Hemorrhoids

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Hemorrhoids, also called piles, are swollen veins in or around the rectum and anus. They’re one of the most common digestive conditions and affect millions of people. Most cases are managed at home, though some need medical treatment.

Hemorrhoids Symptoms

There are several ways to tell if you have hemorrhoids, including:

  • A lump near the anus that may be sensitive
  • Bright red blood on toilet paper or in the toilet bowl
  • Itching or irritation around the anus
  • Pain or discomfort
  • Swelling around the anus

A healthcare provider can confirm the diagnosis with a physical exam.

Types of Hemorrhoids

Hemorrhoids are categorized by their location. Where they form determines how they feel and how they're treated.

External Hemorrhoids

External hemorrhoids form under the skin around the anus, below the dentate line, where pain-sensing nerves are present. They’re more likely to be painful along with swelling and irritation around the anus.

Internal Hemorrhoids

Internal hemorrhoids develop inside the rectum, above the dentate line — a boundary with sensitive nerve endings begin. There are several grades of internal hemorrhoids, including:

  • Grade I: Bleed but don’t prolapse
  • Grade II: Prolapse during straining but retract on their own
  • Grade III: Prolapse and must be pushed back manually
  • Grade IV: Permanently prolapsed and can’t be reduced

Prolapsed Hemorrhoids

A prolapsed hemorrhoid is an internal hemorrhoid that slipped through the anal opening. Mild prolapse may resolve on its own or with gentle manual reduction. Severe or recurring prolapse usually needs medical treatment.

What do Hemorrhoids Feel Like?

External hemorrhoids can feel like a tender lump near the anus. Many people feel a sense of fullness or pressure in the rectal area. Bleeding is often painless and only seen after a bowel movement.

Are Hemorrhoids Painful?

External and prolapsed hemorrhoids often cause a dull, achy discomfort, especially during bowel movements or when sitting, because the surrounding skin contains sensitive nerve endings. Internal hemorrhoids are usually painless unless they prolapse, become strangulated or develop a clot.

Because hemorrhoids are more commonly known, many people assume that's the cause of their pain when they may have a fissure instead — a small tear in the lining of the anus. A fissure causes sharp, intense pain during bowel movements, unlike the duller pain of hemorrhoids.

If you experience sharp, severe pain with bowel movements, talk to your provider since treatment for each condition is different.

Why do Hemorrhoids Itch?

Itching and irritation around the anus are common hemorrhoid symptoms. Internal hemorrhoids can leak mucus, which irritates the sensitive surrounding skin and triggers persistent itching.

Why do Hemorrhoids Bleed?

Hemorrhoids are swollen, engorged blood vessels with thin, fragile walls. Straining during a bowel movement, passing hard stool or friction can rupture those walls, causing bleeding. Internal hemorrhoids bleed easily because the tissue covering them is thin and vulnerable to injury.

Rectal bleeding is a hallmark symptom of hemorrhoids — most often seen as bright red blood on toilet paper or on the surface of stool. The blood is typically bright red and fresh-looking, not dark or mixed into the stool.

What do Hemorrhoids Look Like?

Hemorrhoids look different depending on their location and severity.

  • External hemorrhoids look like a soft lump or cluster of lumps around the outside of the anus
  • Internal hemorrhoids aren’t visible, because they sit inside the rectum
  • Prolapsed hemorrhoids look like pink, moist tissue protruding from the anus
  • Thrombosed hemorrhoids (a blood clot inside) appear as a firm, bluish-purple lump 

Hemorrhoidal Disease Symptoms

Hemorrhoidal disease refers to symptomatic hemorrhoids that affect your daily life. Symptoms include:

  • A feeling of incomplete evacuation after a bowel movement
  • Anal itching or irritation
  • Bright red rectal bleeding during or after bowel movements
  • Mucus discharge
  • Pain or discomfort, especially when sitting
  • Prolapsed tissue protruding from the anus

What Causes Hemorrhoids?

Hemorrhoids form when pressure builds up in the veins of the lower rectum. Common causes include:

  • A low-fiber diet
  • Chronic constipation or diarrhea
  • Heavy lifting or physical strain
  • Obesity
  • Pregnancy, which puts pressure on the pelvic veins
  • Sitting on the toilet for long periods
  • Straining during bowel movements

How to Get Rid of Hemorrhoids: Relief & Recovery

Most hemorrhoids improve within a few days with self-care. Treatment follows a step-by-step approach: home remedies first, then over-the-counter products and medical treatment from a doctor, if needed.

Hemorrhoid Home Remedies

The following home remedies for hemorrhoids relieve symptoms and support healing:

  • Apply a cold compress or ice pack to the area for up to 10 minutes at a time to reduce swelling
  • Clean the anal area gently with water after each bowel movement (avoid harsh soaps)
  • Wear loose, breathable cotton underwear to reduce irritation
  • Take a sitz bath

Sitz Bath for Hemorrhoids

A sitz bath is a warm, shallow bath that soothes the anal area and helps reduce swelling, itching and discomfort.

How to take a sitz bath in a bathtub:

  • Fill the bathtub with 3–4 inches of warm (not hot) water
  • Sit in the water so the anal area is fully submerged
  • Soak for 10–20 minutes
  • Gently pat the area dry — do not rub
  • Repeat 2–3 times per day, especially after bowel movements

Plain warm water works well. Some people add unscented Epsom salts. Avoid soap, perfumes or bath oils, which can irritate sensitive tissue.

Over-the-Counter Care for Hemorrhoids

Hemorrhoid Cream

Topical hemorrhoid creams and ointments are applied directly to the affected area. They typically contain ingredients such as hydrocortisone (to reduce inflammation), lidocaine or pramoxine (to numb pain) or witch hazel (to reduce swelling). Apply as directed — usually 1–4 times per day and after bowel movements. Don’t use hydrocortisone products for more than 7 days without medical advice, as prolonged use can thin the skin.

Suppository for Hemorrhoids

Suppositories are inserted into the rectum to deliver medication directly to internal hemorrhoids. They typically contain similar active ingredients to creams: hydrocortisone, local anesthetics or astringents like witch hazel. Suppositories help relieve internal itching, inflammation and mild bleeding. Use only as directed.

Other common over-the-counter hemorrhoid medications include:

  • Fiber supplements such as psyllium or methylcellulose to add bulk to stools
  • Pain relievers such as acetaminophen or ibuprofen to reduce pain and inflammation
  • Stool softeners, such as docusate sodium, to make bowel movements easier and less painful
  • Topical products, such as creams, ointments, suppositories or pads, containing hydrocortisone, lidocaine or witch hazel for local symptom relief

Medical Hemorrhoids Treatments

Banding Hemorrhoids

Rubber band ligation — commonly called hemorrhoid banding — is one of the most effective office-based procedures for internal hemorrhoids. A small elastic band is placed around the base of the hemorrhoid, cutting off its blood supply. The hemorrhoid shrinks and falls off within 1–2 weeks. The procedure usually takes a few minutes. Most people return to normal activities the same day. Some discomfort or a feeling of pressure is normal for 24–48 hours afterward. Banding is most effective for Grade I–III internal hemorrhoids.

Your doctor will discuss other advanced treatment options if hemorrhoid banding isn’t sufficient.

How to Prevent Hemorrhoids

Most hemorrhoids are preventable with simple lifestyle changes:

  • Avoid straining during bowel movements
  • Eat a high-fiber diet (25–35g of fiber per day) from fruits, vegetables and whole grains to soften stools
  • Don’t sit on the toilet longer than necessary
  • Drink at least 8 glasses of water per day
  • Exercise regularly to support healthy bowel function
  • Go to the bathroom as soon as you feel the urge
  • Use proper technique if you lift heavy objects

When to See a Doctor for Hemorrhoids

You should see a doctor under the following circumstances:

  • A prolapsed hemorrhoid can’t be pushed back in
  • If you’re unsure whether your symptoms are caused by hemorrhoids
  • No improvement after 1–2 weeks of home treatment
  • You experience heavy, persistent, or dark rectal bleeding
  • You have severe pain

Rectal bleeding should always be evaluated by a healthcare professional to rule out other conditions such as colorectal polyps or colorectal cancer.

Frequently Asked Questions (FAQ)

Do Hemorrhoids Go Away?
Many hemorrhoids go away on their own, especially mild cases. Small external hemorrhoids often resolve within a few days with home care. Internal hemorrhoids may last longer or recur if the underlying causes — such as straining or a low-fiber diet — aren’t addressed. Without lifestyle changes, hemorrhoids tend to come back.
How Long do Hemorrhoids Last?
Mild hemorrhoids typically improve within 3–7 days with self-care measures such as a high-fiber diet, adequate hydration, sitz baths and avoiding straining. Larger or more severe hemorrhoids, especially Grade III or IV internal hemorrhoids, may take longer and often require medical treatment. A thrombosed external hemorrhoid is most painful in the first 48–72 hours and usually resolves within 2–4 weeks, though the swelling may last longer.
Can Hemorrhoids Pop?
A thrombosed external hemorrhoid — one containing a blood clot — can rupture on its own. When it does, it may release blood and the clot, which often brings sudden pain relief. This is generally not dangerous, but it does carry a small risk of infection. Don’t attempt to pop a hemorrhoid at home. If a hemorrhoid ruptures, keep the area clean and see a doctor if bleeding is heavy, won’t stop or if signs of infection develop such as increasing pain, warmth, swelling or fever.