Hemorrhoids: Symptoms, Causes, and Effective Treatments

Hemorrhoids, also known as piles, are a normal part of the anal canal. They consist of blood vessels and supporting tissue that help maintain continence.

Hemorrhoidal disease develops when these structures become enlarged, displaced, inflamed, or begin to bleed or cause discomfort. It is a common condition and often improves with changes in diet and bowel habits.

However, rectal bleeding should not automatically be attributed to hemorrhoids. Anal fissures, polyps, intestinal inflammation, and colorectal cancer can also cause blood in the stool. A medical evaluation is necessary to confirm the source.

Hemorrhoids are located where the rectum meets the anus. Depending on their location, they are classified as internal or external.

Internal hemorrhoids develop inside the anal canal. They generally do not cause pain because this area is less sensitive, but they may cause:

• Bright red bleeding.
• Tissue that protrudes during a bowel movement.
• A feeling of incomplete evacuation.
• Mucus discharge.
• Irritation or itching.

Internal hemorrhoids are classified according to the degree of prolapse:

• Grade I: They remain inside the anal canal.
• Grade II: They protrude during a bowel movement and return on their own.
• Grade III: They protrude and must be pushed back manually.
• Grade IV: They remain outside and cannot be returned to the anal canal.

The grade helps guide treatment, but the surgeon also considers bleeding, discomfort, and the effect of symptoms on everyday life.

External hemorrhoids develop under the skin around the anus. They may cause:

• Pain or tenderness.
• Itching.
• Swelling.
• Difficulty cleaning the area.
• A lump near the anus.

After the swelling decreases, a fold of skin called a skin tag may remain. It does not always require treatment.

A thrombosed hemorrhoid develops when a blood clot forms inside an external hemorrhoid. It usually causes:

• Sudden, severe pain.
• A firm and very tender lump.
• Swelling.
• Blue or purple discoloration.

The clot remains localized and does not travel to other parts of the body. Some patients improve with conservative care, while others may benefit from early removal under local anesthesia.

Common symptoms include:

• Bright red blood on toilet paper.
• Blood on the stool or in the toilet.
• Anal itching or irritation.
• Pain or tenderness around the anus.
• Swelling.
• A lump near the anus.
• Tissue protruding during a bowel movement.
• Mucus discharge.
• Difficulty cleaning the area.

Severe pain during and after a bowel movement may be caused by an anal fissure. Constant pain accompanied by fever, redness, or pus may indicate an abscess.

Not every anal symptom is caused by hemorrhoids.

Hemorrhoidal disease is associated with repeated pressure in the anal canal and the gradual weakening of the tissues that support the hemorrhoidal structures.

Associated factors include:

• Frequent straining during bowel movements.
• Chronic constipation.
• Persistent diarrhea.
• Spending too much time sitting on the toilet.
• Pregnancy.
• Obesity.
• Repeated heavy lifting.
• A low-fiber diet.
• Age-related weakening of supporting tissues.
• Family history.
• Persistent changes in bowel habits.

Anal intercourse is not considered a proven cause of hemorrhoidal disease. However, it may irritate an already inflamed area or cause other injuries.

The growing uterus, hormonal changes, constipation, and straining during childbirth can contribute to hemorrhoids.

Many pregnancy-related hemorrhoids improve after delivery. Any cream, medication, or procedure used during pregnancy should be reviewed with a Gynecology and Obstetrics specialist.

Rectal bleeding during pregnancy also requires an evaluation, even when it appears to come from a hemorrhoid.

There is no reliable home test that can confirm the diagnosis. A medical evaluation may include:

• Inspection of the skin around the anus.
• A digital rectal examination.
• Anoscopy.
• Proctoscopy.
• Sigmoidoscopy or colonoscopy in selected cases.

Anoscopy allows the specialist to examine the anal canal and identify internal hemorrhoids, bleeding, inflammation, or other lesions.

A colonoscopy is not necessary for every person with hemorrhoids. It may be recommended when:

• The source of bleeding is unclear.
• There are changes in bowel habits.
• Anemia or unintentional weight loss is present.
• The patient has abdominal pain.
• There is a family history of colorectal cancer.
• Colorectal cancer screening is due.
• Bleeding continues after hemorrhoid treatment.

New rectal bleeding should never be assumed to be caused only by hemorrhoids without considering other conditions.

No. Hemorrhoids are structures in the anal canal that can become enlarged, inflamed, displaced, or cause bleeding. Hemorrhoid surgery refers to procedures used to treat advanced disease or symptoms that do not improve with other options.

Most people with hemorrhoids do not need an operation. Treatment generally begins with fiber, adequate hydration, constipation management, and healthier bowel habits.

When there is persistent prolapse, large external hemorrhoids, combined internal and external disease, or recurrent bleeding, the surgeon may consider an operation.

To learn about surgical techniques, preparation, and postoperative care, read our blog to hemorrhoid surgery: procedures and recovery.

Conservative measures are the initial treatment for most mild cases.

Fiber helps produce softer stools that are easier to pass. Sources include:

• Fruits.
• Vegetables.
• Legumes.
• Whole grains.
• Seeds.
• Nuts.

A fiber supplement such as psyllium may also be used. Increase the amount gradually to reduce gas and abdominal bloating.

Drinking enough fluids helps keep stool from becoming excessively dry. Individual fluid needs depend on climate, physical activity, diet, and medical conditions.

Recommendations include:

• Do not ignore the urge to have a bowel movement.
• Avoid prolonged straining.
• Do not remain on the toilet while using your phone or reading.
• Establish a regular bowel routine.
• Treat persistent constipation or diarrhea.
• Avoid aggressive cleaning of the anal area.

Sitting in warm water may temporarily relieve pain, irritation, and muscle spasm. Scented products or irritating substances are not necessary.

Some over-the-counter products can temporarily relieve itching or inflammation.

Creams containing corticosteroids should not be used for long periods without medical supervision because they can thin and irritate the skin. Local anesthetics can also cause sensitivity or dermatitis.

A physician may recommend pain medication based on the patient’s health and other treatments. If you are bleeding or take blood thinners, consult a medical professional before using anti-inflammatory medication.

Mild symptoms may improve within several days after constipation is addressed, fiber intake is increased, and straining is avoided.

A thrombosed external hemorrhoid is usually most painful during the first few days and then gradually improves. The lump may take several weeks to disappear.

Request an evaluation if symptoms do not improve after one week, keep returning, or include bleeding.

Some patients improve with:

• Pain medication.
• Sitz baths.
• Measures to soften the stool.
• Management of inflammation.
• Medical observation.

When the pain is severe and the thrombosis is recent, the surgeon may offer removal of the thrombosed tissue under local anesthesia. This procedure can provide faster relief and reduce recurrence.

The decision should not be based exclusively on a strict 72-hour rule. The surgeon considers how long symptoms have been present, pain intensity, the appearance of the lesion, and the patient’s preferences.

Never attempt to cut, puncture, or drain a hemorrhoid at home.

When conservative treatment does not work, minimally invasive office procedures may be considered. These techniques are mainly used for internal hemorrhoids and do not treat external hemorrhoids.

The specialist places a small band around the base of the hemorrhoid to interrupt its blood supply. The tissue shrinks and later falls off.

Rubber band ligation is one of the most effective office treatments for grade I and II internal hemorrhoids and selected grade III cases.

It may cause pressure, mild discomfort, or minor bleeding. Severe pain, fever, difficulty urinating, or heavy bleeding after the procedure requires immediate medical attention.

A substance is injected into the hemorrhoidal tissue to make it shrink. It may be used in selected cases of internal bleeding.

Infrared energy is used to reduce blood flow to the hemorrhoid. It may be appropriate for small internal hemorrhoids.

The choice depends on the grade, symptoms, current medications, and the specialist’s experience.

Rubber band ligation, sclerotherapy, and infrared coagulation are outpatient procedures mainly intended for internal hemorrhoids. They are not the same as a hemorrhoidectomy.

Surgery is generally reserved for advanced disease or symptoms that persist after other treatments.

Being referred for a surgical evaluation does not mean that every patient needs an operation. The specialist must confirm the diagnosis, classify the hemorrhoids, and select the least invasive option capable of controlling the symptoms.

Surgery may be recommended when:

• Large, symptomatic external hemorrhoids are present.
• There is combined internal and external disease.
• Internal hemorrhoids are grade III or IV.
• Prolapsed tissue remains outside the anus.
• Bleeding or discomfort does not improve.
• Symptoms return after office procedures.
• The condition significantly affects quality of life.

A hemorrhoidectomy removes hemorrhoidal tissue. It is one of the most effective treatments for advanced disease, although recovery usually causes more pain than office procedures.

After surgery, patients need to:

• Manage pain appropriately.
• Keep stools soft.
• Avoid straining.
• Care for the surgical area.
• Attend follow-up appointments.

This procedure uses a device to identify and tie off the arteries supplying the hemorrhoidal tissue. It may cause less pain than a hemorrhoidectomy, although recurrence may be more likely in some cases.

This procedure uses a stapling device to reposition prolapsed hemorrhoidal tissue.

Current recommendations do not routinely consider it a first-line surgical option because of its higher recurrence rate and certain rare but potentially serious complications. Its use must be individualized.

Although these procedures are generally safe, potential complications include:

• Pain.
• Bleeding.
• Infection.
• Urinary retention.
• Anal narrowing.
• Recurrence.
• Continence problems, which are uncommon.
• The need for another procedure.

Individual risk depends on the technique, the extent of the disease, and the patient’s overall health.

Important preventive measures include:

• Consume enough fiber.
• Maintain adequate hydration.
• Avoid straining.
• Do not spend prolonged periods on the toilet.
• Exercise regularly.
• Treat constipation and diarrhea.
• Maintain a healthy weight.
• Do not repeatedly postpone bowel movements.
• Follow postoperative or post-procedure instructions.

No cream can prevent recurrence on its own. Correcting bowel habits is essential.

Schedule an evaluation with General Surgery or Colorectal Surgery if you have:

• Rectal bleeding.
• A painful anal lump.
• Tissue that protrudes during a bowel movement.
• Persistent itching or irritation.
• Symptoms that do not improve after one week.
• Recurrent episodes.
• Difficulty keeping the area clean.
• Frequent need for creams or suppositories.

An examination can confirm whether hemorrhoids are responsible and identify the least invasive treatment capable of resolving the problem.

Go to the Emergency Department immediately if you experience:

• Heavy or continuous bleeding.
• Dizziness, fainting, pale skin, or severe weakness.
• Severe anal pain accompanied by fever.
• Pus or abnormal discharge.
• Rapidly increasing swelling.
• Severe abdominal pain.
• Black or tarry stools.

Black stools may indicate bleeding from a higher area of the digestive tract and are not the typical pattern associated with hemorrhoids.

At BlueNetHospitals Los Cabos, our Advanced General Surgery specialists can evaluate bleeding, pain, prolapse, or swelling and determine whether you need conservative care, an office procedure, or surgery.

If you have hemorrhoid symptoms, avoid self-medicating for several weeks without confirming the diagnosis.

📲 Schedule your General Surgery appointment via WhatsApp: +52 (624) 151 0693

If you have heavy bleeding, fainting, fever, or severe pain:

📞 24-hour Emergency Care: +52 (624) 1043 911

Hemorrhoids are normal vascular structures in the anal canal. They cause hemorrhoidal disease when they become enlarged, inflamed, displaced, or begin to bleed.

They may cause bright red blood, itching, swelling, a painful lump, or tissue that protrudes during a bowel movement.

They generally are not. Their most common symptom is painless bleeding. Pain may occur if they prolapse, become strangulated, or another condition is present.

No. Fissures, polyps, inflammation, and colorectal cancer can also cause bleeding. New or persistent bleeding requires an evaluation.

Gradually increasing fiber, maintaining adequate hydration, avoiding straining, and limiting time on the toilet may improve mild cases.

They may temporarily relieve itching or inflammation, but they do not correct prolapse or eliminate every hemorrhoid. They should not be used indefinitely.

It is an external hemorrhoid containing a localized blood clot. It causes a firm lump and severe pain, but the clot does not travel to other parts of the body.

It is mainly used for grade I and II internal hemorrhoids and selected grade III cases that do not improve with conservative treatment.

It may be recommended for large external hemorrhoids, combined disease, grade III or IV internal hemorrhoids, persistent prolapse, or symptoms that do not respond to other treatments.

Hemorrhoids are evaluated and treated by a general surgeon or colorectal surgeon, depending on the hospital’s organization and available specialists.