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Hemorrhoids: Symptoms, Home Treatment, and When to See a Doctor

Hemorrhoids are swollen vascular cushions in the lower rectum or around the anus that cause bleeding, itching, and discomfort. About 1 in 20 Americans are affected, and roughly half of adults over 50 experience them at some point [2]. Most cases improve with dietary fiber, increased fluids, sitz baths, and over-the-counter creams. Persistent or heavy rectal bleeding always warrants a provider evaluation to rule out other causes [1][3].

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What are hemorrhoids and why do they happen?

Hemorrhoids are cushions of vascular tissue that exist in everyone's lower rectum. They become symptomatic — and are then commonly called hemorrhoids — when they swell, bleed, or protrude. Approximately 1 in 20 Americans experience symptomatic hemorrhoids, with roughly half of adults over age 50 affected at some point 2. The usual culprits are straining during bowel movements, chronic constipation or diarrhea, prolonged sitting on the toilet, low dietary fiber, and pregnancy.

There are two main types:

  • Internal hemorrhoids form inside the rectum. Because they develop in tissue with few pain fibers, they typically cause painless bright-red bleeding during or after a bowel movement, or a sensation of incomplete emptying. They can prolapse (bulge out through the anal opening) if large.
  • External hemorrhoids develop under the skin around the anus. They contain more pain fibers and can be tender, itchy, or, if a blood clot forms inside (thrombosed external hemorrhoid), acutely and sharply painful 2.

What symptoms do hemorrhoids cause?

Common symptoms include 2:

  • Bright red blood on toilet paper, on the surface of stool, or in the toilet bowl after a bowel movement
  • Itching or irritation around the anus
  • Pain or discomfort, particularly with external hemorrhoids or when a hemorrhoid prolapses
  • Swelling or a lump you can feel near the anus
  • A feeling of fullness or that a bowel movement is incomplete

Internal hemorrhoids usually cause painless bleeding. Pain is more characteristic of external hemorrhoids or prolapse. If you have rectal bleeding without a confirmed hemorrhoid diagnosis — particularly if you are over 45, if the blood is dark, mixed into stool, or accompanied by changes in bowel habits — a provider evaluation is important because bleeding has other potential causes 3.

How to treat hemorrhoids at home

Most mild-to-moderate hemorrhoid symptoms respond to these measures 12:

Increase dietary fiber. Fiber softens stools and reduces straining, which is the single most important behavioral change. Aim for 25 to 35 grams per day from vegetables, legumes, whole grains, and fruit. A psyllium-based supplement can help if dietary fiber alone is insufficient.

Stay well hydrated. Adequate fluid intake works alongside fiber to prevent hard stools.

Sitz baths. Sitting in a few inches of warm water for 10 to 15 minutes after bowel movements soothes irritated tissue and may reduce swelling. Plastic sitz bath basins fit over a toilet seat and are widely available 2.

Avoid prolonged sitting on the toilet. Reading or scrolling while on the toilet prolongs the time spent bearing down, which worsens hemorrhoids.

Over-the-counter products. Creams or suppositories containing witch hazel, hydrocortisone, or numbing agents (such as lidocaine) can temporarily relieve itching and discomfort. Hydrocortisone products should not be used for more than one week without provider guidance, as prolonged use can thin the perianal skin.

Stool softeners. If constipation contributes to straining, a short course of a stool softener (such as docusate) can ease bowel movements while you increase fiber 2.

When should hemorrhoids be evaluated by a clinician?

Uncomplicated hemorrhoids are not dangerous. However, these situations deserve medical evaluation 13:

  • Significant or persistent bleeding. While hemorrhoids are a common cause of rectal bleeding, the same symptom can indicate polyps, colitis, or colorectal cancer. Rectal bleeding should be evaluated by a clinician, particularly in anyone over 45 or without a prior hemorrhoid diagnosis.
  • Severe or acute pain. A thrombosed external hemorrhoid can cause intense pain and may benefit from office-based treatment if caught within the first 72 hours.
  • Symptoms that do not improve. If home measures have not helped after two to three weeks, a clinician can evaluate for procedural options such as rubber band ligation.
  • Prolapse that will not reduce. An internal hemorrhoid that prolapses and does not return on its own should be evaluated.

A Gale primary care clinician can evaluate your symptoms, confirm the diagnosis, and refer you to a gastroenterologist or colorectal surgeon when procedural treatment is appropriate.

What procedural and surgical options exist?

When home measures fail, office-based procedures performed by a GI specialist or colorectal surgeon include 12:

  • Rubber band ligation: The most effective office procedure for internal hemorrhoids. A small band cuts off blood supply, and the hemorrhoid withers in one to two weeks.
  • Sclerotherapy: A chemical solution is injected to shrink the hemorrhoid.
  • Infrared coagulation: Heat is used to create scar tissue that reduces blood flow.

For larger hemorrhoids or those that have not responded to office procedures, hemorrhoidectomy (surgical removal) is the most definitive option, though it carries a longer recovery 1.

Common questions

Can hemorrhoids go away on their own?

Many mild internal hemorrhoids improve with dietary changes, increased fiber, and sitz baths within a few weeks. Thrombosed external hemorrhoids can cause intense short-term pain but often resolve on their own in one to two weeks. Larger or grade III–IV hemorrhoids are less likely to resolve without procedural treatment.

Is rectal bleeding always from hemorrhoids?

No. While hemorrhoids are a common cause of bright red blood on toilet paper or in the toilet bowl, rectal bleeding can also indicate anal fissures, polyps, colitis, or colorectal cancer. Anyone with rectal bleeding — especially over age 45, or with dark blood mixed into stool or accompanied by changes in bowel habits — should be evaluated by a clinician rather than assuming it is hemorrhoids.

Do I need a colonoscopy if I have hemorrhoids?

Not necessarily for the hemorrhoids themselves, but if you have rectal bleeding and have not had a recent colonoscopy, your provider may recommend one to rule out other causes, particularly if you are 45 or older (the recommended screening age) or have risk factors for colorectal cancer.

Are hemorrhoids a sign of something more serious?

In most cases, no. Hemorrhoids are a common, benign condition. However, because their main symptom — rectal bleeding — overlaps with more serious conditions, it is important to have a first episode of rectal bleeding evaluated by a clinician rather than self-diagnosing.

Talk to a clinician

Nina Osei, NP — Nurse Practitioner

checkups, refills & skin. Gale can match you with a licensed clinician for a visit.

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When to see a provider promptly

  • —Heavy or ongoing rectal bleeding — soaking a pad or persistent bright red blood
  • —Dark or maroon blood, or blood mixed into stool (not just on the surface)
  • —Rectal bleeding in anyone over 45 without a prior colonoscopy or confirmed hemorrhoid diagnosis
  • —Sudden, severe anal pain with visible swelling (possible thrombosed hemorrhoid)
  • —Signs of anemia: unusual fatigue, pallor, rapid heartbeat
  • —Prolapsed hemorrhoid that cannot be gently pushed back

Go to an emergency department for heavy, uncontrolled rectal bleeding or sudden severe pain. Contact your Gale primary care clinician for persistent or unexplained rectal bleeding.

This article provides general health education and is not a substitute for an individualized evaluation by a healthcare provider. Rectal bleeding should always be assessed clinically before being attributed to hemorrhoids.

References

  1. 1.Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, Zutshi M (2021). ACG Clinical Guidelines: Management of Benign Anorectal Disorders. American Journal of Gastroenterology. doi:10.14309/ajg.0000000000001507 ✓Conservative management (fiber, sitz baths) as first-line; rubber band ligation and surgical hemorrhoidectomy for refractory cases; clinical classification of hemorrhoid grades
  2. 2.National Institute of Diabetes and Digestive and Kidney Diseases (2023). Definition & Facts of Hemorrhoids. NIDDK Health Information. link ✓Hemorrhoid prevalence (approximately 1 in 20 Americans; ~50% of adults over 50); risk factors including straining, low-fiber diet, and pregnancy; definition of internal vs external hemorrhoids
  3. 3.Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK (2021). ACG Clinical Guidelines: Colorectal Cancer Screening 2021. American Journal of Gastroenterology. doi:10.14309/ajg.0000000000001122 ✓Rectal bleeding in adults 45 and older warrants evaluation; colorectal cancer screening recommendations relevant to patients presenting with rectal bleeding attributed to hemorrhoids

3 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.