What are Hemorrhoids?

Hemorrhoids are veins in the lower rectum or anus that get engorged. Hemorrhoids are extremely common and will affect more than half the population at some point in their lives.

There are two types of hemorrhoids – internal and external – and it is very difficult for a person to know the difference between them. An internal hemorrhoid can look and feel like an external hemorrhoid, so it is important to have a physical examination that determines if internal hemorrhoids have prolapsed and if you have true external hemorrhoids.

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Symptoms of Internal Hemorrhoids

Do not let the name mislead you; internal hemorrhoids can be seen on the outside when they become large and prolapse. The symptoms of internal hemorrhoids include:

  • A bulge or bump
  • Itching
  • Bleeding
  • Dull pressure sensation
  • Pain after bowel movement
  • Rarely do patients experience severe pain

Hemorrhoids are graded on a scale from 1-4 to measure the severity.

  1. Small and on the inside
  2. Medium sized on the inside
  3. Prolapsing out but can be easily pushed back in
  4. Prolapsing out and cannot be pushed back in

*The majority of patients have hemorrhoids from grade 1-3.

To learn more about treatments for hemorrhoids, please visit our hemorrhoid banding page.


External Hemorrhoids

External hemorrhoids often occur after straining during a bowel movement and appear as painful bumps that usually have a purple discoloration. External hemorrhoids can be especially painful when they are surrounded a cluster of nerve endings near a nerve line known as the dentate line.

Symptoms of External Hemorrhoids

The symptoms of external hemorrhoids include:

  • Pain during bowel movement
  • Sensation of pressure near the anus
  • Bump or bulge around the anus
  • Rectal bleeding
  • Rectal itching

Many people believe they have external hemorrhoids when they really have anal fissures. Anal fissures are actually cracks in the rectal skin and the symptoms:

  • Pain
  • Sensation of razor blades passing when having a bowel movement
  • Blood in stool
  • Itching
  • Other symptoms similar to hemorrhoids

The over-the-counter treatment for hemorrhoids will not treat anal fissures. If you believe you have hemorrhoids, but are not feeling any relief, please contact us.

To learn more about the treatments for external hemorrhoids, please visit the hemorrhoids treatment page.


Hemorrhoids FAQ

1. What are hemorrhoids?

Hemorrhoids are veins in the lower rectum or anus that get engorged and cause pain.

2. What are the symptoms of hemorrhoids?

Before diagnosing symptoms, it’s important to realize that there are two different types of hemorrhoids (internal and external) and each present different symptoms. Symptoms for internal hemorrhoids could consist of itching, bleeding, dull pressure sensation, the presence of a prolapse from the anus, and/or pain after bowel movement. External hemorrhoid symptoms would likely include pain, sensation of pressure near the anus, bump or bulge around the anus, and/or rectal itching.

3. What are the causes of hemorrhoids?

Straining during bowel movements, sitting for long periods of time on the toilet, chronic diarrhea or constipation/straining during bowel movements, obesity, and pregnancy.

4.  When should I consult a practitioner and whom should be consult? (gynecologist, general surgeon, etc.)

If you experience any signs or symptoms of hemorrhoids, you should make an appointment with your doctor. You could be referred to a gastroenterologist or a colorectal surgeon and both would be able to provide quality treatment. As a gastroenterologist, Dr. Nowain offers a painless, non-surgical procedure known as hemorrhoid banding to treat internal hemorrhoids.

5.  Why hemorrhoids occur during pregnancy?

  1. The uterus puts pressure on the pelvic veins and the inferior vena cava, a large vein on the right side of the body that takes blood from the lower limbs and returns it to the right side of the heart. This causes an increased pressure in the veins of lower half of a woman’s body during pregnancy, which causes them to become more dilated or swollen.
  2. The hormone progesterone increases during pregnancy and causes the walls of veins to relax, allowing them to swell more easily.
  3. Constipation and straining to have a bowel movement are other common problems that occur during pregnancy that can also cause or aggravate hemorrhoids. Straining causes an increase in pressure of the veins of the pelvis making them more likely to become swollen and symptomatic.
  4. Childbirth (especially vaginal delivery) can cause or aggravate hemorrhoids.

6.  How can I avoid getting hemorrhoids during pregnancy?

Dr. Nowain recommends avoiding constipation. This includes staying hydrated, eating more fiber, and maybe even using over-the-counter stool softeners if necessary (pregnant women should always consult with their obstetrician prior to using any new medication to ensure that it is safe to do so). Additionally, pregnant women should avoid sitting for long periods of time. This can be accomplished by lying down, standing up, or taking frequent walking breaks to breakup prolonged sitting. The goal is to avoid putting extra pressure in the anal or rectal area.

Furthermore, if you have any hemorrhoids, it is best to get them treated and removed before you get pregnant because hemorrhoids cannot be treated by band ligation during pregnancy. This ensures a much more comfortable pregnancy. During pregnancy, hemorrhoids are typically treated with steroid creams, ice packs, and Sitz baths.

7.  Does hemorrhoid cream thin the skin? Should people use over the counter medication without consulting their practitioner?

Some hemorrhoid creams contain steroids (anti-inflammatory) that can thin the skin after prolonged use or with high concentrations. It would be wise to ask your doctor for his or her advice and guidance before prolonged use.

To find answers to other commonly asked questions, see our overall Hemorrhoid Banding FAQ.