Hemorrhoids are swollen, enlarged blood vessels in and around the lower rectum and anus. They’re actually a normal part of your body’s anatomy. Everyone has hemorrhoidal tissue, which consists of vascular cushions that help your anal sphincter close properly and help you distinguish between gas, liquid, and solid stool. The word “hemorrhoids” in everyday use typically refers to hemorrhoidal disease, meaning these cushions have become swollen, irritated, or inflamed enough to cause symptoms like bleeding, itching, or pain.
What Hemorrhoids Actually Are
The tissue that becomes problematic sits in a ring around the inside of your anal canal. These vascular cushions are rich in blood vessels, and when pressure builds in the area, they can stretch and bulge. Think of them like varicose veins, but in your rectum instead of your legs.
The key dividing line is a small ridge inside your anal canal called the dentate line. This boundary determines the two main types. Internal hemorrhoids form above the dentate line, deeper inside the rectum. External hemorrhoids form below it, near the opening of the anus. The distinction matters because the nerve supply is different on each side of that line, which changes how each type feels.
Internal vs. External Hemorrhoids
Internal hemorrhoids sit inside the rectum where there are fewer pain-sensing nerves. They usually don’t hurt. You may not even know you have them unless they bleed, which shows up as bright red blood on toilet paper, in the bowl, or on the surface of your stool. Internal hemorrhoids can, however, push through the anal opening (a condition called prolapse), and that’s when they start causing discomfort.
Doctors grade internal hemorrhoids on a four-point scale based on how much they’ve prolapsed:
- Grade I: Swollen but stays inside the canal. No prolapse.
- Grade II: Pushes out during a bowel movement but slides back in on its own.
- Grade III: Pushes out and needs to be manually pushed back in. Often causes itching and soiling.
- Grade IV: Permanently prolapsed and can’t be pushed back in.
External hemorrhoids form under the skin around the anus, where pain-sensing nerves are plentiful. They tend to itch, ache, and feel tender, especially when you sit. You can often feel them as hard, sore lumps near the anal opening. Sometimes a blood clot forms inside an external hemorrhoid (called a thrombosed hemorrhoid), which causes sudden, severe pain and a firm purple or blue lump. Thrombosed hemorrhoids are intensely painful but not dangerous.
Common Causes
Anything that increases pressure in the veins of your lower rectum can trigger hemorrhoidal swelling. The most common culprit is straining during bowel movements. Holding your breath and bearing down creates a surge of pressure that stretches those vascular cushions over time. Chronic constipation and chronic diarrhea both contribute, for different reasons: constipation means harder stool and more straining, while prolonged diarrhea irritates the anal lining.
Sitting for long periods, especially on the toilet, keeps steady pressure on those veins. Scrolling your phone on the toilet for 20 minutes is genuinely a risk factor. Other contributors include obesity, pregnancy (which puts significant pressure on pelvic veins), regularly lifting heavy objects, a low-fiber diet, and anal intercourse.
How Hemorrhoids Feel
Symptoms depend on the type. With internal hemorrhoids, the most common sign is painless bleeding. You notice bright red blood when you wipe or dripping into the toilet. There’s no pain unless the hemorrhoid has prolapsed, in which case you might feel a soft, moist bulge protruding from the anus.
External hemorrhoids are harder to ignore. You’ll likely feel itching, soreness, or a persistent ache around the anus that gets worse when sitting. Wiping can be painful and may produce small amounts of blood. If a clot forms, the pain ramps up quickly and the area becomes swollen and inflamed.
Managing Symptoms at Home
Most hemorrhoids improve with simple changes. The single most important one is getting enough fiber. Fiber softens your stool so you don’t need to strain. The recommended daily intake is about 14 grams for every 1,000 calories you eat, which works out to roughly 28 grams a day on a standard diet. Good sources include beans, whole grains, fruits, and vegetables. If you can’t get enough through food, a fiber supplement works too. Increase your intake gradually to avoid gas and bloating, and drink plenty of water alongside it.
Warm baths (sometimes called sitz baths) can relieve pain and itching. Sitting in a few inches of warm water for 10 to 15 minutes, especially after a bowel movement, helps relax the muscles and reduce swelling. Over-the-counter creams and suppositories containing witch hazel or hydrocortisone can also provide short-term relief from itching and discomfort.
Beyond that, a few behavioral changes make a real difference: don’t sit on the toilet longer than necessary, don’t strain or hold your breath during bowel movements, and stay physically active to keep your digestive system moving.
When Home Care Isn’t Enough
If symptoms persist after a few weeks of home management, or if bleeding is frequent, there are office-based procedures that can help. The most common is rubber band ligation, where a small band is placed around the base of an internal hemorrhoid to cut off its blood supply. The procedure takes less than five minutes, requires no anesthesia, and you can return to normal activities the same day (though you should avoid heavy lifting for about two weeks). The hemorrhoid shrivels and falls off within a week.
For more advanced cases, particularly grade III or IV internal hemorrhoids that don’t respond to banding, surgical removal is an option. Recovery from surgery takes longer, but it has the highest success rate for severe hemorrhoidal disease.
Hemorrhoids vs. Something More Serious
Rectal bleeding is the symptom that worries people most, and it should prompt attention, especially if it’s new. Hemorrhoids produce bright red blood, typically only during or right after a bowel movement. Colon cancer can also cause rectal bleeding, but the blood tends to be darker and more persistent.
More importantly, colon cancer causes symptoms hemorrhoids don’t: unexplained weight loss, ongoing changes in bowel habits (new constipation or diarrhea that won’t resolve), abdominal cramping, a feeling that you can’t fully empty your bowel, and overwhelming fatigue. Hemorrhoid symptoms tend to come and go. Colon cancer symptoms persist and gradually worsen. If your rectal bleeding is accompanied by any of those additional signs, that warrants a medical evaluation rather than assuming hemorrhoids are the cause.