Hemorrhoids: what they are and how to get relief

Hemorrhoids are swollen cushions of blood vessels and supporting tissue at the end of the rectum. You already have those cushions. They help seal the anal canal so stool and gas stay in until you mean to go. A hemorrhoid is what you get when a cushion swells, slips downward, or both.

Internal hemorrhoids usually show up as painless bright red blood, or as tissue that slips out during a bowel movement. External hemorrhoids sit under the skin at the opening. They itch, ache, and swell. This page covers both types, the four grades, how common hemorrhoids are, what brings a flare on, how doctors check them, and which treatments have evidence behind them.

Most people never need an operation. Home care is fiber, enough fluid, shorter time on the toilet, and a warm soak when you are sore. A doctor visit matters when bleeding is new or heavy, pain is severe, or a week of home care has not helped.

What hemorrhoids are

The American Society of Colon and Rectal Surgeons explains hemorrhoid anatomy for patients in plain terms: every person has hemorrhoidal tissue. It is made of blood vessels, connective tissue, and a small amount of muscle, in the anal canal and just outside it. Only a minority of people develop enlargement or symptoms ¹.

A 1975 anatomical study described specialized cushions of tissue lining the anal canal. The author argued that piles are those cushions after they have been displaced ². A later pressure study in adults without anal disease found that the cushions account for about 15 percent of resting anal pressure. They fill the gap inside the internal sphincter ring so the canal can close ³. Treatment is aimed at the cushion that has slipped or swollen, so the seal can keep working.

A review of how hemorrhoids develop and how they are graded defines them as the symptomatic enlargement and downward displacement of the normal anal cushions. The vessels in the cushion stretch, and the connective tissue that holds the cushion in place breaks down ⁴. The NIDDK definition and facts page describes the same problem from the outside: swollen, inflamed veins around the anus or in the lower rectum ⁵.

Internal and external hemorrhoids

Doctors divide hemorrhoids by a landmark called the dentate line, a boundary inside the anal canal. Above that line, the lining does not sense pain, touch, or temperature the way skin does. Those are internal hemorrhoids, and they are covered by the same kind of lining as the rectum. Below the line, the covering is skin, and it is very sensitive. Those are external hemorrhoids. Some people have mixed hemorrhoids, with tissue on both sides of the line ^1,4.

That split is why two people can both say “hemorrhoids” and mean different problems. Internal hemorrhoids often bleed during a bowel movement and may slip out, called prolapse. If they have not prolapsed, they usually do not hurt. External hemorrhoids cause itching, a tender lump, and aching that is worse with sitting. Rubbing and extra wiping tend to make the outside symptoms worse. For many people, external symptoms ease within a few days ⁶.

A sudden hard lump that you cannot sit on is often a clot in an external hemorrhoid. That problem has its own time course, so it is covered on the thrombosed hemorrhoid page. The full symptom list, including mucus and a feeling that you are not empty, is on hemorrhoid symptoms. A soft, painless flap left after a flare is usually a skin tag, explained in anal skin tags. Itching on its own has several other causes, covered in itchy anus. If you know the condition as piles, the UK name, see piles: symptoms, causes and treatment.

The four grades of internal hemorrhoids

Surgeons grade internal hemorrhoids with the Goligher scale, which is based on prolapse, not on how much blood you see ⁴.

Rubber band ligation, also called banding, is a clinic procedure. A doctor places a small band around the base of an internal hemorrhoid so the extra tissue loses its blood supply, shrinks, and falls off, most often within a week. A meta-analysis of hemorrhoid treatment trials recommended banding as the first procedure for grades 1 to 3. Hemorrhoidectomy, the operation that cuts the tissue out, had a better response rate in those trials, along with more pain and more complications, so the authors reserved it for people who did not improve after banding ¹⁷. The ASCRS patient page also lists hemorrhoidectomy as an option for grade 3 or 4 prolapse, for large external hemorrhoids, and for combined internal and external disease. Fewer than 10 percent of patients seen for symptomatic hemorrhoids need an operation ¹.

Among adults who had hemorrhoids on a screening exam, grade 1 was by far the most common: 277 of 380 people (72.89 percent). Grade 2 accounted for 18.42 percent, grade 3 for 8.16 percent, and grade 4 for 0.53 percent ⁷.

How common hemorrhoids are

The numbers depend on what was counted.

People who say they have hemorrhoids are a smaller group than people who have cushions that look enlarged on an exam. A 1990 analysis of U.S. survey and practice data estimated that 10 million Americans complained of hemorrhoids, a prevalence of 4.4 percent. Rates peaked between ages 45 and 65 and were unusual before age 20 ⁸. NIDDK, citing a later clinical review, says hemorrhoids affect about 1 in 20 Americans, and about half of adults older than 50 have them ⁵. The ASCRS patient page uses a similar figure: roughly 5 percent of people develop symptoms from their hemorrhoids ¹.

An exam finds more. In an Austrian colonoscopy screening study, 380 of 976 adults (38.93 percent) had hemorrhoids. Of those 380, 210 people (55.26 percent) reported no symptoms ⁷. A hemorrhoid noted on a colonoscopy report is often silent.

Care-seeking is somewhere in between. In the United States, hemorrhoids are the third most common outpatient gastrointestinal diagnosis, with nearly 4 million office and emergency visits a year ⁹.

What causes hemorrhoids

The supporting tissue in the cushions weakens with age, and repeated pressure pushes the cushions down. NIDDK lists the pressures that come up most often: straining, long sits on the toilet, chronic constipation or diarrhea, a low-fiber diet, age over 50, pregnancy, and frequent heavy lifting ^5,6. A fuller look at each of those is on what causes hemorrhoids.

Constipation shows up in exam data. In 2,813 people who had a colonoscopy in a polyp-prevention trial, constipation was tied to a higher chance of hemorrhoids (odds ratio 1.43, 95 percent confidence interval 1.11 to 1.86). The highest intake of grain fiber was tied to a lower chance than the lowest intake (odds ratio 0.78, 95 percent confidence interval 0.62 to 0.98). In that same study, having ever been pregnant was not tied to hemorrhoids on the exam, and neither overweight nor obesity was ¹⁰.

An older U.S. survey found that hemorrhoids and constipation did not follow the same pattern by age, race, or income, which led the authors to question constipation as the cause ⁸. A later review from the same research group still called the cause speculative. Low fiber and constipation had been assumed for years and had not been well proved ⁹.

Pregnancy is different from “has ever been pregnant.” NIDDK lists pregnancy itself as a risk ⁵. A study that followed 280 pregnant women and examined them found hemorrhoids in 114 (40.7 percent), mostly in the third trimester and after birth ¹¹. Relief studied for that window is covered on hemorrhoids during pregnancy.

Time on the toilet is the trigger with the newest data. In a 2025 study of 125 adults having a screening colonoscopy, 43 percent had hemorrhoids on the exam, and 66 percent said they used a phone on the toilet. Phone users were younger. Among them, 37.3 percent spent more than five minutes per toilet visit, compared with 7.1 percent of people who did not use a phone. After adjustment for age, sex, body mass index, exercise, straining, and fiber, phone use on the toilet was tied to a 46 percent higher chance of hemorrhoids. The sample was 125 people. What changed most clearly was the time spent sitting ¹².

Hemorrhoid symptoms

Symptoms follow the type.

Internal hemorrhoids, when they have not prolapsed, tend to cause bright red blood on the stool, on the paper, or in the bowl. You may also see tissue slip out. Prolapsed internal hemorrhoids can ache. External hemorrhoids cause itching, one or more hard tender lumps, and pain that is worse when you sit ⁶. The bleeding hemorrhoids page goes through how much blood is ordinary and which patterns are not.

A review of the research adds a caution: bleeding, pain, itching, seepage, prolapse, and mucus were reported equally often by patients who did not have hemorrhoids on evaluation and by patients who did ⁹. That is why the list is a reason for an exam, and why matching the story to what the doctor sees matters.

How doctors diagnose hemorrhoids

A doctor can often make the diagnosis from your history and a look at the area. NIDDK’s diagnosis of hemorrhoids page describes the visit. You will be asked about symptoms, what you eat, how long you sit, laxative or enema use, and other conditions. The exam looks for swelling, a prolapsed internal hemorrhoid, a clot in an external hemorrhoid, leakage, irritated skin, leftover skin tags, and an anal fissure, which is a small tear ¹³.

A gloved finger exam checks muscle tone and feels for tenderness, blood, and lumps. An anoscopy uses a short lighted tube to see the anal canal and the lower rectum. It is done in the office, and most people do not need anesthesia. If the doctor needs a longer look, a rigid proctoscope, a flexible sigmoidoscopy, or a colonoscopy comes next. Hemorrhoids are also found during colonoscopies done for other reasons ¹³.

Bleeding is the symptom that changes the plan. NIDDK says to contact a doctor if you have rectal bleeding at all, or if symptoms are still there after a week of home care ⁶. The US Preventive Services Task Force recommends colon cancer screening for adults age 45 to 75 at average risk, with a more selective decision from 76 to 85 ¹⁴. Screening stays on that schedule when a hemorrhoid is found. The ASCRS patient information says other disease, including anal and colorectal cancer, has to be considered when the story does not fit ¹. What happens at the appointment is spelled out on when to see a doctor for hemorrhoids. The signs that point away from hemorrhoids are covered in hemorrhoids or colon cancer.

What to try for hemorrhoid relief

NIDDK says you can most often treat hemorrhoids at home ¹⁵. The hemorrhoid treatment guide compares home care, store products, office procedures, and surgery. The steps below are the ones to start this week.

1. Add fiber from food, and use a supplement if you are short of the target. NIDDK points to the Dietary Guidelines figure of 14 grams of fiber per 1,000 calories, which is 28 grams a day on a 2,000-calorie diet ¹⁸. The ASCRS patient page suggests a range of 20 to 35 grams a day, plus a supplement once or twice a day for many people ¹. Drink water or other nonalcoholic drinks with the fiber so it can soften the stool. NIDDK says to ask how much to drink, because the amount depends on your health, your activity, and where you live ¹⁸.
2. Do not strain, and do not stay on the toilet to read or scroll ¹⁵.
3. Sit in a few inches of warm water, a sitz bath, several times a day if you are sore ¹⁵. A review of the sitz-bath literature found very little trial evidence that soaks treat anorectal disease. Use the soak for comfort while the fiber and toilet habits do the longer job ¹⁹.
4. For mild pain, swelling, or itching on the outside, an over-the-counter cream, ointment, or suppository is reasonable. NIDDK says doctors usually suggest those products for about a week. Stop and check in if you get a rash or very dry skin, or if nothing has improved when the week is up ¹⁵. Follow the label. Pain pills such as acetaminophen, ibuprofen, naproxen, or aspirin are on the NIDDK list ¹⁵. NHS advice on piles is to skip ibuprofen when they are bleeding, and to skip codeine because it can cause constipation ²¹.
5. If you are still bleeding or still uncomfortable after that week, make the appointment. Severely prolapsed or bleeding internal hemorrhoids may need a procedure even if home care helped a little ^6,15.

Psyllium powders are a practical way to close a fiber gap when food is not enough. The best fiber supplements for hemorrhoids page compares powders, capsules, and gummies. Buyers of a standard orange psyllium powder often say it is easier to drink than they expected, if they drink it before it thickens, and they remind each other to take it with plenty of water.

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Office procedures are for internal hemorrhoids that keep bleeding or prolapsing after home care. Besides banding, doctors use sclerotherapy (an injection that scars the hemorrhoid down), infrared coagulation (a short burst of heat), and electrocoagulation (a similar idea with electric current). All of these are meant to create a small scar that cuts off blood flow and shrinks the cushion. Only a doctor should do them. Do not try to band a hemorrhoid yourself ^15,17.

In the operating room, a hemorrhoidectomy removes large external hemorrhoids and prolapsing internal ones that have not responded to other care. Stapled hemorrhoidopexy uses a stapling device to remove a ring of internal tissue and pull a prolapsing hemorrhoid back up. Both are done with anesthesia ¹⁵.

How to keep hemorrhoids from coming back

The prevention list from NIDDK matches the treatment list, because the same pressures cause the next flare: enough fiber, enough fluid, no straining, no long toilet sits, and less routine heavy lifting ¹⁵. The daily version of that plan is on how to prevent hemorrhoids.

From the NIDDK diet table, a half cup of high-fiber bran cereal has 14 grams, a cup of raspberries has 8 grams, a half cup of cooked navy beans has 9.6 grams, and a medium pear with the skin has 5.5 grams ¹⁸. Cheese, chips, fast food, ice cream, and meat add almost none. If bleeding comes back after a quiet stretch, get it checked again. The next bleed can have a different cause.

When hemorrhoid symptoms need a doctor

Call this week if home care for seven days has not helped, or if you see rectal bleeding ⁶. Ongoing blood loss can lead to anemia, which NIDDK lists as a complication ⁵. Infection of a sore on an external hemorrhoid, a clot, a skin tag left after a clot dissolves, and a strangulated hemorrhoid (the anal muscle cuts off blood flow to a prolapsed internal hemorrhoid) are the other complications on that list ⁵.

Go in the same day for severe anal pain together with rectal bleeding, especially if you also have abdominal pain, diarrhea, or fever ¹⁵. MedlinePlus says to get help right away if you lose a lot of blood or you are bleeding and feel dizzy, lightheaded, or faint ²⁰. NHS advice is emergency care for bleeding that does not stop, a large amount of blood, large clots, or severe pain ²¹.

Screening from age 45 is a B recommendation from the USPSTF for adults at average risk, and screening from 50 to 75 is an A recommendation ¹⁴. If you are pregnant, ask your obstetric clinician before you use a medicated cream. The pregnancy guide lists which options have been studied in that setting.