Hemorrhoids: symptoms, causes and relief

In short

• Hemorrhoids, also called piles, are swollen veins in the lower rectum or around the anus. They are either internal, inside the rectum, or external, under the skin around the anus.
• The usual drivers are straining, constipation, a low-fiber diet, long stretches on the toilet and getting older. Pregnancy and heavy lifting add to the list.
• Care starts with fiber, fluids, soft stools and warm sitz baths. Over-the-counter creams ease mild symptoms but are normally used for about a week.
• If home care is not enough, a doctor can use office procedures such as rubber band ligation. Surgery is kept for large or prolapsing hemorrhoids that have not responded.
• Rectal bleeding can also come from inflammatory bowel disease or colorectal cancer, so do not assume hemorrhoids without being examined.

What hemorrhoids are

Hemorrhoids are swollen, inflamed veins in the lower rectum or around the anus. External hemorrhoids form under the skin around the anus. Internal hemorrhoids form in the lining of the anus and lower rectum, where you cannot see or feel them unless they prolapse, which means they push out through the anal opening.

Piles can be as small as a pea or as large as a grape, and many get better on their own within a few days. The two types behave differently, which is why symptoms vary so much from person to person.

Why they appear

• Straining during bowel movements.
• Sitting on the toilet for long periods, including with a phone.
• Chronic constipation or chronic diarrhea.
• A low-fiber diet.
• Age, as the tissues in the anus and rectum weaken over time.
• Pregnancy.
• Frequent heavy lifting.

Being overweight is also listed as a risk factor by the NHS. What most of these have in common is extra pressure on the veins in the anal area, which is why soft, easy stools are the foundation of both prevention and treatment.

Symptoms: what is typical

• Bright red blood on the stool, on toilet paper or in the toilet bowl after a bowel movement. This is the usual sign of internal hemorrhoids.
• Itching around the anus, more typical of external hemorrhoids.
• Hard, tender lumps near the anus and pain, especially when sitting.
• A feeling that you still need to go after you have finished.
• Mucus on underwear or toilet paper.
• A lump that pushes out during a bowel movement and may go back in on its own or with a gentle push.

Internal hemorrhoids that have not prolapsed are usually painless. A very painful, firm, non-reducible lump at the edge of the anus may be a thrombosed external hemorrhoid, and it is a reason to be seen soon. Sharp pain with every bowel movement can also have other causes, so it is worth asking about.

What helps at home

1. Add fiber graduallyVegetables, fruit, whole grains and legumes soften stool. If food is not enough, a fiber supplement such as psyllium or methylcellulose, or a stool softener, may help; ask your provider which suits you.
2. Drink enough fluidsWater, clear soups and similar fluids help fiber do its job. Fiber without fluids can make constipation worse.
3. Change toilet habitsGo when you feel the urge, do not strain, and do not stay longer than needed. Leave the phone outside the bathroom.
4. Use a warm sitz bathSitting in warm water several times a day eases pain and itching.
5. Clean gentlyPat the area dry instead of rubbing, and keep it clean and dry.
6. Choose pain relief carefullyA wrapped ice pack can ease discomfort. The NHS advises avoiding codeine, which can cause constipation, and avoiding ibuprofen if the piles are bleeding.

Over-the-counter creams, ointments and suppositories may relieve mild pain, swelling and itching from external hemorrhoids and are usually used for about a week. Longer use of products containing steroids, anesthetics or antiseptics can cause allergic reactions, so do not extend them without asking a clinician.

Procedures and surgery

If symptoms last more than a week of home care, or keep coming back, see your primary care provider. Office procedures are preferred over surgery for hemorrhoids that keep causing symptoms because they offer similar benefit with fewer complications.

• Rubber band ligation: a band placed at the base of an internal hemorrhoid cuts off its blood supply, and the tissue usually falls off within a week.
• Sclerotherapy: an injected solution causes scarring that shrinks the hemorrhoid.
• Infrared photocoagulation and electrocoagulation: heat or electric current causes scarring and shrinkage.
• Hemorrhoidectomy or hemorrhoid stapling: surgery under anesthesia for large external or prolapsing internal hemorrhoids that did not respond to other treatment.

Some people take oral flavonoid supplements. A Cochrane review found a potential benefit for bleeding, discharge and itching, but the authors also noted methodological limits and called for stronger trials. Whether they are worth trying is a question for your provider.

Pregnancy

Pregnancy is a recognized risk factor. The basics are the same: fiber, fluids, soft stools and warm baths. Because creams and suppositories are not all suitable during pregnancy and breastfeeding, choose them together with your obstetric provider.

When bleeding needs a doctor

Rectal bleeding is not always from hemorrhoids. It can also signal Crohn's disease, ulcerative colitis or colorectal cancer. Any rectal bleeding should be evaluated, and the NHS says any symptom of bowel cancer warrants a visit to a doctor, including blood in the stool, a lasting change in bowel habit, unexplained weight loss, stomach pain, bloating or tiredness from anemia.

Red flags: call 911 or go to an emergency department now if bleeding does not stop, if you pass a lot of blood or large clots, or if you have severe pain. Get urgent medical advice the same day if the stool is black or dark red, if you have bloody diarrhea, painless bleeding, pus leaking from a pile, or fever with feeling unwell.

How a doctor checks and what to ask

A doctor can often diagnose hemorrhoids from your history and a physical exam, which may include a digital rectal exam and a look inside the anus and rectum. Colonoscopy is considered when there is no obvious source of bleeding, or with abdominal pain, new or worsening constipation, or bleeding that continues after hemorrhoids have been treated.

• Do my symptoms fit hemorrhoids, or should something else be ruled out?
• Do I need a colonoscopy given my age and history?
• Which creams or suppositories are safe for me, and for how long?
• Would a fiber supplement help, and which kind?
• How can I lower the chance of them returning after a procedure?

Questions and answers

Sources

1. NIDDK — Symptoms and causes of hemorrhoids
2. NIDDK — Treatment for hemorrhoids
3. NHS — Piles (haemorrhoids)
4. AAFP — Management of Hemorrhoids: Guidelines From the ASCRS
5. Cochrane — Phlebotonics for haemorrhoids
6. NHS — Bowel cancer: symptoms

Sources checked on 29 October 2026.