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The no-shame guide to hemorrhoids

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Learn the different types of hemorrhoids, why they happen and what to do about them.
Written by Stacey Colino
Updated on June 17, 2021

Hemorrhoids are a hidden problem. People don’t talk about them (at least not in polite company), and we generally don’t see them. But they’re common. Nearly half of us will have them by age 50, according to the American College of Gastroenterology. And about 1 in 3 people who get a colonoscopy discover they have them.

But what are hemorrhoids, exactly? Also called piles, they’re swollen veins in and around the anus and lower rectum. They’re similar to varicose veins. Sometimes they don’t cause symptoms. But when they become enlarged, they can lead to pain, itching, rectal bleeding and other irritating symptoms. Most people with hemorrhoids suffer silently before talking to a doctor. That’s unfortunate, because they can usually be easily checked out and treated.

Many people can heal hemorrhoids with over-the-counter (OTC) treatments and changes to their daily habits. Others need to see a doctor. But first, it helps to know what you’re dealing with.

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Types of hemorrhoids

Hemorrhoids can occur in or around the anus or inside the rectum. Here’s how the different types compare:

Internal hemorrhoids. These are swollen veins inside the rectum that you can’t see or feel. If you strain while pooping, you might notice small smears of blood on the toilet paper or in the bowl. During bowel movements, these hemorrhoids can push through the anus. This leads to pain and irritation.

“Hemorrhoids can make people think they have more stool to pass because they feel a fullness in the anal area,” explains Cindy Yoshida, MD, a professor in the division of gastroenterology and hepatology at University of Virginia Digestive Health Center in Charlottesville. “They will often strain to get out that little pea-sized bit of extra stool, but they should try to avoid doing that because straining only makes [hemorrhoids] worse.”

External hemorrhoids. These are inflamed veins, which form beneath the skin around the anus. They can be itchy and painful, and you can feel them with your hand. Sometimes they bleed or cause swelling of the skin around the anus. “The skin overlying them can be fragile, so hemorrhoids can have a tendency to bleed,” notes Dr. Yoshida.

Thrombosed hemorrhoids. These are blood clots that form most often inside an external hemorrhoid. If they’re large, they can become tender, painful lumps. And if the skin on the top of the mass cracks or opens, you may notice light bleeding.

What causes hemorrhoids?

Anything that puts pressure on your pelvis or bottom can make your anal and rectal veins swell. Risk factors include:

  • Childbirth. Pregnancy and childbirth both increase rectal pressure, which can raise the risk of hemorrhoids.
  • Weight gain. “For Americans in general, we tend to gain weight as we age, and that can add extra pressure to pelvic veins,” Dr. Yoshida says.
  • Chronic constipation. If you often need to push really hard or strain to have a bowel movement, that increases pressure on the rectal veins.
  • Advancing age. “As we get older, the supportive tissues become more lax, allowing hemorrhoids to stretch and become engorged,” says Syed Husain, MBBS, who specializes in colon and rectal surgery at the Ohio State University Wexner Medical Center in Columbus.
  • Regular weightlifting. For some people, pumping serious iron or frequently straining to lift heavy objects can lead to rectal trouble.

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How to prevent and treat hemorrhoids

Avoid straining on the toilet, for starters. And don’t spend a long time sitting, especially in the bathroom. “Avoid reading, browsing the internet or answering emails while using the potty,” Dr. Husain says.

You can also address the problem by what you put into your body, starting with more fiber: 20 to 30 grams per day is ideal. An over-the-counter (OTC) fiber supplement, such as psyllium (Metamucil®) or methylcellulose (Citrucel®), may help here. Keep yourself hydrated and think about taking a stool softener if you’re struggling on the toilet.

Dealing with constipation? Learn more about how to manage it here.

For minor itching or burning around the anus, an OTC product such as Tucks Medicated Cooling Pads® or Preparation H® ointment (or a generic hydrocortisone rectal cream) can help, says Dr. Yoshida. So can soaking in a warm bath. You might also look for a sitz bath, which fits over the toilet to clean your underside. To ease pain and discomfort, Dr. Husain also recommends applying a warm compress 2 or 3 times a day, for at least 10 minutes each time.

If symptoms don’t let up within a week, see your doctor. “Bleeding can be a sign of something more ominous, such as colorectal cancer,” Dr. Yoshida says. “Anyone with persistent rectal bleeding should see their doctor for a rectal exam or possibly a colonoscopy.”

If you have severe hemorrhoids, your doctor may be able to take care of them with:

  • Rubber band ligation. A small rubber band is placed around the base of the hemorrhoid to cut off its blood supply, causing it to fall off.
  • Coagulation. An electric current, laser or infrared heat is used to zap and shrivel a hemorrhoid.
  • Sclerotherapy. A medication is injected into the hemorrhoid to shrink it.
  • Surgery. A large hemorrhoid is removed while you’re under anesthesia. Stitches may be used to close the surgical site.

The thing to remember is that you’re not alone, and you have nothing to be embarrassed about. Hemorrhoids are common. Talk to a pharmacist if you have questions, and visit a doctor if you need more help. Don’t be afraid to get the relief you need.

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Additional sources
Hemorrhoid basics: American College of Gastroenterology
Hemorrhoids and colonoscopy stat: Clinical Gastroenterology and Hepatology. (2019.) “Rethinking What We Know About Hemorrhoids.”