What are hemorrhoids? A Doctor-Reviewed Answer

Hemorrhoids are swollen veins in the lower rectum or around the anus. They are common and often improve with fiber, fluids, bowel habit changes, and medical treatment when needed.

Overview: what are hemorrhoids?

What are hemorrhoids? Hemorrhoids are swollen veins in the lower rectum or around the anus, similar in concept to varicose veins in other parts of the body. They can develop inside the rectum, where they are called internal hemorrhoids, or under the skin around the anus, where they are called external hemorrhoids.

Hemorrhoids are very common and do not always cause symptoms. When symptoms do appear, they may include bright red blood on toilet paper, itching, irritation, soreness, swelling, or a feeling that something is bulging or not fully emptying after a bowel movement.

A helpful way to understand hemorrhoids is to think of them as a problem of pressure and irritation rather than a dangerous disease in most cases. They often flare when bowel movements are hard to pass or when a person strains repeatedly, but they can usually be managed successfully with lifestyle changes and, if necessary, medical care.

How hemorrhoids feel and the different types

The symptoms of hemorrhoids depend on where they are located. Internal hemorrhoids are inside the rectum and may not be felt at all. They most often cause painless bright red bleeding during or after a bowel movement. Sometimes an internal hemorrhoid can prolapse, meaning it bulges through the anal opening, which may cause discomfort, mucus, or a sensation of pressure.

External hemorrhoids form under the skin around the anus. These are more likely to cause itching, tenderness, swelling, and pain, especially when sitting or cleaning the area. If a blood clot forms inside an external hemorrhoid, it is called a thrombosed hemorrhoid. This can cause sudden, more intense pain and a firm lump near the anus.

Not every anal or rectal symptom is caused by hemorrhoids. Conditions such as anal fissure, skin irritation, inflammation, or other anorectal disorders can cause similar discomfort. That is one reason symptoms should be assessed in context rather than self-diagnosed based on bleeding alone.

• Internal hemorrhoids: usually painless bleeding, sometimes prolapse or pressure
• External hemorrhoids: itching, swelling, discomfort, tenderness
• Thrombosed external hemorrhoids: sudden pain and a firm bluish or purple lump

Why hemorrhoids happen: causes and risk factors

Hemorrhoids develop when pressure in the veins of the lower rectum and anus increases. Repeated straining during bowel movements is a common trigger. Constipation, hard stools, and sitting on the toilet for long periods can all raise pressure in this area. Chronic diarrhea can also irritate tissues and contribute to symptoms.

Diet and daily habits matter. A low-fiber diet may lead to harder stools and more straining. Not drinking enough fluids can have a similar effect. Long periods of sitting, reduced physical activity, and obesity may increase the likelihood of hemorrhoids in some people.

Pregnancy is another common risk factor because the growing uterus increases pressure in the pelvis and constipation may become more common. Aging can also play a role because the supporting tissues in the anal canal may weaken over time. Some people have recurrent symptoms because of a combination of bowel habits, anatomy, and repeated irritation rather than one single cause.

How doctors diagnose hemorrhoids

Doctors usually diagnose hemorrhoids by asking about symptoms and examining the anal and rectal area. This often begins with a medical history that covers bleeding, pain, bowel habits, constipation, pregnancy, medications, and any personal or family history of intestinal disease. The exact pattern of symptoms can help distinguish hemorrhoids from other causes of rectal problems.

The physical exam may include inspection of the area around the anus and a digital rectal examination. Internal hemorrhoids may require a small lighted instrument called an anoscope to view the anal canal. If there is rectal bleeding, a doctor may recommend additional evaluation depending on a person’s age, risk factors, and whether the bleeding pattern is typical for hemorrhoids.

This step is important because rectal bleeding can sometimes be caused by conditions other than hemorrhoids, including inflammation, polyps, or colon cancer. In some cases, testing such as colonoscopy may be advised to rule out other causes and make sure the correct condition is being treated.

Treatment options for hemorrhoids

Treatment depends on the severity of symptoms and whether hemorrhoids are internal, external, or thrombosed. Many people improve with simple measures that reduce straining and irritation. Increasing dietary fiber, drinking enough water, using warm sitz baths, and avoiding prolonged sitting on the toilet can help symptoms settle over time.

Doctors may also recommend short-term use of topical treatments or stool-softening strategies, depending on the situation. These approaches may ease discomfort, but lasting improvement usually comes from making bowel movements softer and easier to pass. Painful thrombosed external hemorrhoids may sometimes need a timely office procedure to remove the clot if symptoms are severe and recent.

When symptoms continue despite self-care, office-based treatments may be considered. These can include procedures such as rubber band ligation for selected internal hemorrhoids, which cuts off blood supply so the tissue shrinks. More advanced or recurrent cases may need surgery, including hemorrhoidectomy, especially when prolapse, repeated bleeding, or significant pain affects daily life.

Prevention and self-care that can make a real difference

Preventing hemorrhoid flare-ups often means reducing strain during bowel movements. A fiber-rich eating pattern with fruits, vegetables, legumes, and whole grains can help stools stay soft and bulky. Some people also benefit from a fiber supplement if they do not meet fiber needs through food. Fluids are important because fiber works best when the body is well hydrated.

Bowel habits matter as much as diet. Going to the bathroom when the urge appears can help avoid hard stools that form when stool remains in the colon too long. It is also helpful to avoid reading or using a phone on the toilet, since sitting there for extended periods can increase pressure on anal veins.

Gentle exercise supports regular bowel movements and may reduce constipation. For symptom relief during a flare, warm water soaks, careful cleaning with soft unscented materials, and avoiding excessive rubbing may reduce irritation. If symptoms keep returning, a doctor can help identify the pattern and rule out other conditions that may mimic hemorrhoids.

When to seek medical care

Medical care is important if there is rectal bleeding, even if hemorrhoids seem likely. Bright red blood is often caused by hemorrhoids, but bleeding should not be assumed to be harmless without proper assessment, especially if it is new, persistent, heavy, or accompanied by changes in bowel habits.

A person should also seek care for severe pain, a painful lump near the anus, fever, drainage, dizziness, black stools, or symptoms that do not improve with self-care. These features can suggest a thrombosed hemorrhoid or another condition that needs prompt attention.

If there is ongoing prolapse, recurrent bleeding, or uncertainty about the diagnosis, specialist evaluation may be recommended. Near the end of the care pathway, patients may be reassured to know that Acibadem International’s multidisciplinary specialists in JCI-accredited hospitals diagnose and treat hemorrhoids and related colorectal conditions for international patients.

Frequently asked questions

Are hemorrhoids serious?

Hemorrhoids are usually not serious, although they can be uncomfortable and disruptive. The main concern is that rectal bleeding or anal pain can also happen with other conditions, so symptoms sometimes need medical evaluation.

Do hemorrhoids go away on their own?

Mild hemorrhoids often improve with self-care, especially if bowel movements become softer and straining is reduced. Even when symptoms settle, flare-ups can return if constipation, prolonged toilet sitting, or other triggers continue.

What is the difference between internal and external hemorrhoids?

Internal hemorrhoids are inside the rectum and commonly cause painless bleeding. External hemorrhoids are under the skin around the anus and are more likely to cause itching, swelling, tenderness, or pain.

Can hemorrhoids cause bleeding without pain?

Yes. Internal hemorrhoids often cause bright red bleeding during or after a bowel movement without much pain. However, any rectal bleeding should be discussed with a doctor if it is new, recurrent, or unexplained.

What makes hemorrhoids worse?

Straining, constipation, hard stools, sitting on the toilet for a long time, dehydration, and a low-fiber diet can make hemorrhoids worse. Pregnancy and prolonged sitting may also increase pressure in the area and contribute to symptoms.

When is surgery needed for hemorrhoids?

Surgery is usually considered when symptoms are severe, recurrent, prolapsing, or not improving with lifestyle measures and office treatments. A colorectal specialist can explain whether a procedure is appropriate based on the type of hemorrhoid and the person's symptoms.

References

• National Institute of Diabetes and Digestive and Kidney Diseases
• American Society of Colon and Rectal Surgeons
• Mayo Clinic
• National Health Service
• MedlinePlus

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.