Hemorrhoids

Hemorrhoids are swollen veins in the lowest part of the rectum and anus, similar to varicose veins elsewhere in the body — extremely common, with most adults experiencing them at some point in life.

Symptoms

Depending on the type, symptoms include itching, discomfort or pain around the anus, a visible or palpable lump, and bright red blood on toilet paper or in the toilet bowl, usually associated with a bowel movement.

Internal vs. External

Internal hemorrhoids develop inside the rectum and are usually painless, though they can bleed or, if severely enlarged, prolapse (protrude) outside the anus. External hemorrhoids develop under the skin around the anus and tend to be more noticeably itchy or painful, especially if a blood clot forms within them (a thrombosed hemorrhoid).

What Causes Them

Straining during bowel movements, chronic constipation or diarrhea, prolonged sitting (including on the toilet), pregnancy, and a low-fiber diet are the most common contributing factors, all related to increased pressure on the veins in this area.

Treatment

Most cases improve with simple measures: increasing fiber and fluid intake to soften stool, avoiding straining, warm sitz baths, and over-the-counter creams or suppositories for symptom relief. For persistent or more severe cases, in-office procedures (such as rubber band ligation) or, rarely, surgery may be considered. A thrombosed external hemorrhoid that's acutely painful is a bit different — seeing a doctor promptly, ideally within about 72 hours of the pain starting, matters because in-office removal of the clot tends to relieve pain faster during that early window, whereas after a few days conservative treatment is usually recommended instead. A thrombosed external hemorrhoid that's acutely painful is a bit different — seeing a doctor promptly, ideally within about 72 hours of the pain starting, matters because in-office removal of the clot tends to relieve pain faster during that early window, whereas after a few days conservative treatment is usually recommended instead.

When to See a Doctor

See a doctor for rectal bleeding to confirm it's from hemorrhoids and not another cause, or for hemorrhoids that don't improve with home treatment, are severely painful, or prolapse and don't go back in.