Causes
Hemorrhoids develop when pressure in the veins of the lower rectum increases. Contributing factors include:- Straining during bowel movements: The single most common cause, usually related to constipation and hard stools.
- Chronic constipation or diarrhea: Both irritate and pressurize the anal veins; ongoing diarrhea can occur with conditions such as irritable bowel syndrome.
- Prolonged sitting on the toilet: Long periods of sitting, including scrolling on a phone in the bathroom, allow the veins to swell.
- Low-fiber diet: Leads to harder stools and more straining.
- Pregnancy: The growing uterus and hormonal changes increase pressure on pelvic veins.
- Heavy lifting and obesity: Both raise pressure inside the abdomen.
- Aging: Supporting tissues in the rectum and anus naturally weaken over time.
Symptoms
Symptoms depend on whether the hemorrhoids are internal (inside the rectum) or external (under the skin around the anus):- Painless bright red bleeding: The hallmark of internal hemorrhoids — blood on the toilet paper, in the bowl, or coating the stool.
- Prolapse: An internal hemorrhoid may bulge through the anus during a bowel movement and then recede or need to be pushed back.
- Itching and irritation: Common around the anus, especially with external hemorrhoids.
- Pain and swelling: A sudden, tender lump can form if blood clots inside an external hemorrhoid (a thrombosed hemorrhoid), which can be quite painful for several days.
- Mucus and leakage: Prolapsed hemorrhoids can cause mucus discharge and make hygiene difficult, leading to further skin irritation.
Diagnosis
A doctor can usually diagnose hemorrhoids with a visual and digital rectal examination, sometimes using a small lighted scope (anoscope) to see internal hemorrhoids. Importantly, rectal bleeding should never simply be assumed to be hemorrhoids — depending on your age and risk factors, a colonoscopy may be recommended to rule out other causes of bleeding such as colon polyps or inflammatory conditions like ulcerative colitis. Chronic slow blood loss can occasionally cause iron-deficiency anemia, which is another reason persistent bleeding deserves a complete evaluation rather than reassurance alone.Treatment
Most hemorrhoids improve with conservative care:- Fiber and fluids: Softer, bulkier stools eliminate straining, which allows hemorrhoids to shrink and helps prevent new ones.
- Fiber supplements and stool softeners: Psyllium or methylcellulose supplements, and a stool softener such as docusate when needed, keep stools soft while the area heals.
- Good toilet habits: Avoid delaying the urge, limit time on the toilet, and do not strain.
- Sitz baths: Soaking the area in warm water several times a day relieves irritation and spasm.
- Topical treatments: Short courses of over-the-counter creams, ointments, or witch hazel pads can ease itching and discomfort.
- Office procedures: Persistent internal hemorrhoids often respond to rubber band ligation, sclerotherapy, or infrared coagulation — quick outpatient procedures that cut off the hemorrhoid's blood supply.
- Surgery: Reserved for large, prolapsing, or repeatedly thrombosed hemorrhoids that fail other measures.
When to Seek Care
See a doctor promptly for heavy or persistent rectal bleeding, bleeding with lightheadedness or weakness, severe pain, or a change in bowel habits. New rectal bleeding always deserves evaluation, even if you have had hemorrhoids before. Hemorrhoids are a common, fixable problem — there is no need to live with them or feel embarrassed about seeking help. Schedule a visit with Zimmer Medical Group for an evaluation and a treatment plan that brings lasting relief.Getting Hemorrhoids to Settle, and Keeping Them Settled
Most hemorrhoids resolve with a few weeks of consistent care, and most that come back do so because the habit that caused them returned. The details below are what make conservative treatment work, and how to tell hemorrhoids from the conditions that imitate them.
Fiber has to be taken every day, with water
A fiber supplement works by holding water in the stool, so it fails when taken without a full glass and when skipped on good days. The goal is a soft stool that passes without effort rather than a particular number of bowel movements. When fiber alone is not enough, an osmotic laxative such as polyethylene glycol is safe for long-term daily use and does not cause dependence. Our constipation beyond fiber and water article covers what to do when the basics stall, and the chronic constipation page explains the conditions that keep stools hard.
Creams are for a week or two, not for months
A hydrocortisone cream or suppository calms itching and swelling, but using it beyond about a week thins the delicate skin around the anus and makes irritation worse. Witch hazel pads, a barrier ointment, and gentle cleaning with water rather than dry paper do most of the ongoing work. Symptoms that persist after two weeks of home care are a reason for an examination rather than another tube.
A thrombosed hemorrhoid is a timing question
A sudden, hard, painful lump at the anal opening is a clot in an external hemorrhoid. Seen within the first two or three days, a small office procedure to remove the clot brings quick relief; after that, the clot is already dissolving and the pain eases on its own over a week or two with sitz baths. It is not dangerous either way, but the timing decides which approach helps.
What hemorrhoids are confused with
Sharp pain during and after a bowel movement, rather than painless bleeding, usually means an anal fissure, which needs a different treatment; our hemorrhoids versus anal fissure article walks through the difference. Bleeding mixed into the stool, dark blood, a change in bowel habit, or new bleeding after age 45 is investigated for colon polyps and cancer before it is attributed to hemorrhoids, and bloody diarrhea is checked for ulcerative colitis. Our colon cancer screening options guide explains the tests. Slow blood loss over months can produce anemia, which is why tiredness alongside bleeding is checked with a blood count.
Banding, and what comes after
Rubber band ligation takes minutes in the office, treats one or two hemorrhoids at a time, and causes a dull ache for a day or two; heavier bleeding about a week later, when the band falls off, is uncommon but is a reason to call. Mention any blood thinner before a procedure. Whatever the treatment, hemorrhoids return in the same conditions that produced them, which is why the fiber and the toilet habits continue afterward. Our gastrointestinal team coordinates evaluation and referral when a procedure is needed. The NIDDK and MedlinePlus publish patient guidance on treatment.
If rectal bleeding has not stopped after two weeks of home care, or you have never had it evaluated, schedule a visit.