Hemorrhoids
Hemorrhoids are swollen veins around the anus or in the lower rectum. They can cause bleeding, itching, discomfort or prolapse, but rectal bleeding should not automatically be assumed to come from hemorrhoids without appropriate evaluation.
At a glance
Quick facts
- Category
- Anorectal condition
- Types
- Internal and external
- Common symptom
- Bright-red rectal bleeding
- Other symptoms
- Itching, swelling, pain or prolapse
- First-line care
- Fiber, fluids, bowel-habit changes
- Procedures
- Banding and surgery in selected cases
Dr. Francis Chibueze Nwokpoku
Medical Officer · 9th Division Hospital, Nigerian Army
Reviewed for clinical accuracy, important omissions and patient-facing safety wording.
Names & terminology
How this entity may be named or searched
- Hemorrhoids / haemorrhoids
- Swollen veins in or around the anus and lower rectum.
- Piles
- Common non-medical term for hemorrhoids.
- Internal hemorrhoids
- Arise inside the lower rectum and may bleed or prolapse.
- External hemorrhoids
- Form under the skin around the anus and can become painful if thrombosed.
Structured entity profile
Clinical profile
Overview
Hemorrhoids are swollen, inflamed veins around the anus or in the lower rectum. External hemorrhoids lie beneath the skin around the anus; internal hemorrhoids arise inside the anal canal and lower rectum. [1]
They are common: NIDDK estimates that about 1 in 20 Americans has hemorrhoids, and about half of adults older than 50 are affected. [1]
Symptoms and warning signs
Internal hemorrhoids commonly cause bright-red bleeding and may prolapse. External hemorrhoids may itch or feel tender; a thrombosed external hemorrhoid can cause sudden significant pain and a firm lump. [2]
SYMPTOM MATRIX
Symptoms depend on whether hemorrhoids are internal or external
Bleeding is common but should not be self-diagnosed when persistent, heavy or unexplained.
- Bright-red blood with bowel movements
- Anal itching or irritation
- Swelling around the anus
- Prolapse of internal hemorrhoids
- Mild discomfort
- Mucus leakage
- Feeling of incomplete cleaning
- Tender external lump
- Pain with thrombosed external hemorrhoid
- Heavy or ongoing rectal bleeding
- Dizziness or fainting
- Black or tarry stool
- Severe pain with fever
- Bleeding with unexplained weight loss or major bowel-habit change
Rectal bleeding can have causes other than hemorrhoids and may need further investigation.
Diagnosis
Diagnosis begins with medical history and examination of the anal area. A digital rectal examination may assess tenderness, blood, masses and sphincter tone. [3]
Anoscopy or proctoscopy can identify internal hemorrhoids. Colonoscopy or other bowel evaluation may be appropriate when symptoms, age, risk factors or bleeding characteristics suggest another cause. [3]
Diagnostic pathway
Confirm hemorrhoids and do not miss another cause of bleeding
The extent of investigation depends on the bleeding pattern, age and colorectal-risk context.
Finding a hemorrhoid does not establish that every episode of rectal bleeding is caused by hemorrhoids. Source [3]
Constipation, straining and bowel habits
Risk is associated with straining, prolonged time on the toilet, chronic constipation or diarrhea, low-fiber intake, pregnancy, aging and repeated heavy lifting. Reducing straining is a central part of prevention and treatment. [1]
Treatment and management
First-line treatment focuses on softer stools and less straining: adequate dietary fiber, fluids, physical activity and avoiding prolonged sitting on the toilet. Short-term over-the-counter creams or suppositories may reduce symptoms for some people. [4]
Persistent bleeding or prolapsing internal hemorrhoids can be treated with office procedures such as rubber band ligation. Surgery is reserved for selected severe, recurrent or highly prolapsed disease. [4]
Treatment & care hub
Start with bowel habits, then escalate if symptoms persist
Treatment intensity depends on bleeding, prolapse, thrombosis and response to conservative care.
Reduce constipation and straining
Stool-softening dietary and bowel-habit measures are the foundation of treatment.
Reduce local irritation
Selected topical treatments can help itching or discomfort but do not address the underlying bowel pattern.
Treat bleeding or prolapse
Rubber band ligation and other office techniques target symptomatic internal hemorrhoids.
Treat advanced or recurrent hemorrhoids
Surgical procedures are considered when other treatment is insufficient or anatomy is severe.
Reducing recurrence
Regular fiber intake, hydration, prompt response to the urge to defecate and limiting prolonged toilet sitting can reduce constipation and repeated straining. Recurring rectal bleeding should still be reviewed rather than assumed to be recurrent hemorrhoids. [4]
I counsel patients to avoid prolonged sitting and straining on the toilet; spending extra time there, including while using a phone, can make this habit harder to change.
United States estimate
About 1 in 20 Americans has hemorrhoids
Prevalence rises with age.
Common questions
Frequently asked questions
Yes. Piles is a common term for hemorrhoids.
Yes. Internal hemorrhoids commonly cause bright-red bleeding, but persistent rectal bleeding should be evaluated for other causes.
It is an external hemorrhoid containing a blood clot, which can cause sudden pain and a tender lump.
Increasing fiber, improving hydration and reducing straining or prolonged toilet sitting are common first-line measures.
Persistent bleeding, prolapse or severe symptoms may be treated with office procedures such as banding or, in selected cases, surgery.
Sources
- NIDDK, NIH — Definition & Facts of Hemorrhoids
- NIDDK, NIH — Symptoms & Causes of Hemorrhoids
- NIDDK, NIH — Diagnosis of Hemorrhoids
- NIDDK, NIH — Treatment of Hemorrhoids
This article is based on trusted medical sources and has undergone clinician review. It is not a substitute for personalized medical advice.
Bleeding or an anorectal protrusion should not automatically be assumed to be hemorrhoids. I also consider other causes, including rectal prolapse, when the appearance or history is atypical.