You’re feeling pain or maybe even a new lump near your anus where poop comes out. Maybe you’ve noticed bright red blood in the toilet or on the toilet paper. You’re wondering if you have a hemorrhoid, and if so, what may have caused it.
Here’s the thing: everyone has hemorrhoids. Most of the time, hemorrhoids don’t cause symptoms. But some hemorrhoids can get irritated, which can cause swelling, pain and bleeding. Hemorrhoids get more common as you get older – about half of people over the age of 50 have inflamed hemorrhoids.
Over-the-counter medications, self-care and lifestyle changes are often enough to find relief from hemorrhoid symptoms. But there are times when you should talk to a primary care doctor about them – especially if they’re bleeding or painful.
Read on to learn about the types of hemorrhoids, causes, treatments, and how to prevent hemorrhoid symptoms or keep them from coming back.
Signs and symptoms of hemorrhoids | Causes of hemorrhoids | Treatments for hemorrhoids | Preventing hemorrhoids | When to see a doctor
What are hemorrhoids exactly?
Hemorrhoids are swollen blood vessels on your bottom. In other countries they can also be called piles. You can have them inside your anus and outside your anus opening.
How long hemorrhoids last
Sometimes hemorrhoid symptoms clear up in just a few days. But you can also have hemorrhoids that stay irritated for a long time, with regular flare-ups.
Signs of a hemorrhoid
Hemorrhoids can be hard to spot if they aren’t external. Most of the time they are on the inside of your body. Often, your symptoms are the only clue to whether or not you have hemorrhoids.
What hemorrhoids look like and what hemorrhoids feel like really depends on the type you have.
Types of hemorrhoids and their symptoms
You can have external or internal hemorrhoids, or thrombosed hemorrhoids where blood forms a clot. Learn more about these types of hemorrhoids and their symptoms:
External hemorrhoid symptoms
External hemorrhoids develop under the skin around your anus.
- What external hemorrhoids look like: External hemorrhoids look like small blue or red bumps or lumps around the anal opening.
- What external hemorrhoids feel like: External hemorrhoids feel soft when you touch them.
Internal hemorrhoid symptoms
You have internal hemorrhoids on the inside of your anus.
- What internal hemorrhoids look like: They can’t be seen unless they pop out (prolapse) through the anal opening. You may also notice bleeding from internal hemorrhoids.
- What internal hemorrhoids feel like: Internal hemorrhoids don’t usually cause symptoms you can feel.
A thrombosed hemorrhoid is when blood fills a hemorrhoid, forming a clot (thrombus). These blood clots often form quickly. They are usually reabsorbed back into the body, but sometimes they can break open. Clots are more likely to form in external hemorrhoids, but they form in internal hemorrhoids, too. External hemorrhoids with blood clots can be painful and often need treatment.
- What thrombosed hemorrhoids look like: Depending on your skin tone, a thrombosed external hemorrhoid can look blue or purple. You may have a single lump or a circle of bumps. Blood from a thrombosed hemorrhoid is usually dark and clotted.
- What thrombosed hemorrhoids feel like: Thrombosed hemorrhoids are firm and hard instead of soft. They can be extremely painful, both before and after they rupture.
Most causes of hemorrhoids have one thing in common: Pressure
There are many possible causes of hemorrhoids, but they are usually affected by activities, habits and medical conditions that put added pressure on the anus and rectum (the part of your intestines that connects to your anus). But irritation of hemorrhoidal tissue can also cause symptomatic hemorrhoids. You may also be more likely to have hemorrhoid problems if others in your family have them.
Chronic constipation and diarrhea
Occasional constipation and diarrhea likely won’t result in hemorrhoids. But if you’re experiencing these conditions on a frequent and ongoing basis, it’s possible that they could increase your chance of getting them.
- Chronic constipation – Straining to move stool increases the pressure in your anus and rectum, making it more likely that hemorrhoids will bulge and bleed.
- Chronic diarrhea – If you have chronic diarrhea, it can irritate hemorrhoids, causing them to bleed and burn.
Chronic constipation and diarrhea could be due to underlying conditions, so check with your doctor to be sure. Depending on the frequency and severity of your symptoms, they may refer you to a digestive health specialist
Hemorrhoids from pregnancy or birth
Swollen hemorrhoids are common during pregnancy. A main reason is that your enlarged uterus is increasing the pressure on your rectum and anus. But hormonal changes during pregnancy also make hemorrhoids more likely since they can weaken the muscles around your bottom, increasing the chance of constipation. Postpartum hemorrhoids are usually hemorrhoids that have continued from pregnancy or that were caused by childbirth.
Lifestyle factors that can cause hemorrhoids
Spending a lot of time on the toilet
Spending long stretches on the toilet can make it more likely that you’ll get hemorrhoids. That’s because when you sit on a toilet seat, it can cause blood to pool in hemorrhoid blood vessels – so don’t linger on the toilet. You can finish reading the newspaper or scrolling on your phone after you’re out of the bathroom.
Regularly lifting heavy objects
When you lift or move heavy objects (like weights or boxes), it’s common to hold your breath and strain. This can force down the air in your lungs, increasing pressure on your internal organs. The added pressure can also cause hemorrhoid blood vessels to swell and push outward.
People who are very overweight are more likely to have hemorrhoids. Part of the reason is the excess body weight that increases the pressure on blood vessels surrounding the anus and rectum.
People who are very overweight may also have lifestyle factors that make hemorrhoids more likely – such as a low-fiber diet and a sedentary lifestyle that includes lots of sitting and low levels of activity.
Anal intercourse can irritate hemorrhoids causing symptoms like bleeding and discomfort. If you have symptoms from hemorrhoids, it may be a good idea to hold off on anal sex until your symptoms go away.
Regardless of the type of hemorrhoids you have – whether internal, external or thrombosed – if they’re causing you painful or bothersome symptoms, there are a range of treatments available.
Often, your symptoms will go away with home remedies such as medications and self-care. But if they don’t, there are medical treatments that can help.
Medications for hemorrhoids
You may be able to find relief from your hemorrhoid symptoms using over-the-counter medications such as hemorrhoid creams, pads and wipes.
The best products for hemorrhoids usually contain one or more of the following ingredients: lidocaine, witch hazel, hydrocortisone or zinc oxide. What works best may depend on which symptoms are most bothersome.
- Painful hemorrhoids – Topical pain relievers like lidocaine numb the area to provide temporary pain relief. It’s easy to find creams that are 5% lidocaine. But other types of hemorrhoid creams also include lidocaine.
- Inflamed hemorrhoids – Zinc oxide and witch hazel are ingredients that can help soothe and protect skin as it heals – while also reduce itching and swelling. Anusol Plus is a popular zinc oxide cream that also includes a topical pain reliever to numb the area. Tucks Medicated Cooling Pads with witch hazel are a great choice to provide immediate relief from burning and itching.
- Itchy skin near hemorrhoids – While hemorrhoids generally aren’t itchy, the surrounding skin can be. If itchiness is a problem, ask your doctor about ways to soothe your skin.
You can also use oral pain medication such as ibuprofen (like Advil), acetaminophen (like Tylenol) or aspirin to provide temporary hemorrhoid relief if they are painful.
There are also ways to soothe your hemorrhoids without medicines.
Sitz bath for hemorrhoids
A sitz bath is a warm, shallow bath of water. Sitting in warm water can relieve the pain, burning and itching caused by hemorrhoids. The warm water helps relax the muscles in the anal region and improve blood circulation to the area, reducing your symptoms and helping you heal. Sitz baths are also recommended during postpartum recovery after a vaginal labor and delivery.
To take a sitz bath, fill a bathtub with about 4 inches of warm water and soak your bottom for about 20 minutes, a few times a day. There are also sitz baths for toilets, small plastic tubs that fit inside the seat, that you can buy at retail stores and online.
Unless a doctor tells you otherwise, don’t add salt or anything else to the water. It’s possible that these substances might make your symptoms worse.
Ice packs for hemorrhoids
Ice packs can help with swelling and pain from hemorrhoids. Here’s what to do:
- Put an ice pack on a flat surface and cover it with a thin cloth (you should never apply ice directly to your skin).
- Sit on it for about 10 minutes.
- Repeat throughout the day for relief from your hemorrhoid symptoms.
Skip the hemorrhoid cushions
You may have heard about donut cushions or other hemorrhoid pillows. These cushions are open in the center, which means that the center part of your butt is unsupported. Using these cushions may provide temporary relief from your symptoms, but they can make hemorrhoids worse.
A better option can be to sit on something soft – a couch or bed – and lean backwards to take pressure off the area that hurts. Getting up and moving around may also help with your symptoms.
Procedures for hemorrhoids
If you have hemorrhoids that are causing bothersome symptoms or don’t go away, your doctor may refer you to a colorectal surgeon.
Rubber band ligation for bleeding internal hemorrhoids
This procedure involves putting small rubber bands around the base of an internal hemorrhoid. This cuts off the blood supply to the hemorrhoid and helps reduce bleeding.
Surgery to remove external or internal hemorrhoids
Surgery to remove hemorrhoids is pretty rare. But it may be an option when other treatments haven’t worked, your hemorrhoids are large or severe, or if they keep coming back in the same place.
How to prevent hemorrhoids: It starts with softer stool
Making changes to what you eat and do is the best way to improve digestion and prevent symptomatic hemorrhoids. When you have healthy poop, it glides through your digestive system and comes out easily – which means less pressure on your anus and rectum.
Don’t hold it
If you occasionally hold in your poop for an hour or two, it’s probably okay. But if you frequently skip bowel movements, your stool can dry out inside you, making it harder to pass. This can lead to constipation and possibly other complications. Most people should have a bowel movement at least three times a week. If you’re pooping less often, it’s a good idea to talk to a doctor.
Don’t push too hard when pooping
While the goal is to avoid constipation, there are certain times when you get backed up – and you just want to get the poop out right away. Here are tips that can help you get your stool out safely:
- Position your body – Start by sitting up straight on the toilet. It can also help if your knees are higher than your hips, so try lifting your heels or using a footstool.
- Brace yourself – Keeping your back straight, lean forward and rest your forearms on your knees. This allows your stomach muscles to push forward.
- Push then pause – While pushing, keep your mouth slightly open and breathe out. Don’t hold your breath. When pushing becomes difficult, pause briefly before repeating the brace.
- A big finish – To finish up, pull up on the muscles that close your bottom. This helps with overall bowel control.
Eat a balanced, fiber-rich diet
If you’re not eating enough fiber, it takes longer for your food to travel through your system – and the digestive process (and your stool) is harder.
A colon-healthy diet should include 20-30 grams of fiber each day. Fruits, veggies and whole grains are all good sources of natural fiber. But if you’re having a hard time getting enough fiber from your foods, consider adding a supplement. Studies show that over-the-counter fiber supplements (like Metamucil and Citrucel) relieve constipation and improve hemorrhoid symptoms such as bleeding.
However, it's best to slowly increase the amount of fiber into your diet – too much fiber too fast can lead to uncomfortable gas.
Drink lots of fluids
If you have hemorrhoids, it’s good to drink at least 6-8 glasses of fluids a day – and alcoholic beverages don’t count. It’s especially important to get enough fluids if you’re taking a fiber supplement. These products need water to bulk up your stool. If you don’t drink enough, you may actually make your constipation worse.
Sitting increases the pressure on the veins in your anus – this is especially true about sitting on the toilet. So avoid long periods of sitting, even moving around for a few minutes every hour can make a difference.
Get regular exercise
The benefits of exercise are virtually endless, so it’s probably no surprise that exercise will help with hemorrhoids too. Exercise helps prevent constipation and may help you get rid of any extra weight which could be making hemorrhoids worse.
So which exercises are best for hemorrhoids? Walking and yoga are great ways to get your body (and your stool) moving. And stretches that strengthen the muscles in your butt or pelvis can be especially helpful. An easy stretch you can do anytime (and anywhere) is a pelvic floor contraction.
How to do pelvic floor contractions (Kegel exercises)
- Contract your sphincter muscles – While sitting down, contract your anal sphincter as if you were trying to keep from passing gas. Hold for five seconds.
- Rest – Wait for 10 seconds.
- Repeat – Contract and rest your muscles five more times. Then, do 2-4 more sets of these stretches throughout the day. You can also try doing a series of quick contractions.
Not all exercises are appropriate if you have hemorrhoids. Exercises like weightlifting, squats, sit-ups and rowing can put too much pressure on your anorectal muscles. And activities like cycling and horseback riding can be uncomfortable if you have external hemorrhoids.
When to see a doctor about hemorrhoids symptoms
Hemorrhoids usually aren’t anything to worry about. Contact a primary care doctor if your hemorrhoids don’t get better after a week or you’re seeing blood in the toilet, in your poop or on your toilet paper. If necessary, your doctor can refer you to a colorectal surgeon or a digestive health specialist for more advanced care.
Rectal bleeding can also be a sign of more serious conditions. And there are rare complications of hemorrhoids, including infections and anemia. So go to urgent care if you’re seeing a lot of blood in the toilet. Call 911 if you see signs of shock such as weakness, dizziness or fast breathing.