A hemorrhoid is a swollen or inflamed vascular cushion in and around the anal canal. Everyone has these cushions naturally. They’re spongy clusters of blood vessels, connective tissue, and muscle that sit just inside the anus, and they serve a real purpose: they help seal the anal canal closed and contribute roughly 15 to 20 percent of your ability to maintain continence. When people say they “have hemorrhoids,” they mean these cushions have become enlarged, irritated, or pushed out of position enough to cause symptoms like bleeding, itching, or pain.
What Hemorrhoids Actually Are
The anal cushions that become hemorrhoids are present from birth. In their normal state, they’re soft, blood-filled pads arranged in three main clusters inside the upper anal canal. Their tissue resembles erectile tissue, made up of a dense network of tiny blood vessels (arterioles, venules, and sinusoids) supported by elastic fibers and a small muscle that anchors them in place.
These cushions do more than just sit there. When you’re at rest, the pressure from your internal anal sphincter compresses them, causing them to fill with blood and swell just enough to form a seal. This keeps small amounts of stool, liquid, or gas from leaking out. Before a bowel movement, the cushions also help you sense what’s coming, whether it’s gas or stool, so your body can respond appropriately. After you go, they refill with blood and slide back into position to close the canal again.
Problems start when these cushions are repeatedly stretched, engorged with too much blood, or lose the connective tissue support that holds them in place. That’s when a normal anatomical structure becomes a symptomatic hemorrhoid.
Internal vs. External Hemorrhoids
Hemorrhoids fall into two categories based on where they form, and the distinction matters because the symptoms are quite different.
Internal hemorrhoids develop inside the anal canal, above a boundary called the dentate line. Because this area has relatively few pain-sensing nerves, internal hemorrhoids typically don’t hurt. The most common sign is bright red blood on toilet paper, on the surface of your stool, or dripping into the bowl. You often can’t feel them at all unless they’ve started to prolapse, meaning they bulge out through the opening of the anus.
Doctors grade internal hemorrhoids on a four-point scale. Grade I hemorrhoids bulge into the canal during a bowel movement but don’t come out. Grade II hemorrhoids push outside during straining but slide back in on their own. Grade III hemorrhoids come out and stay out until you push them back in manually. Grade IV hemorrhoids are permanently outside and can’t be pushed back in at all.
External hemorrhoids form under the skin around the outside of the anus. Unlike internal ones, they can be itchy, sore, and painful, especially when sitting. They feel like small, soft lumps near the anus and can’t be pushed back inside because they aren’t coming from inside the canal.
Sometimes a blood clot forms inside an external hemorrhoid, creating what’s called a thrombosed hemorrhoid. This causes a sudden, firm lump that may look blue, black, or purple and is often intensely painful. The pain from a thrombosed hemorrhoid tends to peak within the first 48 to 72 hours and then gradually improves as the clot is absorbed, though the lump itself can linger for weeks.
What Causes Them to Flare
Anything that increases pressure on the veins in and around the anal canal or weakens the tissue supporting the cushions can trigger hemorrhoid symptoms. The most common culprit is straining during bowel movements. Hard stool forces you to bear down, which increases pressure in the abdomen and blocks blood from draining out of the hemorrhoidal veins. The cushions engorge, stretch, and over time lose their elasticity.
Chronic constipation and spending long periods sitting on the toilet (scrolling your phone, reading) compound the problem. Pregnancy is another well-known trigger. The growing uterus presses on pelvic veins, causing congestion in the anal cushions. Most pregnancy-related hemorrhoids resolve on their own after delivery. Obesity, heavy lifting, a low-fiber diet, and chronic diarrhea all increase risk through similar mechanisms of repeated pressure and irritation.
Age plays a significant role. In one large study, 52% of adults over 50 reported hemorrhoid symptoms, compared to just 4.3% of people under 20. The connective tissue and muscle fibers anchoring the anal cushions weaken over decades, making prolapse and swelling more likely even without an obvious trigger.
What the Symptoms Feel Like
The experience varies depending on the type. With internal hemorrhoids, many people notice nothing until they see blood. It’s usually bright red and painless, appearing on the tissue after wiping or streaking the surface of the stool. If an internal hemorrhoid prolapses, you may feel a soft lump at the anal opening, along with a sensation of fullness or incomplete evacuation.
External hemorrhoids announce themselves differently. You might feel a tender bump near the anus that’s sore when you sit or wipe. Itching and irritation around the anal area are common. If a clot forms, the pain can be sharp and sudden, with noticeable swelling that’s sensitive to touch. The affected area may look discolored.
Mucus discharge and a feeling of wetness around the anus can occur with prolapsed internal hemorrhoids, since the displaced tissue secretes moisture that irritates the surrounding skin.
When Bleeding Needs a Closer Look
Bright red blood from a hemorrhoid is common and usually not dangerous, but rectal bleeding should never be automatically dismissed. Research published in the British Journal of General Practice found that even among patients who had visible hemorrhoids and bright red bleeding not mixed with stool, 2% still had a colorectal cancer present. The hemorrhoids were real, but they weren’t the only thing going on.
Certain features of rectal bleeding raise the concern for something more serious. Dark blood, blood that’s mixed into the stool rather than sitting on top of it, and a change in bowel habits are all associated with a higher likelihood of colorectal disease. Age matters too. Compared to people under 50, the odds of colorectal cancer in someone with rectal bleeding are roughly five times higher between ages 50 and 69, and eight times higher after 70. If your bleeding pattern changes, doesn’t improve with basic treatment, or comes with weight loss or new bowel changes, getting it evaluated is important.
Managing Hemorrhoids at Home
Most hemorrhoids, particularly grade I and grade II internal hemorrhoids, improve with straightforward changes. The single most effective adjustment is increasing your fiber intake to soften your stool and reduce straining. Current dietary guidelines recommend about 14 grams of fiber per 1,000 calories you eat, which works out to roughly 28 grams a day on a standard 2,000-calorie diet. Good sources include beans, lentils, whole grains, fruits, and vegetables. If you’re adding fiber to your diet, increase it gradually and drink plenty of water to avoid bloating.
Warm sitz baths, where you sit in a few inches of warm water for 10 to 15 minutes, can relieve pain and itching. Over-the-counter creams and suppositories containing ingredients like witch hazel or hydrocortisone provide temporary symptom relief. Keeping the anal area clean and dry, avoiding prolonged sitting on the toilet, and not straining or holding your breath during bowel movements all help prevent flares from recurring.
When Procedures Are Needed
If home measures aren’t enough, several office-based and surgical options exist. The most common is rubber band ligation, a procedure where a small band is placed around the base of an internal hemorrhoid to cut off its blood supply. The banded tissue shrinks and falls off within a few days. Most studies find it 70 to 80 percent effective. You can typically return to your usual activities the same day, though heavy lifting should be avoided for at least two weeks.
For larger or more advanced hemorrhoids (grade III and IV), surgical removal may be recommended. Recovery from surgery is more involved and can take several weeks, but it has the highest long-term success rate. Other options include infrared coagulation, where heat is used to shrink the tissue, and newer techniques that staple prolapsed tissue back into place. The right approach depends on the size, location, and grade of the hemorrhoid, as well as how much it’s affecting your daily life.