Hemorrhoids, also known as piles, are swollen veins in the lower part of the anus and rectum. When the walls of these vessels stretch, they can become irritated. Older age, pregnancy, and constipation can cause piles.

Although hemorrhoids can sometimes be painful, they often get better on their own. Lifestyle changes, such as eating more fiber and exercising, can help relieve symptoms and lower the risk of future hemorrhoids.

This article explains the symptoms, causes, and treatment options for hemorrhoids, including how to prevent them and when to seek help.

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Symptoms of hemorrhoids often include:

  • bleeding
  • itching or irritation in the anal area
  • discomfort, pain, or soreness around the anus
  • lumps and swelling in the anal region
  • dilation, or bulging, of a vein, which may or may not be painful, depending on where it occurs

Symptoms can be uncomfortable or alarming, but they often improve on their own after a few days.

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Although healthcare professionals do not fully understand why hemorrhoids appear, they may occur for the following reasons:

  • Pregnancy: During pregnancy, the increasing weight of the developing fetus and uterus put pressure on the pelvis. Hemorrhoids may occur in up to 35% of pregnant people.
  • Aging: Hemorrhoids are most common among adults ages 45–65 years. However, young people and children can also get them.
  • Diarrhea: Hemorrhoids can occur after cases of chronic diarrhea.
  • Chronic constipation: Straining to move a stool puts additional pressure on the walls of the blood vessels, which may result in hemorrhoids.
  • Sitting for too long: Spending a long time in a seated position, especially on the toilet, can cause hemorrhoids.
  • Diet: Eating low fiber foods may contribute to hemorrhoids.
  • Heavy lifting: Repeatedly lifting heavy objects can lead to hemorrhoids.
  • Anal intercourse: This can cause new hemorrhoids or worsen existing ones.
  • Weight: Research links being overweight to a higher risk of hemorrhoids. This may result from increased pressure within the abdomen.

In many cases, simple measures will alleviate symptoms while hemorrhoids heal on their own. However, medication or surgery may be necessary in some instances.

Home treatments

The following home treatments may help relieve symptoms of hemorrhoids:

  • Hydrate: Increasing water intake may help to soften hard stools, reducing straining that can cause or worsen hemorrhoids.
  • Topical creams and ointments: Over-the-counter (OTC) creams for external hemorrhoids can help reduce itching, discomfort, and swelling.
  • Fiber supplements: Taking fiber supplements like methylcellulose (Citrucel) and psyllium (Metamucil) can reduce constipation and help with hemorrhoids.
  • Ice packs and cold compresses: Applying a cold compress to the affected area may ease pain.
  • A sitz bath: A sitz bath involves sitting in a tub of shallow, warm water. Taking one a few times each day may help reduce hemorrhoid pain.


Hemorrhoid medications come in various forms, including suppositories, ointments, and pads. A person can usually buy them over the counter.

  • Zinc oxide: Creams containing zinc oxide may help with irritation. One ointment, Calmoseptine, combines zinc oxide and menthol. It may be effective for relieving anal itching, which can be related to hemorrhoids.
  • Witch hazel: Astringents, such as witch hazel, may provide temporary relief.
  • Steroid cream: Corticosteroids such as hydrocortisone can help reduce inflammation, but they may damage the skin with prolonged use.
  • Lidocaine: Lidocaine acts as a local anesthetic. Creams or suppositories that combine the anti-inflammatory tribenoside (Glyvenol) with lidocaine may help improve symptoms of pain and itching due to hemorrhoids.
  • Analgesics: OTC painkillers such as aspirin, ibuprofen (Advil, Motrin), and acetaminophen (Tylenol, Panadol) may help alleviate hemorrhoid pain.

A person should talk with a doctor if symptoms do not improve after using these medications.

Nonsurgical treatment options

If home remedies do not improve hemorrhoids, a person may need further treatment. Nonsurgical options include:

  • Rubber band ligation: This outpatient procedure for internal hemorrhoids involves placing an elastic band on the base of the hemorrhoid to block its blood supply. The hemorrhoid will either shrink or fall off.
  • Sclerotherapy: During this procedure, doctors inject a liquid into an internal hemorrhoid. This produces a scar that cuts off the blood supply to the hemorrhoid, causing it to shrink.
  • Infrared photocoagulation: Shining infrared light toward an internal hemorrhoid heats the area, causing scar tissue to form. This blocks the hemorrhoid’s blood supply and reduces its size.
  • Electrocoagulation: Doctors send a low electric current into a hemorrhoid to create scarring. This scar tissue cuts off the blood supply, leading the hemorrhoid to shrink.

A doctor will usually carry out these procedures while a person is under local anesthesia.

Surgical options

Surgery may involve the complete removal of external hemorrhoids or prolapsed internal hemorrhoids. This procedure is known as a hemorrhoidectomy.

Alternatively, a doctor or surgeon may staple a prolapsed hemorrhoid back into place in the anus.

During these procedures, a patient may receive a spinal block, local, or general anesthesia. Most people can go home on the same day as the surgery.

Hemorrhoids can be either internal or external. Healthcare professionals use a grading system to describe internal hemorrhoids based on whether they remain in the rectum or protrude out of the anus.

Internal hemorrhoids

Internal hemorrhoids occur inside the rectum and are not visible from the outside. They are typically painless. Often, rectal bleeding is the first sign of internal hemorrhoids.

If an internal hemorrhoid protrudes through the anus, it’s called a prolapsed hemorrhoid. This condition may be due to a weakening of the muscles around the anus and can be painful.

Healthcare professionals grade internal hemorrhoids from 1 to 4, depending on the degree of prolapse:

  • Grade 1: Hemorrhoids remain in the rectum without prolapsing.
  • Grade 2: Hemorrhoids prolapse when a person passes stool, then return inside on their own.
  • Grade 3: Hemorrhoids are prolapsed and require pushing back in.
  • Grade 4: Hemorrhoids are prolapsed and will not go back inside.

External hemorrhoids

External hemorrhoids occur in the skin around the anus and are, therefore, visible.

There are more sensitive nerves in this part of the body, so external hemorrhoids can be very painful. Straining when passing stool may cause external or internal hemorrhoids to bleed.

A doctor will likely ask about a person’s medical history and perform a physical examination and other tests to check for hemorrhoids.

They will examine the area surrounding the anus for external hemorrhoids, which involves looking for:

They may also perform a digital rectal exam to diagnose internal hemorrhoids. This involves manually inspecting the anus using a gloved, lubricated finger to check for blood, sensitivity, and lumps.

If a doctor does not find internal hemorrhoids with a digital rectal exam, they may use a small device called an anoscope to check the anal and rectal lining. They may be able to view internal hemorrhoids as bulges through the device.

Lifestyle changes can help lower the risk of hemorrhoids. These include:

  • Eating a healthy diet: Eating plenty of foods rich in fiber, such as fruits, vegetables, and whole grains, can help keep stools soft. Taking OTC fiber supplements and staying hydrated can also ease constipation.
  • Avoiding straining: A person should try not to strain when using the toilet. Straining puts pressure on the veins in the lower rectum.
  • Going to the bathroom when necessary: It is best to avoid waiting to use the toilet. The longer a person waits, the drier the stools will be.
  • Getting regular physical activity: Exercise helps stool move through the bowel, making bowel movements more regular.
  • Maintaining a moderate body weight: Being overweight increases the risk of hemorrhoids.

Hemorrhoid symptoms often resolve on their own with conservative treatment, although there is a 10–50% chance they will return over 5 years. The chance of hemorrhoids returning after surgery is less than 5%.

Complications can sometimes occur, such as:

Anyone with the following symptoms should seek immediate medical help.

  • persistent or heavy bleeding, with or without pain
  • pus leaking from hemorrhoids
  • fever
  • severe pain

It is important for a person to talk with a doctor if hemorrhoids show no improvement after a week or if new hemorrhoids keep forming.

Besides hemorrhoids, conditions such as colorectal and anal cancers can cause bleeding from the rectum.

Hemorrhoids are common and will often resolve without medical treatment. While symptoms may be painful, they often improve after several days of home treatments.

Lifestyle changes, such as proper hydration, maintaining a moderate weight, and eating more fiber, can also help prevent hemorrhoids.

If hemorrhoid symptoms persist beyond a week or complications occur, a person may need medical treatment. A person should call a doctor if more severe symptoms appear, particularly heavy bleeding, severe pain, or fever.