. Do this several times a day, especially after bowel movements. Soak for about 15 minutes at a time. Be careful! If the water is too warm, it can burn you.
  • Use over-the-counter medicines as recommended by your doctor or pharmacist. They include ointments, creams, and suppositories. Examples include zinc oxide, petroleum jelly, and Preparation H.
• Take a day of bedrest.

  Do this to take pressure off inflamed, irritated veins. If you are pregnant, you may find it helpful to lie on your side. If you aren't pregnant, sleeping on your stomach with a pillow under your hips will help reduce swelling of hemorrhoids.

• Try not to sit or stand for a long time.

  Limit sitting and standing when hemorrhoids are irritated. If you must sit for a long time, sit on a pillow.

• Avoid lifting heavy objects.
• Wear cotton underwear.

  It prevents moisture buildup, which can irritate hemorrhoids.

• Wear loose clothing.

  This reduces pressure on the anal area.

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Medicines can help relieve symptoms of hemorrhoids. Over-the-counter (OTC) treatments you can try include:

• Ointments that protect the skin. They form a barrier over hemorrhoids. This can prevent more injury and reduce itching. Examples include zinc oxide and petroleum jelly.
• Suppositories. These can help relieve irritation. They can also lubricate the anal canal during bowel movements. They include Preparation H and Tucks.
• 1% hydrocortisone ointment. This is a type of steroid medicine. It may relieve inflammation and itching.
• Products that numb an area. Although these products help some people, others become allergic to them. Ask your doctor before you use them. These products often have "-caine" in the name or the ingredients.
• OTC pain relievers. Acetaminophen can help with pain. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help with pain and swelling.

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