Hemorrhoids: Symptoms, Home Care, and When Bleeding Needs a Check

Hemorrhoids are swollen veins in the lower rectum or around the anus, and they are a common reason for itching, soreness and bright red blood on toilet paper. Many cases improve with fiber, fluids, warm baths and less straining. Heavy bleeding, dizziness, black or maroon stools, or bleeding that keeps returning needs medical evaluation, because other conditions can look similar. This article covers symptoms, home care, treatments and when bleeding needs a check.

What hemorrhoids are and how they feel

MedlinePlus (NIH) describes hemorrhoids as swollen veins in the anus and lower rectum, similar in some ways to varicose veins in the legs. Almost everyone has the cushions of tissue where hemorrhoids form. They become a problem when the tissue swells, stretches or becomes irritated.

There are two main types, and the symptoms differ.

• Internal hemorrhoids sit inside the rectum. They are often painless, and bleeding may be the first sign you notice. Larger ones can slip down and protrude (prolapse) during a bowel movement.
• External hemorrhoids sit under the skin around the anus. They can itch, ache or feel like a tender lump. If a blood clot forms inside one (a thrombosed hemorrhoid), it can cause sudden, firm, painful swelling.

Common symptoms

Symptoms vary from person to person and often come and go. They may include:

• Bright red blood on toilet paper, on the stool surface or in the toilet bowl
• Itching or irritation around the anus
• Pain or discomfort, especially when sitting or after a bowel movement
• A lump or swelling near the anus
• A feeling that the bowel has not fully emptied
• Mucus leakage or a sense of fullness

Hemorrhoids on their own are generally not a cause of fever, severe belly pain or vomiting. Those symptoms call for a different explanation.

Why hemorrhoids develop

Several factors contribute, and the exact mechanism is not fully understood. Pressure in the veins of the lower rectum appears to play a role. Factors often associated with hemorrhoids include:

• Straining during bowel movements
• Chronic constipation or long-lasting diarrhea
• Sitting for long periods, especially on the toilet
• Pregnancy and childbirth
• Low-fiber eating patterns
• Heavy lifting and excess body weight
• Aging, as the supporting tissue may weaken over time

If diarrhea has lasted for weeks, see our article on what causes diarrhea that lasts more than two weeks, since that is worth sorting out separately.

Home care for hemorrhoid symptoms

Many people find that simple steps can help ease symptoms while the swelling settles. Outcomes vary, and these steps may reduce symptoms rather than remove the hemorrhoid itself.

Soften the stool

• Add fiber gradually from fruits, vegetables, beans and whole grains. Increasing it too fast can cause gas and bloating.
• Drink fluids through the day.
• Ask a pharmacist or your clinician whether a fiber supplement or stool softener fits your situation, especially if you take other medicines or have other health conditions.

Change toilet habits

• Go when you feel the urge instead of holding it.
• Avoid straining and avoid sitting on the toilet for long stretches, including with a phone.
• Clean gently with moist wipes or water, and pat dry. Hard wiping can irritate the skin.

Soothe the area

• Warm water baths (sitz baths) for 10 to 15 minutes may relieve discomfort and itching for some people.
• A cold pack wrapped in a cloth may ease swelling.
• Over-the-counter creams, ointments and pads are sold for hemorrhoids. Follow the product label and ask a pharmacist about ingredients. Steroid-containing creams are generally meant for short-term use, so check the label directions and ask a clinician before using one longer than directed.

Pain medicines such as acetaminophen (Tylenol) are one option for discomfort. Follow the label, and ask a clinician or pharmacist if you have liver disease or take other medicines that contain acetaminophen. Aspirin and NSAIDs such as ibuprofen or naproxen can increase bleeding risk, so avoid them for hemorrhoid pain unless a clinician has recommended them for you.

When rectal bleeding needs a check

Bleeding from hemorrhoids is common, but bleeding is also a symptom of other digestive conditions. MedlinePlus (NIH) notes that gastrointestinal bleeding can come from anywhere along the digestive tract, and it lists causes beyond hemorrhoids. These include anal fissures, diverticular disease, inflammatory bowel disease, polyps and colorectal cancer. Colorectal cancer is much less common than hemorrhoids as a source of bright red blood, and one symptom alone does not establish it. Still, you cannot reliably tell the cause by looking, so a clinician needs to evaluate bleeding that is new, persistent or unexplained.

See a clinician soon if you notice:

• Bleeding that happens repeatedly or does not improve after about a week of home care
• A change in bowel habits, such as new constipation, diarrhea or narrower stools
• Unplanned weight loss, tiredness or signs of anemia such as paleness
• Rectal bleeding if you are older or have a family history of colorectal cancer or inflammatory bowel disease
• A painful lump that does not ease, or a prolapsed hemorrhoid that will not go back in

For a broader look at stool blood, see What Does Blood in Your Stool Mean? Belly pain with these symptoms is covered in Causes of Abdominal Pain.

Bleeding that needs emergency care

Large amounts of blood, black tarry stools, maroon or dark red blood mixed through the stool, or bleeding with dizziness, fainting, a racing heart or confusion can indicate significant blood loss from somewhere in the digestive tract. Call 911 if black tarry or maroon stools come with weakness, lightheadedness or fainting, and do not drive yourself. Without those symptoms, black tarry or maroon stools still need emergency room evaluation the same day without delay. People who take blood thinners (anticoagulants) or antiplatelet medicines should call their prescriber the same day about more than a small amount of rectal bleeding so the prescriber can decide what to do. Do not stop or change a prescribed medicine on your own.

How clinicians evaluate hemorrhoids

Clinicians combine your history, a visual exam of the anus and often a gentle rectal exam. Depending on your age, symptoms and risk factors, they may suggest anoscopy, sigmoidoscopy or colonoscopy to look for other causes of bleeding. A blood count may be checked if blood loss is a concern. Which tests are appropriate is a decision for you and your clinician.

Medical treatments when home care is not enough

Hemorrhoids that keep bleeding or prolapsing may need a procedure. Options described in the medical literature include:

• Rubber band ligation: a small band placed around an internal hemorrhoid to cut off its blood supply, done in the office.
• Sclerotherapy and coagulation methods: injections or heat, light or electrical energy used to shrink the tissue. A report on direct current electrotherapy for internal hemorrhoids describes one such approach.
• Hemorrhoidectomy: surgical removal for larger or more severe disease. Recovery can be uncomfortable, and published work discusses ways to improve comfort afterward.
• Transanal hemorrhoidal dearterialization (THD): a procedure that closes off the arteries feeding the hemorrhoids.
• Rectal artery embolization: a newer, catheter-based approach being studied for bleeding hemorrhoids, with evidence still developing.

The best choice depends on the type and size of the hemorrhoid, your symptoms and your other health conditions. Risks, recovery and the chance of recurrence differ by procedure, so discuss them with a surgeon or gastroenterologist.

Lowering the chance of flare-ups

Hemorrhoids can return. Regular fiber, fluids, movement, avoiding straining and not lingering on the toilet may reduce flare-ups. During pregnancy, constipation is common and hemorrhoids can follow, so ask your obstetric clinician which stool-softening approaches are appropriate for you.

When to Seek Medical Care