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  2. Signs of Hemorrhoids

Signs of Hemorrhoids

  1. What are hemorrhoids?
  2. Signs of hemorrhoids
  3. Signs of hemorrhoids in pregnancy
  4. Signs of hemorrhoids and other conditions
  5. Diagnosis
  6. When to seek medical advice
  7. FAQ

What are hemorrhoids?

Hemorrhoids are clusters of tissue containing enlarged blood vessels around the anus and lower rectum. When this vascular tissue becomes swollen, similar to varicose veins, they can cause problems such as bleeding, itching or pain. This condition is what most people know as hemorrhoids or piles.[1]

Hemorrhoids can form inside or outside the anus, and internal hemorrhoids can prolapse, distend outside the anus and become visible. Hemorrhoids can be painless, but in certain circumstances they can become painful. Hemorrhoids that bleed may look alarming, but they are generally harmless. However, rectal bleeding always should be investigated by a doctor to rule out more serious conditions that may require specific treatment, such as bowel polyps or an anal fistula.[1][2] If there is no rectal bleeding, but the other symptoms listed on this resource seem familiar, try a symptom assessment on the Ada app.

Around half the population will experience signs and symptoms of hemorrhoids by the age of 50. Simple treatments like sitz baths and topical hemorrhoid creams, will relieve the most unpleasant symptoms although will likely not make the hemorrhoid itself go away for good.

Hemorrhoids are not contagious and are not usually associated with further health risks. In rare cases, however, a person may experience severe bleeding. In very rare cases, this could turn into iron-deficiency anemia if not addressed.[3]

Read more about hemorrhoids »

Signs of hemorrhoids

Hemorrhoids can form inside the rectum and/or outside the anus. Internal and external hemorrhoids share some common symptoms, such as bleeding, but there are also some differences between them. Their similarities include:

  • Both internal and external hemorrhoids can cause leakage of feces and anal mucus.
  • Hemorrhoids can also make cleaning the anus after a bowel movement more difficult, and feces can remain on the bottom. Due to this, hemorrhoids may produce a bad smell.[4]

Leaking feces and anal mucus can also irritate the anus. This can cause the anus to itch, a condition known as pruritus ani.[5]

Signs of internal hemorrhoids

Internal hemorrhoids are the most common type of hemorrhoid. The swellings develop inside the anal canal. Small hemorrhoids stay inside the anal canal and cannot be seen or felt by the person who has them. Larger hemorrhoids may fall outside the anus in a process called prolapse, often during a bowel movement or while wiping. Hemorrhoids which prolapse may go back inside the anal canal on their own,or may be pushed back in by the person.

Internal hemorrhoids are graded according to their severity. To find out more, see the resource on hemorrhoids.

There is generally no pain associated with an internal hemorrhoid. Noticeable signs and symptoms of internal hemorrhoids include:[6][7]

  • Bright red blood on the stool, wiping paper or in the toilet bowl
  • Bodily tissue that falls outside the anus (prolapse)
  • Mucus or feces discharge
  • A feeling of not having fully evacuated the bowels

Additional signs of a prolapsed internal hemorrhoid include:

  • Itching around the anus (pruritus ani)
  • Feeling a lump outside the anus

An internal hemorrhoid cannot be seen unless it falls outside the anus (prolapse). A prolapsed internal hemorrhoid looks and feels like:[7][8]

  • Approximately the size of a grape
  • A rubbery texture
  • Soft to the touch
  • Skin colored or reddish appearance
  • Can usually be pushed inside the anus
  • There may be more than one

If an internal hemorrhoid cannot be pushed back into the anus, it may become trapped by the sphincter muscle. This is called a strangulated hemorrhoid and can cause severe pain.[9]

A prolapsed hemorrhoid is different to a rectal prolapse. In rectal prolapse, the rectum itself falls out of the anus.[10]

Signs of external hemorrhoids

External hemorrhoids are swellings that form on the outside of the anus. Signs and symptoms that a person may have external hemorrhoids include:[2][7][11]

  • Lumps around the anus
  • Itching around the anus (pruritus ani)
  • Discomfort
  • Bleeding from the anus during and after bowel movement
  • A feeling of not having fully evacuated the bowels
  • Difficulty fully cleaning the anus after bowel movement
  • Discharge of mucus or feces
  • In most cases, no pain

External hemorrhoids look and feel like:[7][8]

  • Small lump next to the anal opening
  • A rubbery texture
  • Skin colored or reddish appearance
  • There may be more than one

Signs of thrombosed hemorrhoids

A thrombosed hemorrhoid is a hemorrhoid which has developed a blood clot inside. This can happen to both external and internal hemorrhoids. Signs and symptoms of a thrombosed hemorrhoid include:[6][7][^8[11]][12]

  • Sudden onset of pain
  • Constant pain

Thrombosed hemorrhoids look and feel like:

  • Blue or purple in color
  • A lump or bulge
  • Firm to the touch

A thrombosed hemorrhoid will often hurt, but is not dangerous.

Signs of anal skin tags

Skin tags are not hemorrhoids, but they can be caused by a previous external hemorrhoid. Skin tags are caused when the skin is stretched, such as by an external hemorrhoid. Once the hemorrhoid has resolved itself, the skin may remain stretched, resulting in a skin tag.[13]

Skin tags are benign, but it is advisable to get any lump checked by a doctor to confirm a diagnosis.

Skin tags look and feel like:[6][14]

  • Small bumps or raised areas
  • Soft
  • Scaly

Signs of hemorrhoids in pregnancy

Pregnancy creates more pressure in the abdomen than usual, which can cause vascular tissue in the rectum and anus to swell. Hemorrhoids are common in the third trimester of pregnancy; around a third of pregnant people experience them. It is also common to develop hemorrhoids during childbirth.

Hemorrhoids in pregnancy develop the same way as non-pregnancy hemorrhoids and can be internal, external or become thrombosed. Most cases of hemorrhoids in pregnancy resolve after birth.[15]

Signs of hemorrhoids and other conditions

Some signs and symptoms of hemorrhoids also occur in other conditions. If feeling unwell and unsure of the cause, then try a symptom assessment on the Ada app.

Bleeding from the anus

A common sign of hemorrhoids is bleeding from the anus. Blood from hemorrhoids is bright red because it comes directly from arteries or veins. The blood can be found on the wiping paper, in the toilet bowl or on the stool.

Bright red blood can also be a sign of an anal fissure, anal abscess and/or anal fistula. Symptoms of these conditions that are not shared with hemorrhoids include:[16][17]

  • Anal fissure: Sharp pain during and after passing a stool
  • Anal abscess: Firm, tender, non-thrombosed lump around the anus, and sometimes fever
  • Anal fistula: Commonly forms after a previous abscess

A polyp in the colon or rectum can also cause bleeding. In the case of colorectal polyps, the blood is seen in the stool. If a person has polyps they will also likely experience abdominal pain, mucus from the anus and a change in bowel habits. Polyps can develop into colorectal cancer and should be examined by a doctor.[18]

Bleeding from the anus can also be a sign of colon cancer or rectal cancer. One symptom of colorectal cancer is bright red blood from the rectum or dark blood in the stool. Colorectal cancer may not show early signs, so it is important for everyone over 50 to be screened. If a person has symptoms of colorectal cancer, they should see a doctor immediately. Other signs of colorectal cancer include:[19][20][21]

  • Change in bowel habits, such as having diarrhea or being constipated, which lasts more than a few days, or episodes of diarrhea followed by episodes of constipation and vice versa
  • A feeling of needing a bowel movement that does not go away after having one
  • Unexplained and/or unintended weight loss
  • Tiredness, or feeling weaker than normal
  • Pain from gas, bloating, cramps or a feeling of being full

Bleeding from the anus can also be a sign of anal cancer. Bright red blood may come from the rectum or anus, or may be in the stool. If a person has symptoms of anal cancer they should see a doctor immediately. Other signs of anal cancer include:[22][23]

  • Pain around the anus
  • Itching around the anus (pruritus ani)
  • A lump near the anus
  • Mucus discharge or feces leaking from the anus
  • Change in bowel habits, such as having diarrhea

Pain around the anus

Hemorrhoids can be painful if a prolapsed hemorrhoid becomes trapped by the sphincter muscle or an external hemorrhoid develops a blood clot (thrombosed hemorrhoid).

Pain that is constant and very often throbbing around the anus is a sign of anal abscess. Anal abscesses are most often caused by infection, for example, of glands surrounding the anus, so fever may also be present.[24]

Milder, intermittent pain around the anus that is even more pronounced when sitting down, having a bowel movement or when coughing could be a symptom of anal fistula. Anal fistulas most commonly form following an anal abscess.[24]

Pain around the anus can also be a sign of anal cancer. If a person has symptoms of anal cancer, they should see a doctor immediately. Other signs of anal cancer include:[22][23]

  • Bleeding from the rectum or anus
  • Itching around the anus (pruritus ani)
  • A lump near the anus
  • Mucus discharge or feces leaking from the anus
  • Change in bowel habits, such as having diarrhea

Anal itching

A sign of hemorrhoids can be itching around the anus (pruritus ani). However, there are several other conditions and causes that can create the symptoms of an itchy anus.

Itching around the anus can be caused by an anal fistula. An anal fistula is also accompanied by a constant, throbbing pain and is often the result of a previous anal abscess.[17][25]

Pinworms can be a cause of itching around the anus, particularly at night. Pinworms lay their eggs on the skin around the anus, and worms may be seen in stools.[26]

Anal itching can also be caused by:[27]

  • Irritants such as soap or laundry detergent
  • Not cleaning the anal area properly
  • Moisture from sweat, such as caused by wearing manmade fibers close to the bottom
  • Certain foods, including coffee, tea, chocolate, spicy foods and citrus fruit
  • Long-term use or non-prescribed use of topical steroids applied to the anus

Good to know: Anal itching can also be a sign of anal cancer. Other signs of anal cancer may include:[22][23]

  • Bleeding from the rectum or anus
  • Pain around the anus
  • A lump near the anus
  • Mucus discharge or feces leaking from the anus
  • Change in bowel habits, such as having diarrhea

Medical attention should be sought promptly in all cases where a person has symptoms of anal cancer.

Lump near the anus

External hemorrhoids and skin tags will feel like a small lump near the anus.

Anal fissures sometimes produce small lumps or skin tags near the anus. If a person has an anal fissure, they will also experience pain during and after passing a stool.[16]

A lump near the anus could be a sign of anal cancer. See the above section for more information about its other possible signs and seek prompt medical attention in all cases where anal cancer is suspected.

Bad smell around the anus

Hemorrhoids can cause leakage of feces and mucus, which may have a foul smell.

An anal fistula can result in bad smelling discharge from the anus. Another symptom of anal fistula is a mild, intermittent pain around the anus. A constant, throbbing pain that is even more pronounced when sitting down, having a bowel movement or when coughing can be the result of an anal abcess that often precedes an anal fistula.[17][25]

Proctitis and anusitis are conditions where the rectum and anus become inflamed. These conditions can cause bad smelling discharge. Someone with these conditions will also likely experience a frequent urge to have a bowel movement, pain and a feeling a fullness in the rectum.[28][29]

A bad smell could be caused by fecal incontinence, which can be a sign of anal cancer. See earlier sections for more information about its other possible signs, and seek prompt medical attention in all cases where anal cancer is suspected.

Diagnosing hemorrhoids

Hemorrhoids are usually diagnosed through a combination of medical history and physical examination.

For more information, see the resource on hemorrhoids.

When to seek medical advice for hemorrhoids

Lumps around the rectum and anus, and bleeding from the rectum and anus should be examined by a doctor to rule out more serious conditions.

If hemorrhoids become painful, or cause discomfort or distress, seek medical advice. Many people wait a long time before consulting a doctor, possibly due to embarrassment. Early intervention can ease discomfort. There are various ways to treat hemorrhoids, many of which are painless and/or more successful the earlier the treatment is started.[30]

For more information about treatments, see the resource on hemorrhoids.

Signs of hemorrhoids FAQs

Q: Do I have hemorrhoids or cancer?
A: Hemorrhoids, anal cancer and colorectal cancer can cause bleeding, with bright red blood. Other signs of colorectal cancer include:

  • Dark red blood in the stool
  • Change in bowel habits, such as having diarrhea or being constipated, which lasts more than a few days or frequently changes from one to the other
  • A feeling of needing a bowel movement that does not go away after having one
  • Unexplained weight loss
  • Tiredness or feeling weaker than normal
  • Pain from gas, bloating, cramps or a feeling of being full

Other signs of anal cancer include:

  • Pain around the anus
  • Itching around the anus (pruritus ani)
  • A lump near the anus
  • Mucus discharge
  • Change in bowel habits, such as having diarrhea

If a person suspects they may have cancer, they should see a medical professional immediately.

Q: Are hemorrhoids supposed to bleed?
A: It is normal for hemorrhoids to bleed with bright red blood. Bleeding from hemorrhoids will most often not be painful and is usually not dangerous. It is rare for someone to bleed excessively. However, bleeding from the rectum and anus can be a sign of colorectal or anal cancer and should be examined by a doctor, especially in cases where a person is not aware of a pre-existing problem, such as hemorrhoids.


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