Hemorrhoids: Causes, Symptoms & Treatment Options
A plain-language guide to what hemorrhoids are, why they happen, which over-the-counter treatments actually work, and when it's time to call a doctor.
Quick answer: Hemorrhoids are swollen veins in or around the rectum and anus. They're extremely common — about 3 in 4 adults get them at some point. Most cases improve within a few days using sitz baths, high-fiber diet, and over-the-counter creams. See a doctor if you have rectal bleeding, pain that doesn't improve after a week, or a hard lump that won't go away.
In this guide
What Are Hemorrhoids?
Hemorrhoids (also called piles) are swollen, inflamed veins in the lower rectum or around the anus — similar to varicose veins in the legs. Technically, everyone has hemorrhoidal tissue (it helps with bowel control), but the term "hemorrhoids" is used when that tissue becomes enlarged, irritated, or symptomatic.
They affect an estimated 75% of adults at some point in their lives and are the most common reason people visit a colorectal specialist. Despite being very common, most people feel embarrassed to discuss them — which often leads to delayed treatment and unnecessary discomfort.
Types of Hemorrhoids
Internal Hemorrhoids
Located inside the rectum where there are few pain-sensing nerves, internal hemorrhoids are usually painless. The main sign is bright red blood on toilet paper or in the bowl after a bowel movement. Occasionally they prolapse (push through the anal opening), which can cause discomfort and mucus discharge.
External Hemorrhoids
Found under the skin around the anus, external hemorrhoids have many pain-sensitive nerve endings. They can cause pain, itching, swelling, and bleeding. They're the type most people notice and the most uncomfortable.
Thrombosed Hemorrhoids
When an external hemorrhoid develops a blood clot (thrombosis), it becomes a firm, very painful lump. This is not dangerous, but it is one of the more severe hemorrhoid presentations. Pain typically peaks within 48–72 hours. A doctor can drain it in-office for fast relief.
Prolapsed Internal Hemorrhoids (Grades I–IV)
Doctors grade internal hemorrhoids by how far they've prolapsed:
- Grade I — bleed but don't protrude
- Grade II — protrude during straining, retract on their own
- Grade III — protrude and require manual pushing back in
- Grade IV — permanently prolapsed; cannot be pushed back
Symptoms to Know
- Bright red blood on toilet paper, in the bowl, or on stool surface
- Itching or irritation around the anus
- Pain or discomfort, especially during or after bowel movements
- Swelling or a lump around the anus
- Mucus discharge or a feeling that the bowel isn't fully emptied
- Leaking feces (rare; in severe prolapse)
Important: Rectal bleeding is not always hemorrhoids. Dark or maroon blood, blood mixed throughout the stool, unexplained weight loss, or changes in bowel habits that last more than a few weeks should be evaluated by a doctor to rule out other conditions including colorectal cancer.
Causes & Risk Factors
Hemorrhoids develop when pressure builds up in the veins of the lower rectum. Common causes include:
- Straining during bowel movements — the #1 cause
- Chronic constipation or diarrhea
- Sitting on the toilet for long periods
- Low-fiber diet
- Pregnancy — the uterus presses on rectal veins; hemorrhoids are extremely common in the third trimester
- Obesity
- Heavy lifting
- Age over 50 — supporting tissues weaken over time
- Family history — some people inherit weaker vein walls
Home Treatment & OTC Medications
For most people with mild to moderate hemorrhoids, home treatment resolves symptoms within 7–10 days. The cornerstones are:
Sitz Baths
Soak the anal area in warm water (not hot) for 15–20 minutes, 2–3 times daily and after each bowel movement. This is one of the most effective non-medication treatments for reducing pain and swelling.
Fiber + Fluids
Softening stool is the most important long-term step. Aim for 25–35 grams of fiber per day from fruits, vegetables, whole grains, and legumes. Drink at least 8 cups of water daily. Fiber supplements (psyllium, methylcellulose) are also effective.
Over-the-Counter Medications
Several OTC products are proven to relieve hemorrhoid symptoms. Use an Rx.com discount card to save on all of them:
| Medication | What it does | Type |
|---|---|---|
| Hydrocortisone cream | Reduces itching and inflammation | Topical steroid (OTC 1%; Rx 2.5%) |
| Lidocaine ointment | Numbs pain and burning | Topical anesthetic |
| Witch hazel pads | Soothes irritation; natural astringent | Topical (Tucks pads) |
| Ibuprofen (Advil, Motrin) | Reduces pain and swelling | Oral NSAID |
| Acetaminophen (Tylenol) | Relieves pain | Oral pain reliever |
| Docusate sodium (Colace) | Stool softener — reduces straining | Oral stool softener |
💡 Tip: Products that combine a numbing agent (like pramoxine) with a vasoconstrictor (like phenylephrine) — such as Preparation H — address multiple symptoms at once and are often the most convenient starting point.
Medical & Surgical Options
If symptoms don't improve after 1–2 weeks of home treatment, or if you have Grade III/IV prolapse, a doctor may recommend one of the following:
Rubber Band Ligation (Most Common)
A small elastic band is placed around the base of an internal hemorrhoid, cutting off its blood supply. The hemorrhoid shrinks and falls off within a week. Done in-office, no anesthesia required. Works for Grade I–III hemorrhoids with a high success rate.
Sclerotherapy
A chemical solution is injected into the hemorrhoid to shrink it. Faster recovery but slightly lower success rate than banding.
Infrared Coagulation
Infrared light or heat is used to scar and shrink internal hemorrhoids. Effective for Grade I–II hemorrhoids.
Hemorrhoidectomy (Surgery)
Surgical removal under anesthesia. Reserved for large external hemorrhoids, severe Grade III/IV internal hemorrhoids, or cases where other treatments have failed. Most effective long-term solution but involves 2–4 weeks of recovery.
Stapled Hemorrhoidopexy (PPH)
A circular stapling device repositions prolapsed internal hemorrhoids and cuts off their blood supply. Less post-operative pain than traditional hemorrhoidectomy but higher chance of recurrence.
When to See a Doctor
Most hemorrhoids don't need a doctor visit — but certain signs warrant prompt medical evaluation:
- Rectal bleeding (to rule out other causes)
- A hard, painful lump that doesn't improve within 48–72 hours (may be thrombosed)
- Severe pain not relieved by OTC treatments
- Symptoms that haven't improved after 1 week of home treatment
- Hemorrhoids that keep coming back
- Any change in bowel habits, unexplained weight loss, or dark/maroon stool
Prevention
The same steps that treat hemorrhoids also prevent them from coming back:
- Eat more fiber — 25–35 g/day from whole foods or supplements
- Drink more water — at least 8 cups/day
- Don't delay going to the bathroom — when you feel the urge, go
- Limit time on the toilet — don't read or scroll your phone
- Exercise regularly — even walking 30 minutes/day helps bowel function
- Avoid heavy straining — use proper form when lifting
- Manage your weight
Frequently Asked Questions
How long do hemorrhoids last?
Small external hemorrhoids typically resolve on their own within 3–5 days with home care. Larger ones may take 1–2 weeks. Internal hemorrhoids can be chronic if the underlying cause (constipation, straining) isn't addressed. Without treatment, they often keep coming back.
Do hemorrhoids go away on their own?
Yes, many small hemorrhoids improve without any treatment, especially with better diet and hydration. However, large or prolapsed hemorrhoids rarely resolve completely on their own and usually require medical treatment to fully clear.
What does hemorrhoid pain feel like?
External hemorrhoids typically feel like a tender, firm lump near the anus with a burning, throbbing sensation — especially during and after bowel movements. Internal hemorrhoids are usually painless but may cause a feeling of pressure or fullness. A thrombosed hemorrhoid is the most painful type — a sharp, constant ache.
Can I exercise with hemorrhoids?
Yes — gentle exercise like walking, swimming, and yoga can actually help by improving bowel function and reducing straining. Avoid heavy weightlifting, cycling, and rowing during a flare-up, as these increase pressure on rectal veins.
Are hemorrhoids dangerous?
Hemorrhoids themselves are not dangerous or cancerous. However, rectal bleeding should always be evaluated by a doctor to rule out other conditions. Severe untreated hemorrhoids can cause chronic blood loss leading to anemia, but this is uncommon.
What is the best OTC treatment for hemorrhoids?
Hydrocortisone cream reduces inflammation and itching; lidocaine ointment numbs pain; and witch hazel pads soothe irritation naturally. For pain, ibuprofen works better than acetaminophen because it also reduces swelling. A docusate sodium stool softener prevents straining, which is the root cause for most people.
Can hemorrhoids come back after treatment?
Yes. Even after procedures like rubber band ligation, hemorrhoids can recur if the underlying habits don't change. A high-fiber diet, good hydration, and avoiding straining are the best long-term prevention strategies.