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A nagging itch, some pain and maybe a little blood — if you're experiencing these symptoms around your anal area, you might be wondering, "Do I have hemorrhoids?" You are not alone. Hemorrhoids are incredibly common. Nearly half of people older than 50 in the United States have them and it’s the outpatient gastrointestinal (GI) diagnosis. Understanding what hemorrhoids are, recognizing the symptoms, and knowing when to seek help can guide your next steps.

Ahmad Alkaddour, MD, a gastroenterologist at Northwestern Medicine, shares insights about hemorrhoids and answers common questions.

What are hemorrhoids?

Hemorrhoids are swollen veins in your anus and lower rectum, caused by extra pressure. Hemorrhoids can be internal (inside the rectum) or external (under the skin around the anus).

Why do they happen?

Anything that puts pressure on the veins in your rectum and anus can lead to hemorrhoids. Common factors include:

• Straining during bowel movements: This is a major culprit. Chronic constipation or diarrhea can force frequent straining, which puts pressure on your veins.
• Sitting on the toilet for long periods: Spending too much time on the toilet can increase pressure on your veins.
• Obesity: Excess weight puts added pressure on your rectal veins.
• Pregnancy: A growing baby puts pressure on the veins in the lower abdomen and pelvis. Hormonal changes during pregnancy can also contribute.
• Aging: As you age, the tissues supporting the veins in the rectum and anus weaken, making them more susceptible to swelling.
• Lifting heavy objects: Repeatedly lifting heavy items can increase pressure in your pelvic area.
• A low-fiber diet: A lack of fiber can lead to constipation, which can result in hemorrhoids.
• Genetics: Some people are predisposed to developing hemorrhoids.

What are the key symptoms?

Here's a breakdown of common symptoms. However, each person’s symptoms may vary.

• Rectal bleeding
• This is often the most alarming symptom. You might notice bright red blood on toilet paper, in the toilet bowl or streaked on your stool.
• It's usually painless, especially with internal hemorrhoids.
• Anal itching
• An irritating itch around the anus is a frequent complaint, particularly with external hemorrhoids.
• Anal pain or discomfort
• External hemorrhoids can cause significant pain, especially if a blood clot forms inside a vein (thrombosis).
• Internal hemorrhoids may cause discomfort or a feeling of fullness in the rectum.
• Painful hemorrhoids can make it hard to clean your anal area after a bowel movement, leading to increased irritation.
• Lumps or swelling
• You might feel a tender lump or swelling around your anus.
• Mucus discharge
• Some people experience mucus leaking from the anus.
• A lingering feeling of needing to go
• You might experience the sensation that your bowel movement wasn't fully completed.

Internal vs. external hemorrhoids: What are the main differences?

• Internal hemorrhoids
• Located inside the rectum
• Typically can't be seen or felt
• Often painless but can cause bleeding
• May bulge out of the anus during bowel movements
• External hemorrhoids
• Located under the skin around the anus
• Can usually be seen and felt
• Sometimes painful, especially if a blood clot forms in the vein
• May cause itching and swelling

How are hemorrhoids diagnosed?

Blood in your poop can be a sign of hemorrhoids as well as other conditions, such as colorectal cancer or an anal fissure (a small tear in the lining of your anus).

“Anytime there's rectal bleeding, you should be evaluated by a doctor,” says Dr. Alkaddour. “An anal fissure and colon cancer can present like hemorrhoids.”

To confirm the diagnosis, your physician may run several tests, including:

• Digital rectal exam. For this procedure, your physician inserts a gloved, lubricated finger into your rectum to check for signs of swollen blood vessels.
• Anoscopy. A lighted, hollow tube known as an anoscope is inserted into your anal canal to inspect internal hemorrhoids.
• Proctoscopy. A proctoscope — a lighted tube that is slightly longer than an anoscope — is put into your anus to look at your whole rectum.
• Sigmoidoscopy. This examination inspects a portion of your large intestine using a short, flexible, lighted tube known as a sigmoidoscope. The device is inserted through the rectum and inflates your intestine with air to expand it and create a clearer view inside. It assists in identifying the causes of diarrhea, abdominal discomfort, constipation, unusual growths and bleeding. If necessary, a tissue sample (biopsy) can be collected.
• Colonoscopy. This procedure examines the entire length of your large intestine. A long, flexible, lighted instrument called a colonoscope is inserted through your rectum and into your colon. It allows your physician to observe your colon’s lining and detect any abnormal growths, inflamed or reddened tissue, ulcers or bleeding. They can extract a tissue sample (biopsy) for testing as well as address certain issues that are discovered during the examination.

Finding Relief

If you suspect you have hemorrhoids, don't panic — many effective home remedies and medical treatments are available. The right treatment approach will depend on your symptoms, age and overall health.

The primary objective of treatment is to alleviate your symptoms. This can be achieved through:

• Taking a sitz bath by sitting in warm, plain water in a bathtub
• Applying ice packs to minimize swelling
• Using hemorrhoid creams or rectal suppositories

Your physician might also recommend increasing your fiber and fluid intake to help soften your stools. Softer stools reduce straining during bowel movements, which decreases the pressure on your veins.

Incorporating more fiber into your diet involves consuming more: 

• Fruits
• Vegetables
• Whole grains

Your physician may also suggest that you take stool softeners, laxatives or fiber supplements. Additionally, you can reduce your need to push during a bowel movement by using a toilet stool. The short stool goes under your feet while you are on the toilet and puts your body in a squatting position, changing the angle of your rectal canal and leading to easier release of stool (poop).

In certain situations, medical procedures may be needed to remove or reduce internal and external hemorrhoids. These include:

• Rubber band ligation. A small rubber band is placed around the base of a hemorrhoid to cut off its blood supply. The hemorrhoid reduces in size and disappears within several days.
• Sclerotherapy. A chemical solution is injected into the hemorrhoid to shrink it.
• Electrical coagulation (also known as infrared photocoagulation). A tool with an infrared light beam is used to cauterize hemorrhoid tissue.
• Stapled hemorrhoidectomy (or hemorrhoidopexy). A surgeon uses a stapling device to remove hemorrhoid tissue. This surgical procedure is typically reserved for severe cases.

When should I seek medical help?  

While many of the symptoms of hemorrhoids can improve with lifestyle changes, it's important to talk with your doctor if you experience any of the following:

• Severe pain
• Rectal bleeding
• Symptoms that don’t improve with home treatment
• Changes in your bowel habits
• Dizziness or lightheadedness, which could indicate significant blood loss

Don't let embarrassment keep you from seeking medical help. Hemorrhoids are a common condition, and effective treatments are available. Your care team can help you find the best course of action.