Hemorrhoids usually announce themselves with a few unmistakable signs: bright red blood on the toilet paper, itching around the anus, or a tender lump you can see or feel. About 3 to 30 percent of the population deals with them at any given time, and they account for roughly 3.3 million medical visits per year in the United States alone. The good news is that most hemorrhoids are easy to identify on your own once you know what to look for.
External Hemorrhoid Symptoms
External hemorrhoids form under the skin around the anus, so they’re the type you’re most likely to notice yourself. The hallmark signs are itching or irritation in the anal area, a feeling of discomfort or soreness, swelling you can feel with your fingers, and sometimes bleeding after a bowel movement. You may notice a small, firm lump near the opening of the anus that feels tender when you sit or wipe.
Most external hemorrhoids cause mild to moderate discomfort rather than sharp pain. If the pain suddenly becomes severe and you notice a blue or purple lump, that’s a sign a blood clot has formed inside the hemorrhoid. This is called a thrombosed hemorrhoid, and it’s the most painful version. The lump typically looks bluish-purple, feels firm, and can range from pea-sized to marble-sized. You can usually see it or feel it clearly. The intense pain from a thrombosed hemorrhoid tends to peak within the first 48 to 72 hours and then gradually eases as the clot is reabsorbed by your body.
Internal Hemorrhoid Symptoms
Internal hemorrhoids sit inside the rectum, so you can’t see or feel them in most cases. They rarely hurt because the tissue lining the inside of the rectum has few pain-sensing nerves. The main clue is painless bleeding: small amounts of bright red blood on the toilet paper, on the surface of your stool, or dripping into the toilet bowl after you go.
Internal hemorrhoids can become more obvious if they prolapse, meaning they push through the anal opening during a bowel movement. A prolapsed hemorrhoid feels like a soft, wet bump protruding from the anus. In milder cases it slides back in on its own. In more advanced cases you may need to gently push it back in, or it may stay outside permanently. Prolapsed hemorrhoids are more likely to cause pain, irritation, and mucus leakage than ones that stay inside.
Hemorrhoids vs. Anal Fissures
Because both conditions involve bleeding and discomfort around the anus, it’s easy to confuse them. The key difference is what you feel. Hemorrhoids are swollen lumps. Anal fissures are small tears in the skin of the anus. Fissures cause a sharp, cutting pain during bowel movements that can linger as a burning or stinging sensation afterward. Hemorrhoids, by contrast, tend to produce a duller ache, pressure, or itching rather than that tearing quality of pain.
If you can feel a distinct lump, that points toward a hemorrhoid. If the pain is concentrated during and right after passing stool and feels like a paper cut, a fissure is more likely. Both can bleed, and both can itch, but fissures carry a higher risk of infection if left untreated because open cuts in the skin can allow bacteria in. A perianal abscess, another condition in the same area, produces intense throbbing pain along with pus or discharge, which hemorrhoids do not.
What Causes Them
Hemorrhoids develop when the veins around the anus or inside the rectum swell under pressure. Straining during bowel movements is the most common trigger, especially if you’re constipated and pushing hard. Sitting on the toilet for long periods has the same effect because it keeps steady pressure on those veins. Chronic diarrhea can also irritate and inflame the area.
Pregnancy is a major risk factor. About 30 to 40 percent of pregnant women develop hemorrhoids, most commonly in the third trimester, when the growing uterus puts increasing pressure on the pelvic veins. Heavy lifting, obesity, and a low-fiber diet that leads to hard stools all raise the risk as well. The veins around the anus also weaken naturally with age, which is why hemorrhoids become more common as you get older.
How a Doctor Confirms the Diagnosis
A doctor can often diagnose hemorrhoids with just a medical history and a quick physical exam. For external hemorrhoids, this means visually checking the area around the anus for lumps, swelling, skin irritation, or signs of a blood clot. They’ll also look for skin tags, which are small flaps of extra skin left behind after an external hemorrhoid heals.
Internal hemorrhoids require a bit more. Your doctor will perform a digital rectal exam, using a gloved, lubricated finger to check for tenderness, blood, or swollen tissue inside the rectum. If they need a closer look, they may use an anoscope, a short, lighted tube that lets them see the lining of the anus and lower rectum directly. This takes only a few minutes and is done in the office. In some cases, a longer instrument called a proctoscope is used to examine the rectum and lower colon more thoroughly. Neither procedure requires sedation.
Internal hemorrhoids are also sometimes discovered incidentally during a colonoscopy or sigmoidoscopy performed for other reasons.
Signs That Need Medical Attention
Typical hemorrhoidal bleeding is small in volume: a few drops of bright red blood on the tissue or in the bowl. It rarely causes anemia. But rectal bleeding can also signal other conditions, so certain red flags warrant a visit to your doctor: unexplained weight loss, fever, blood that’s dark or mixed into the stool rather than sitting on the surface, a personal or family history of colon cancer, or bleeding that doesn’t improve with basic home care within a week or two.
People under 40 who have classic hemorrhoid-type bleeding and no red flag symptoms generally don’t need a colonoscopy. But if the bleeding pattern changes, becomes heavier, or is accompanied by any of those warning signs, further evaluation is important regardless of age. Severe pain from a thrombosed hemorrhoid that doesn’t start improving after a few days is also worth getting checked, since a doctor can drain the clot in the office for faster relief.
What You Can Do at Home
Most hemorrhoids improve within one to two weeks with simple self-care. Soaking in a warm bath for 10 to 15 minutes several times a day (sometimes called a sitz bath) relieves pain and reduces swelling. Over-the-counter creams and suppositories containing hydrocortisone or witch hazel can ease itching and irritation. Applying a cold pack wrapped in a cloth for short intervals helps with swelling.
The most effective long-term strategy is softening your stools so you don’t strain. That means eating more fiber (fruits, vegetables, whole grains, or a fiber supplement), drinking plenty of water, and not ignoring the urge to go. Delaying bowel movements makes stools harder and straining worse. Keeping bathroom visits short helps too. Scrolling your phone on the toilet keeps pressure on those veins far longer than necessary.