Overview

Hemorrhoids (HEM-uh-roids), also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).

Nearly three out of four adults will have hemorrhoids from time to time. Hemorrhoids have a number of causes, but often the cause is unknown.

Fortunately, effective options are available to treat hemorrhoids. Many people get relief with home treatments and lifestyle changes.

Symptoms

Signs and symptoms of hemorrhoids usually depend on the type of hemorrhoid.

External hemorrhoids

These are under the skin around your anus. Signs and symptoms might include:

  • Itching or irritation in your anal region
  • Pain or discomfort
  • Swelling around your anus
  • Bleeding

Internal hemorrhoids

Internal hemorrhoids lie inside the rectum. You usually can't see or feel them, and they rarely cause discomfort. But straining or irritation when passing stool can cause:

  • Painless bleeding during bowel movements. You might notice small amounts of bright red blood on your toilet tissue or in the toilet.
  • A hemorrhoid to push through the anal opening (prolapsed or protruding hemorrhoid), resulting in pain and irritation.

Thrombosed hemorrhoids

If blood pools in an external hemorrhoid and forms a clot (thrombus), it can result in:

  • Severe pain
  • Swelling
  • Inflammation
  • A hard lump near your anus

When to see a doctor

If you have bleeding during bowel movements or you have hemorrhoids that don't improve after a week of home care, talk to your doctor.

Don't assume rectal bleeding is due to hemorrhoids, especially if you have changes in bowel habits or if your stools change in color or consistency. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer.

Seek emergency care if you have large amounts of rectal bleeding, lightheadedness, dizziness or faintness.

Causes

The veins around your anus tend to stretch under pressure and may bulge or swell. Hemorrhoids can develop from increased pressure in the lower rectum due to:

  • Straining during bowel movements
  • Sitting for long periods of time on the toilet
  • Having chronic diarrhea or constipation
  • Being obese
  • Being pregnant
  • Having anal intercourse
  • Eating a low-fiber diet
  • Regular heavy lifting

Risk factors

As you age, your risk of hemorrhoids increases. That's because the tissues that support the veins in your rectum and anus can weaken and stretch. This can also happen when you're pregnant, because the baby's weight puts pressure on the anal region.

Complications

Complications of hemorrhoids are rare but include:

  • Anemia. Rarely, chronic blood loss from hemorrhoids may cause anemia, in which you don't have enough healthy red blood cells to carry oxygen to your cells.
  • Strangulated hemorrhoid. If the blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be "strangulated," which can cause extreme pain.
  • Blood clot. Occasionally, a clot can form in a hemorrhoid (thrombosed hemorrhoid). Although not dangerous, it can be extremely painful and sometimes needs to be lanced and drained.

Prevention

The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:

  • Eat high-fiber foods. Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can cause hemorrhoids. Add fiber to your diet slowly to avoid problems with gas.
  • Drink plenty of fluids. Drink six to eight glasses of water and other liquids (not alcohol) each day to help keep stools soft.
  • Consider fiber supplements. Most people don't get enough of the recommended amount of fiber — 20 to 30 grams a day — in their diet. Studies have shown that over-the-counter fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), improve overall symptoms and bleeding from hemorrhoids.

    If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause or worsen constipation.

  • Don't strain. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.
  • Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could dry out and be harder to pass.
  • Exercise. Stay active to help prevent constipation and to reduce pressure on veins, which can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that might be contributing to your hemorrhoids.
  • Avoid long periods of sitting. Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.

Hemorrhoids care at Mayo Clinic

July 03, 2019
References
  1. Davis BR, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Diseases of the Colon and Rectum. 2018;61:284.
  2. Definition & facts of hemorrhoids. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/symptoms-causes. Accessed May 25, 2019.
  3. What are hemorrhoids? The American Society of Colon and Rectal Surgeons. https://www.fascrs.org/patients/disease-condition/hemorrhoids-expanded-version. Accessed May 25, 2019.
  4. Kellerman RD, et al. Hemorrhoids, anal fissure, and anorectal abscess and fistula. In: Conn's Current Therapy 2019. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Accessed May 25, 2019.
  5. Bleday R, et al. Home and office treatment of symptomatic hemorrhoids. https://www.uptodate.com/contents/search. Accessed May 25, 2019.
  6. Brown AY. AllScripts EPSi. Rochester, Minn. April 16, 2019.

Related

News from Mayo Clinic

Products & Services