What Is a Hemorrhoid? Here’s Everything You Need to Know

Content medically reviewed by Dustin Nowotny, DO

Hemorrhoids are surprisingly common, with about 1 in 20 Americans experiencing them. But what is a hemorrhoid, and what should you do if you have one?

"Hemorrhoids are swollen veins or blood vessels in and around your rectum and anus," said Dr. Dustin Nowotny, General Surgeon at Essentia Health. "You can think of hemorrhoids like varicose veins, but in a more delicate area."

Hemorrhoids, which can be internal (in the lining of the lower rectum or anus) or external (under the skin surrounding the anus), develop when pressure increases in the veins around the anus or in your rectum. Both types of hemorrhoids can develop due to several reasons, including –   

• Having chronic diarrhea or constipation
• Lifting heavy objects frequently
• Not having enough fiber in your diet
• Sitting on the toilet for too long
• Straining during bowel movements

During pregnancy, women can develop hemorrhoids because the growing baby puts pressure on the veins and tissues in the anus and rectum. Age can also weaken these tissues, making hemorrhoids more common in people over the age of 50. Being overweight is also a risk factor.

How to Tell if You Have Hemorrhoids

Symptoms of hemorrhoids depend on whether they are internal or external. If you have external hemorrhoids, symptoms include –

• Anal pain, often when sitting down
• Itching around the anus
• One or more tender lumps near the anus

Internal hemorrhoids can cause rectal bleeding. This can appear as bright red blood on toilet paper, in your stool, or in the toilet bowl after you have a bowel movement. Sometimes, internal hemorrhoids can prolapse, which means they protrude through the opening in your anus.

“Internal hemorrhoids typically only cause pain if they prolapse,” Nowotny said. “However, small amounts of stool particles and mucus can collect on them and cause irritation, which can worsen with frequent wiping.”

External hemorrhoids, on the other hand, can be quite uncomfortable, as the skin around the anus becomes irritated. Blood clots can also form in external hemorrhoids, causing sudden, severe pain. If a clot forms, it usually dissolves, but the excess skin left behind can become itchy and irritated.

Home Treatment and Prevention

“For external hemorrhoids, you can try at-home treatments to see if they go away on their own,” Nowotny said. “But if you have bleeding from your rectum, it’s best to see your primary care provider right away.”

Over-the-counter creams or suppositories, which you insert into your rectum, can relieve mild symptoms such as pain, itching and swelling. You can also use medicated cooling pads, wipes, and pain relievers such as acetaminophen, ibuprofen, or aspirin.

In addition to medicine, you can try soaking in a sitz bath several times a day. This is a shallow bath of warm water that only covers your buttocks and hips.Making simple lifestyle changes like these can also treat existing hemorrhoids and prevent hemorrhoids from forming, prevention is the best medicine –    

• Drinking plenty of water every day
• Eating a high-fiber diet or taking fiber supplements
• Not straining when you have a bowel movement and avoiding sitting on the toilet for longer than necessary
• Taking a stool softener

Diagnosing Hemorrhoids

If symptoms don’t improve within one week of home treatment or if you have rectal bleeding, make an appointment with your primary care provider.Your provider will begin by talking with you about your medical history and symptoms. They will also ask questions about your diet, bathroom habits, and whether you use enemas or laxatives. Next, they will do a physical exam, which may include examining your anal area for –

• Irritated skin
• Lumps or swelling
• Skin tags, or extra skin left behind from a dissolved blood clot in an external hemorrhoid
• Small tears called anal fissures, which can bleed, itch, or be painful
• Stool or mucus leakage

For internal hemorrhoids, your provider will do a digital rectal exam, in which they will feel inside your rectum for lumps or abnormalities. Diagnosing internal hemorrhoids may also require other minor procedures. An anoscopy checks the lining of your lower rectum and anus. A rigid proctosigmoidoscopy is a similar procedure in which the provider uses a proctoscope to examine the lining of the rectum and the lower part of the colon.

Procedures to Treat Hemorrhoids

If at-home treatments don’t work for internal hemorrhoids, your provider may refer you to be seen by a general surgery provider who may recommend a medical procedure to shrink the hemorrhoid. This type of procedure creates scar tissue and cuts off the blood supply to the hemorrhoid. These procedures can be done in a clinic –    

• Electrocoagulation.  A special tool directs an electric current into the hemorrhoid, creating scar tissue.
• Infrared photocoagulation. Heat from an infrared light causes scar tissue to form in the hemorrhoid.
• Rubber band ligation. Used on bleeding or prolapsed hemorrhoids, this procedure involves placing a specialized rubber band around the hemorrhoid’s base to cut off blood supply.
• Sclerotherapy. Your provider creates scar tissue by injecting a special solution into the hemorrhoid.

In severe cases, a colorectal surgical procedure called a hemorrhoidectomy may be necessary to remove large external hemorrhoids or prolapsed internal hemorrhoids. Another surgical procedure called hemorrhoidal dearterialization can control the blood vessels feeding the hemorrhoids, as well as pull a prolapsed hemorrhoid back up inside the anus without cutting tissue. At Essentia Health, surgeons may use advanced minimally invasive techniques to perform these surgical procedures and help you quickly recover.