10 Common Hemorrhoids Symptoms You Should Know About

Hemorrhoids, also known as piles, are swollen veins in the lower rectum and anus that affect millions of people worldwide. They can occur internally inside the rectum or externally under the skin around the anus. Understanding the symptoms of hemorrhoids is crucial for early recognition and proper management of this common condition. While hemorrhoids can be uncomfortable and sometimes painful, recognizing the signs early can help you take appropriate action and seek medical advice when necessary.

This comprehensive guide will walk you through the most common symptoms associated with both internal and external hemorrhoids, helping you identify what you might be experiencing and when it’s time to consult a healthcare professional.

1. Rectal Bleeding

One of the most common and noticeable symptoms of hemorrhoids is rectal bleeding. This typically appears as bright red blood on toilet paper, in the toilet bowl, or on the surface of your stool after a bowel movement. The blood is usually painless and occurs when hard stools damage the surface of the hemorrhoid.

With internal hemorrhoids, bleeding is often the first and sometimes the only symptom you’ll notice. The blood appears bright red because it’s fresh and hasn’t been digested. It’s important to note that while hemorrhoid bleeding is typically painless, any rectal bleeding should be evaluated by a healthcare provider to rule out other more serious conditions such as colorectal cancer or inflammatory bowel disease.

The amount of bleeding can vary from person to person – some may notice just a few drops, while others might see more significant amounts. The bleeding usually stops on its own after the bowel movement is complete.

2. Pain and Discomfort in the Anal Area

Pain is particularly common with external hemorrhoids and thrombosed hemorrhoids. The discomfort can range from mild irritation to severe, sharp pain that makes sitting, walking, or having a bowel movement extremely uncomfortable. External hemorrhoids are more likely to cause pain because they’re located in an area with more pain-sensing nerves.

The pain may be constant or may worsen during certain activities such as sitting for long periods, during bowel movements, or when wiping after using the bathroom. When a blood clot forms in an external hemorrhoid (thrombosed hemorrhoid), the pain can be particularly intense and sudden. This type of pain is often described as a severe, constant ache accompanied by swelling.

Internal hemorrhoids, on the other hand, typically don’t cause pain unless they prolapse (protrude through the anal opening) or become strangulated when the blood supply is cut off.

3. Itching and Irritation

Anal itching, medically known as pruritus ani, is a frustrating and common symptom of hemorrhoids. This persistent itching around the anal area can be quite bothersome and may worsen at night or after bowel movements. The itching occurs due to several factors related to hemorrhoids.

When hemorrhoids produce mucus discharge, this moisture can irritate the sensitive skin around the anus, leading to itching. Additionally, swollen hemorrhoid tissue can make it difficult to clean the area properly after bowel movements, leaving small amounts of stool that cause irritation and itching.

The urge to scratch can be overwhelming, but scratching can further irritate the area, potentially causing small tears in the skin and creating a cycle of itching and irritation. The skin around the anus may also become inflamed and sensitive, making the itching sensation even more pronounced.

4. Swelling Around the Anus

Swelling around the anal area is a telltale sign of external hemorrhoids. You may notice one or more lumps near your anus that feel swollen, firm, or tender to the touch. This swelling occurs when the veins in the anal area become enlarged and inflamed.

The size of the swelling can vary considerably – from the size of a small pea to as large as a grape or even bigger in severe cases. The swollen area may feel hard or soft depending on whether a blood clot has formed inside. Some people describe feeling like they’re sitting on a marble or small ball.

This swelling can make everyday activities uncomfortable, particularly sitting, walking, or exercising. The swollen tissue may also make it more difficult to keep the anal area clean after bowel movements, which can contribute to irritation and other symptoms.

5. A Lump or Bulge Near the Anus

Many people with hemorrhoids report feeling a lump or bulge near or protruding from the anus. With external hemorrhoids, you can typically feel this lump around the outside of the anal opening. These lumps may be sensitive or painful to touch, especially if a blood clot has formed.

In cases of prolapsed internal hemorrhoids, you might feel or see pink, moist tissue that protrudes from the anus. This happens when internal hemorrhoids become enlarged enough to stretch and push through the anal opening. Initially, prolapsed hemorrhoids may retract back inside the rectum on their own after a bowel movement, but in more advanced cases, they may remain outside and need to be gently pushed back in, or they may not go back in at all.

The presence of a visible or palpable lump can be alarming, but it’s important to remember that hemorrhoids are generally not dangerous. However, any new lump or growth in the anal area should be examined by a healthcare professional to ensure an accurate diagnosis.

6. Leakage of Feces or Mucus

Some people with hemorrhoids experience involuntary leakage of small amounts of stool or mucus. This symptom, also called fecal incontinence or soiling, can be embarrassing and distressing. It occurs for several reasons related to hemorrhoid development.

When internal hemorrhoids prolapse, they can interfere with the anal sphincter’s ability to close completely, allowing small amounts of stool or mucus to leak out. Additionally, hemorrhoids themselves can produce mucus discharge, which may leak from the anus and stain underwear.

This leakage can contribute to other symptoms such as itching, irritation, and a feeling of dampness or uncleanliness in the anal area. The constant moisture can also lead to skin irritation and inflammation around the anus, creating a condition sometimes called perianal dermatitis.

7. Feeling Like Your Bowel Hasn’t Completely Emptied

Many individuals with hemorrhoids describe a persistent feeling that their bowels haven’t completely emptied, even immediately after having a bowel movement. This sensation, known as tenesmus, can be uncomfortable and frustrating, often leading people to strain or spend extra time on the toilet trying to pass more stool.

This feeling is particularly common with internal hemorrhoids that have prolapsed or become enlarged. The swollen hemorrhoid tissue can create a sensation of fullness or pressure in the rectum that mimics the feeling of needing to have a bowel movement, even when the bowels are actually empty.

Ironically, straining in response to this feeling can actually worsen hemorrhoids and create a vicious cycle. It’s important to resist the urge to strain and to leave the bathroom even when you feel this sensation, as prolonged sitting and straining can exacerbate hemorrhoid symptoms.

8. Painful Bowel Movements

Experiencing pain during or immediately after a bowel movement is a common symptom of hemorrhoids, particularly external hemorrhoids or prolapsed internal hemorrhoids. The pain can range from a sharp, stinging sensation to a dull, throbbing ache that persists after the bowel movement is complete.

The pain during defecation occurs because passing stool puts pressure on the swollen hemorrhoid tissue. Hard or large stools can be especially painful as they stretch the anal canal and may cause the hemorrhoid to bleed. Some people describe the sensation as feeling like they’re passing glass or sharp objects.

After the bowel movement, you may continue to experience throbbing or aching pain that can last for several minutes to hours. This post-bowel movement discomfort can make people anxious about their next trip to the bathroom, sometimes leading them to delay bowel movements, which unfortunately can make stools harder and more difficult to pass, creating another problematic cycle.

9. Sensitive Lumps That Are Tender to Touch

External hemorrhoids often present as sensitive lumps around the anal opening that are particularly tender when touched, pressed, or during activities like sitting or wiping. These tender areas can make even gentle contact uncomfortable or painful.

The tenderness is especially pronounced when a thrombosed external hemorrhoid develops – this occurs when a blood clot forms within the hemorrhoid. A thrombosed hemorrhoid typically appears as a firm, bluish or purple lump near the anus and can be extremely painful and sensitive. The affected area may feel hard and warm to the touch.

Even non-thrombosed external hemorrhoids can be quite tender, particularly when inflamed. The tenderness may increase with certain positions or activities, and many people find that they need to adjust how they sit or avoid certain types of physical activity to minimize discomfort.

10. Visible Protrusion During Bowel Movements

In cases of internal hemorrhoids that have progressed, you may notice tissue protruding or bulging from the anus during or after bowel movements. This prolapse can be startling when first experienced, but it’s a common symptom of more advanced internal hemorrhoids.

There are different degrees of prolapse. In early stages, the hemorrhoid tissue may protrude during straining or bowel movements but spontaneously retract back inside afterward. As the condition progresses, the prolapsed tissue may need to be manually pushed back inside. In the most advanced stage, the prolapsed hemorrhoid remains outside permanently and cannot be pushed back in.

The prolapsed tissue typically appears as pink or red, moist, bulging tissue that may look similar to the lining inside your mouth. It may or may not be painful, depending on whether it becomes trapped or strangulated. A prolapsed hemorrhoid can interfere with hygiene and may be accompanied by mucus discharge and soiling.

What Causes Hemorrhoids?

Understanding what causes hemorrhoids can help you recognize your risk factors and potentially prevent future occurrences. Hemorrhoids develop when the veins in the rectum and anus become swollen due to increased pressure. Several factors contribute to this increased pressure:

Straining During Bowel Movements: This is one of the most common causes. Chronic constipation or diarrhea that leads to frequent straining puts significant pressure on the veins in the rectal area.

Chronic Constipation or Diarrhea: Both conditions can contribute to hemorrhoid development. Constipation causes straining, while chronic diarrhea can irritate and inflame the anal area.

Prolonged Sitting: Sitting for long periods, especially on the toilet, increases pressure on the veins in the anus and can lead to hemorrhoids. This is particularly common in people with desk jobs or those who spend extended time sitting.

Pregnancy and Childbirth: Pregnancy increases pressure on the pelvic veins, and the strain of childbirth can cause or worsen hemorrhoids. This makes hemorrhoids particularly common in females during and after pregnancy.

Obesity: Carrying excess weight, especially around the abdomen, puts additional pressure on pelvic veins and can contribute to hemorrhoid development.

Heavy Lifting: Regularly lifting heavy objects, especially with improper technique, increases abdominal pressure and can contribute to hemorrhoids.

Low-Fiber Diet: A diet lacking in fiber can lead to harder stools that require more straining to pass, increasing the risk of hemorrhoids.

Age: Hemorrhoids become more common as we age because the tissues supporting the veins in the rectum and anus can weaken and stretch over time.

Chronic Coughing: Persistent coughing increases abdominal pressure and can contribute to hemorrhoid development.

How to Prevent Hemorrhoids

While not all cases of hemorrhoids can be prevented, there are several lifestyle modifications and habits that can significantly reduce your risk of developing them or prevent existing hemorrhoids from worsening:

Maintain a High-Fiber Diet: Eating plenty of fruits, vegetables, whole grains, and legumes helps keep stools soft and easier to pass, reducing the need for straining. Aim for 25-35 grams of fiber daily.

Stay Well Hydrated: Drinking adequate water throughout the day helps prevent constipation by keeping stools soft. Aim for at least 8 glasses of water daily.

Don’t Delay Bowel Movements: When you feel the urge to have a bowel movement, go promptly. Delaying can cause stools to become harder and more difficult to pass.

Avoid Straining: Never force a bowel movement or strain excessively. If you’re having trouble, it’s better to wait and try again later rather than push hard.

Don’t Sit Too Long on the Toilet: Spending extended periods sitting on the toilet, even if you’re just reading or using your phone, increases pressure on the anal veins. Go to the bathroom only when you feel the need, and leave promptly after you’re finished.

Exercise Regularly: Regular physical activity helps prevent constipation and reduces pressure on veins by helping you maintain a healthy weight. Exercise also promotes regular bowel movements.

Maintain a Healthy Weight: Losing excess weight reduces pressure on the pelvic and rectal veins, lowering your risk of developing hemorrhoids.

Avoid Heavy Lifting: If you must lift heavy objects, use proper technique – bend at the knees, not at the waist, and avoid holding your breath, which increases abdominal pressure.

Practice Good Bathroom Habits: Avoid reading or using electronic devices while on the toilet, as this encourages prolonged sitting. Also, consider using moistened toilet paper or wipes for gentler cleaning.

Do Kegel Exercises: These exercises strengthen the muscles around the anus and rectum, improving circulation and potentially reducing hemorrhoid risk.

Frequently Asked Questions About Hemorrhoids

How do you know if you have hemorrhoids?

Common signs include painless bright red bleeding during bowel movements, itching or irritation in the anal area, pain or discomfort, swelling around the anus, or a lump near the anal opening. Internal hemorrhoids may cause bleeding without pain, while external hemorrhoids are often painful and visible.

Do all hemorrhoids bleed?

No, not all hemorrhoids bleed. Bleeding is more common with internal hemorrhoids and typically appears as bright red blood on toilet paper or in the toilet bowl. External hemorrhoids may not bleed unless they’re irritated or damaged.

What’s the difference between internal and external hemorrhoids?

Internal hemorrhoids develop inside the rectum and are usually painless but may bleed. External hemorrhoids form under the skin around the anus, are often painful, and can be felt or seen as lumps. Internal hemorrhoids can prolapse or protrude outside the anus.

Are hemorrhoids more common in females or males?

Hemorrhoids affect both men and women, though women may be more prone to them during pregnancy and childbirth due to increased pressure on pelvic veins. Overall, hemorrhoids are equally common in both sexes, particularly as people age.

Can hemorrhoids go away on their own?

Small hemorrhoids often improve or resolve on their own within a few days to a week, especially with home care measures like increasing fiber intake, staying hydrated, and avoiding straining. However, larger or more severe hemorrhoids may require medical attention.

When should I see a doctor about hemorrhoids?

You should consult a healthcare provider if you experience persistent or severe pain, bleeding that doesn’t stop or is heavy, symptoms that don’t improve after a week of home care, or if you notice any changes in bowel habits. Any rectal bleeding should be evaluated to rule out other conditions.

Are hemorrhoids dangerous?

Hemorrhoids are rarely dangerous, though they can be uncomfortable and bothersome. In rare cases, complications can occur, such as severe bleeding leading to anemia or strangulated hemorrhoids where the blood supply is cut off. It’s important to have symptoms evaluated by a healthcare professional.

Can you get hemorrhoids from sitting too much?

Yes, prolonged sitting increases pressure on the veins in the lower rectum and anus, which can contribute to hemorrhoid development. This is particularly true for extended sitting on the toilet, which puts even more direct pressure on the anal area.

What causes hemorrhoids in younger people?

In younger individuals, hemorrhoids are often caused by chronic constipation and straining, low-fiber diets, prolonged sitting (especially on the toilet), heavy lifting, obesity, or in women, pregnancy and childbirth. Lifestyle factors play a significant role in hemorrhoid development at any age.

Can hemorrhoids cause severe pain?

Yes, particularly thrombosed external hemorrhoids can cause severe, sudden pain. This occurs when a blood clot forms within the hemorrhoid. Regular external hemorrhoids can also be quite painful, while internal hemorrhoids typically only cause pain if they prolapse and become trapped.

References:

• Mayo Clinic – Hemorrhoids
• National Institute of Diabetes and Digestive and Kidney Diseases – Hemorrhoids
• Johns Hopkins Medicine – Hemorrhoids
• Cleveland Clinic – Hemorrhoids
• NHS – Piles (Haemorrhoids)