What is Hemorrhoids?

What is Hemorrhoids?

Hemorrhoids, or piles, are enlarged or swollen blood vessels in the lower rectum and anus. They are very common and can occur in both men and women. They don’t cause serious health problems but can be annoying and uncomfortable.

While we are all born with hemorrhoids, they don’t usually bother us. They can, however, swell over time and cause symptoms that may require treatment. This occurs in about one in 20 Americans. Hemorrhoidal symptoms become more common as you age: About half of adults over the age of 50 have them.

Types of Hemorrhoids


There are two main types of hemorrhoids:

  • External hemorrhoids. These are swollen blood vessels that form under the skin around the anus. Your anus is the opening of your rectum to the outside of your body. These are usually painless unless they become very swollen and form blood clots (thrombose).
    • Thrombosed hemorrhoids. Sometimes, a blood clot can form in an external hemorrhoid. These can appear as painful masses quite suddenly. If they are big, they can be very uncomfortable.
  • Internal hemorrhoids. These are swollen blood vessels that form within the lower rectum. They may bleed but are usually painless. They may protrude from the anus (prolapse) during a bowel movement.
    • Prolapsed hemorrhoids. The internal hemorrhoids can prolapse, which means that they stretch and bulge out of your rectum. They can retract spontaneously or be pushed back in with external pressure. In rare cases, prolapsed internal hemorrhoids cannot be pushed back into normal position and require urgent treatment. These complications can cause various degrees of discomfort and pain.

Grades of Hemorrhoids


If you have internal hemorrhoids, your doctor may grade them based on how much they prolapse, or stick out, of your anal canal.

There are four different grades:

  • Grade 1 hemorrhoids do not prolapse or protrude externally. They usually bleed or cause other symptoms like itching, burning, or discomfort.
  • Grade 2 hemorrhoids protrude into your anal canal when you have a bowel movement or try to have one, but they return to their regular position when you stop straining.
  • Grade 3 hemorrhoids protrude, either with straining or just on their own, until you push them back in again.
  • Grade 4 hemorrhoids are chronically prolapsed, which means they stick out of your anal canal and can’t be pushed back in.

Signs & Symptoms of Hemorrhoids


How do you know if you have hemorrhoids? Often, there are no signs of hemorrhoids. But some of the most common hemorrhoid symptoms include:

  • Rectal bleeding. If you have internal hemorrhoids, you might notice bright red blood in your bowel movements, in the toilet bowl, or when you wipe yourself. While there usually isn’t much blood, even a small amount in toilet water can make it appear bright red, which may be scary. External hemorrhoids may bleed if they become thrombosed.
  • Itchy anus. Hemorrhoids commonly cause anal itching and irritation of the skin that’s around your anus. This is particularly true of internal hemorrhoids, which often prolapse into the anal canal.
  • Lumps near anus. You may notice at least one hard, tender lump in the area. This is particularly true if you have external hemorrhoids.
  • Pain in anus. You may experience pain, especially when you sit.
  • “Stuck” stool. If you have internal hemorrhoids, it may feel like your bowel movements (BMs) are “stuck” at your anus. It may also be hard to clean yourself after a BM, and you may notice mucus discharge.
  • Skin tags. If you have had a previous thrombosed hemorrhoid, it can stretch out skin even after your body absorbs the blood clot. The resulting skin tags are soft and painless.

New York Presbyterian’s colon and rectal surgeons and gastroenterologists can help treat common symptoms of hemorrhoids. Learn more about options here.

What Causes Hemorrhoids?


Hemorrhoids are essentially varicose veins that affect your anal area. Any time you strain, you put pressure on them.

Some causes of hemorrhoids include:

  • Straining due to weightlifting. Exercise itself may be protective against hemorrhoids, as it helps you lose weight that may be associated with hemorrhoids. But if you strain while you lift, it can put pressure on rectal vessels, which may lead to hemorrhoids.
  • Sitting for a long time. This increases pressure on anal veins, raising the risk of hemorrhoids.
  • Pushing hard to have a bowel movement. Pushing down during a BM can put pressure on the muscles and veins in the pelvic floor, resulting in hemorrhoids.
  • Chronic constipation or diarrhea. Constant straining can lead to hemorrhoids.
  • A low-fiber diet. This can cause constipation and, in some cases, hemorrhoids.
  • Pregnancy. During pregnancy, increased blood volume enlarges all veins, including the ones in the rectum. In addition, the weight of the fetus presses on the veins in your pelvis and alters blood flow. In some cases, this can lead to hemorrhoids.

It’s important to remember that certain anal symptoms, like rectal pain or bleeding, need to get checked out. These may not always be caused by a hemorrhoid, but by another, more serious bowel disease such as Crohn’s disease, ulcerative colitis, or even colon cancer.



Are hemorrhoids dangerous? The short answer is no. Hemorrhoids can be a pain in the butt — literally. But it’s very rare to develop complications from them. When complications do occur, they usually involve:

  • Anemia. Over time, hemorrhoids can cause blood loss
  • Blood clots. These may need to be lanced and drained
  • Strangulated hemorrhoid. The blood supply to an internal hemorrhoid may be cut off, which causes extreme pain
  • Infections. Since it’s harder to keep the area clean, you’re more at risk for bacterial or fungal infections in your rectal area



Hemorrhoids are painful and a nuisance, but there are ways to lower the incidence of flare-ups.

Here’s how to prevent hemorrhoids:

  • Not sitting too long on the toilet. The shape of a toilet seat puts extra pressure on your rectum and anus. Over time, this can cause swollen veins.
  • Not delaying bowel movements. If you put off your BMs, it can worsen constipation and trigger hemorrhoids.
  • Eating high-fiber foods. This makes your stools softer and easier to pass, which can help prevent hemorrhoids from forming. The Dietary Guidelines for Americans recommends 14 grams for every 1,000 calories you eat, or 28 grams for 2,000 calories. A half cup of high-fiber bran has 14 grams, a medium-sized apple has almost 5 grams, and a cup of raspberries has 8 grams.
  • Taking laxatives. If upping fiber intake isn’t enough, a laxative can improve constipation. Taking laxatives as needed may prevent long-term issues with constipation — and hemorrhoids. You may take laxatives in pill form, or your doctor may recommend it as an enema that you insert into your rectum.
  • Drink plenty of fluids. Water and other liquids in your diet, like clear soups, can help prevent constipation and allow the fiber in your diet to work better.
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