Hemorrhoids are swollen blood vessels in and around the anus and rectum. Many people do not know they have hemorrhoids until they bleed, become uncomfortable, or start causing pain.

Straining during a bowel movement is the main reason for bleeding hemorrhoids. Other triggers include diarrhea or constipation and sitting or standing for a long time. They can also happen during pregnancy or after lifting a heavy item.

Signs of bleeding hemorrhoids include bright, red blood staining the toilet paper or feces.

Most people can treat hemorrhoids at home. In more severe cases, surgery may be necessary.

In this article, we look at why hemorrhoids bleed and what symptoms to look for. We also provide information on home remedies, medical treatments, and when to see a doctor.

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Everyone has hemorrhoidal tissue inside their anal canals. It consists of blood vessels, connective tissue, and muscle.

When a person strains, sneezes, or exerts themselves, hemorrhoidal tissue swells to prevent feces from leaving the body. In most cases, the tissue returns to its usual size, but sometimes, it remains enlarged. When this happens, the enlarged tissue can form hemorrhoids.

Hemorrhoids can bleed:

  • after a bowel movement, especially if there is straining
  • with diarrhea or constipation
  • after sitting or standing for a long time
  • during pregnancy
  • when lifting a heavy object
  • if a blood clot blocks the blood supply, leading to ulceration and dead tissue

Hemorrhoids often remain inside the anal canal, but sometimes they bulge outward from the anus and become visible outside of the body. Either type can bleed, but only external ones are painful.

Hemorrhoids, or piles, are the most common cause of bleeding from the rectum.

If hemorrhoids bleed, a person may see traces or streaks of bright, red blood:

  • on tissues after wiping
  • in the toilet bowl
  • in the stool

If the blood is dark red, the person should notify a doctor as this can indicate a problem higher up in the gastrointestinal tract.

Thrombosed hemorrhoid

A thrombosed hemorrhoid is when a blood clot develops within the hemorrhoid.

As the swelling increases, pressure from surrounding tissues or stool can cause the hemorrhoid to rupture and bleed, often at the end of a bowel movement. This can lead to significant bleeding. There may also be severe pain.

A person should seek medical help at once if they notice:

  • severe pain
  • constant bleeding from the hemorrhoid
  • more than a few drops of blood in the toilet bowl, perhaps with blood clots
  • a bluish lump on the anus, suggesting a thrombosed hemorrhoid

Anyone with severe bleeding should seek medical help at once.

A thrombosed hemorrhoid also needs urgent treatment. Without treatment, thrombosed hemorrhoids can compress and damage the blood vessels in surrounding, healthy tissues.

If a person has symptoms of hemorrhoids that do not improve after 7 days, they should see a doctor.

What are some other causes of blood in the stool?

Medical treatments for bleeding hemorrhoids will depend on the severity of symptoms, the size of the hemorrhoids, and whether the person has already tried other treatment options.

The following are some treatment options that may take place in a doctor’s office:

  • Rubber band ligation involves placing a small band at the base of an internal hemorrhoid to cut off its blood supply. Hemorrhoids will usually fall off around 5–7 days later.
  • Sclerotherapy involves injecting chemicals into the hemorrhoid to make it shrink. Scarring occurs in the blood vessels, stopping blood from flowing through them.
  • Cryotherapy freezes the blood vessels, scarring the tissue and blocking the blood flow.
  • Infrared photocoagulation uses a laser to damage hemorrhoidal tissue, causing it to shrink and slough off.

If a person has large or bulky hemorrhoids or other treatments have not helped, more invasive surgery may be necessary, such as:

  • Hemorrhoidectomy: The doctor will numb the area with a local anesthetic, then cut the hemorrhoid away. For large hemorrhoids, a person may need general anesthesia.
  • Stapled hemorrhoidectomy: The doctor will staple the hemorrhoids back inside of the anus.
  • Hemorrhoid artery ligation: The doctor stitches the arteries that supply blood to the hemorrhoid, and it shrinks.

All these procedures aim to tie off the bleeding blood vessels so that they no longer bleed.

Learn more about hemorrhoid surgeries here.

Home remedies cannot resolve bleeding hemorrhoids, but they can help relieve hemorrhoids and their symptoms.

Here are some home remedies to relieve discomfort and reduce the risk of further bleeding:

Sitz bath

A sitz bath is a small plastic tub that fits over the toilet seat. Filling it with warm water, around 104°F or 40°C, and sitting in it for up to 15 minutes can help maintain hygiene and relieve pain and irritation. Do not add anything to the water.

Ice

Applying ice packs or ice covered with a cloth to swollen areas can help reduce hemorrhoid pain and inflammation.

Good toilet habits

Toilet habits that can help include:

  • using the bathroom when the person feels an urge to go, without delay
  • avoiding excessive straining or pushing
  • limiting time on the toilet to 3–5 minutes
  • avoiding excessive wiping

Water

If a person increases their water intake, it may help soften their stool, making it easier to pass. Less straining during bowel movements gives hemorrhoids a chance to heal.

Experts recommend a daily water intake of 64 fluid ounces or more for people with hemorrhoids.

OTC treatments include:

  • creams or suppositories containing steroids, which reduce inflammation
  • bulk-forming agents that work best when a person takes them in the morning and drinks plenty of fluids during the day
  • stool softeners, which may contain polyethylene glycol or docusate
  • rectal ointments containing witch hazel

Bleeding hemorrhoids often happen when a person strains when passing stool. Maintaining regular bowel movements can help prevent both hemorrhoids and bleeding. Other preventative measures include:

  • increasing fiber intake
  • drinking plenty of water
  • exercising

Most cases of hemorrhoids resolve with conservative treatment, such as home remedies and OTC medications. Internal hemorrhoids have a 10–50% chance of returning in the next 5 years, but less than 5% after surgery. The chance of external hemorrhoids recurring after conservative treatment is over 50%, but only 5–10% after surgery.

Possible complications of both types of hemorrhoids and surgery include:

  • infection
  • thrombosis, where a blood clot forms
  • incontinence

Following surgery, there is also a 30–50% chance of urinary retention.

Bleeding hemorrhoids can cause concern, but they do not always need medical intervention. If bleeding is heavy or persistent, however, or there is severe pain, a person should contact a doctor.

Adopting a high fiber diet and drinking plenty of water can help reduce the risk of hemorrhoids and bleeding.

A person should see a doctor if they have concerns about hemorrhoid symptoms, there is persistent or heavy bleeding, or they notice dark, red blood. The doctor will discuss treatment options with them and may carry out tests to rule out other conditions.

Here are some questions people often ask about bleeding hemorrhoids.

How do you treat a bleeding hemorrhoid?

To relieve discomfort, a person can take a sitz bath or apply ice wrapped in a cloth. OTC options can also help reduce inflammation and soften stool. Consuming plenty of water and fiber can help improve bowel movements and reduce the risk of straining, making hemorrhoids less likely to bleed.

Are bleeding hemorrhoids serious?

In most cases, occasional spotting with bright, red blood is not serious. However, if bleeding continues, there is severe pain, or the blood is dark red, a person should see a doctor, as these may be signs of a more serious condition.

Should I go to a doctor for bleeding hemorrhoids?

A person should see a doctor at once if bleeding is persistent or there is a lot of blood, which may include blood clots. They should also seek help if they notice dark, red blood, which can be a sign of problems in the stomach or intestines.

How long does it take for a bleeding hemorrhoid to heal?

This will depend on the individual, but if it persists longer than a week or the person is unsure why it is happening, they should see a doctor.

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