Signs and Symptoms of Hemorrhoids (Piles)

Hemorrhoids, sometimes called piles or enlarged hemorrhoids, are veins around your anus or inside your rectum that have become swollen. The rectum is the part of the lower intestine closest to your anus. Hemorrhoids are a common but bothersome condition. They can cause itching, burning, pain, or bleeding from the anus. 

Hemorrhoids appear as lumps or bumps in the anal area. They usually develop when there is too much pressure on the veins in that area over a period of time. This pressure can be caused by chronic constipation, pregnancy, a diet that has too little fiber, and other factors. Researchers believe there may be a genetic component to hemorrhoids as well.

All genders can develop hemorrhoids, and they become more common as people get older. In fact, three out of four people over the age of 45 have experienced hemorrhoids.

Common Symptoms 

Hemorrhoids are classified as either external or internal. The external kind presents as visible bumps around your anus. The internal kind are not visible but can still cause uncomfortable symptoms. Symptoms are likely to become more severe as the size of a hemorrhoid increases.

Both external and internal hemorrhoids can cause an itching or burning sensation. You may have pain when you are sitting. You may also have blood or mucus discharge, or stool leakage, from your anus. 

While your hemorrhoids may not go away without a medical procedure, you can take steps to ease the symptoms.

External Hemorrhoid Symptoms 

Symptoms of external hemorrhoids may appear abruptly, often after a brief bout of increased pressure on the rectal walls. This pressure can have various causes, including pregnancy, diarrhea, or straining to have a bowel movement due to constipation. Symptoms may then get worse with continued pressure or excessive rubbing around the anus.

Common symptoms of external hemorrhoids include:

• Swelling of the skin around the anus
• Hard lumps around the anus that can range from small to quite large
• Itching or burning around the anus
• Pain or aching when you sit down
• Inability to fully clean the area around the anus

These symptoms usually go away on their own within days. There are a few ways you can try to speed up this process, including eating a diet higher in fiber, drinking more water, or taking warm baths. You also can avoid constipating foods, such as cheeses and meats.

Certain complications can arise from external hemorrhoids. Sometimes a blood clot (a clump of blood) can form in a hemorrhoid, which can lead to extreme and constant pain. This is referred to as a thrombosed hemorrhoid. When the clots go away, they often leave a section of loose skin behind known as a skin tag.

Also, if you develop blisters or scabs around your anus, this may be a sign that irritation from your hemorrhoids has led to anal eczema. 

Internal Hemorrhoid Symptoms 

Not all internal hemorrhoids cause symptoms. Symptoms that occur can range from painless to very painful. These symptoms usually get worse slowly, and they may come and go. Symptoms may include:

• Bleeding from the rectum that you can see on toilet paper or in the toilet bowl
• Feeling like you cannot fully empty your bowels
• Mucus discharge from the anus

Sometimes, an internal hemorrhoid can extend outside of the anus. This is called a prolapsed hemorrhoid. It may be able to be pushed back inside the anus, or it may pull back inside the anus on its own, only protruding out during a bowel movement. How much a hemorrhoid has prolapsed determines its grade, or severity. Doctors place hemorrhoid severity on a scale of 1–4, with 4 being the most severe.

Unless the internal hemorrhoid is prolapsed, you likely will not experience pain. If it has prolapsed, however, you may feel pain and itching in the area.

Symptoms in Children

Hemorrhoids are very rare in young children. When they do appear, they are most often caused by liver failure rather than digestive problems. They appear more commonly in teenagers, usually due to straining on the toilet.

When to See a Healthcare Provider 

While hemorrhoids are extremely common and symptoms usually go away on their own, these symptoms actually can be a sign of something more serious. For instance, pain and bleeding from your rectum could be the result of inflammatory bowel disease (IBD) or cancer. It is important to have a healthcare provider examine you to rule out any underlying conditions.

In particular, if your hemorrhoids do not go away after you have been treating them yourself for a week, make an appointment with your primary doctor or a proctologist (a doctor who specializes in colon and rectal surgery). And any time you see blood after a bowel movement, tell your healthcare provider right away. 

If your hemorrhoids are causing severe pain or affecting your quality of life, your healthcare provider may be able to remove or shrink them with a medical procedure.

A Quick Review 

Hemorrhoid symptoms may vary depending on whether they are internal (inside the rectum) or external (outside the anus). External hemorrhoids usually are uncomfortable, while internal hemorrhoids may have no symptoms. However, you may have pain if an internal hemorrhoid has prolapsed.

If you see blood that has come from your anus, or if you are in severe pain, visit your healthcare provider as soon as possible. They can help you manage your symptoms and explore surgical and nonsurgical options for treating the condition.