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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
  • 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, which is when the swellings become visible outside of the anus.

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, anal fissure 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 of American adults will experience signs and symptoms of hemorrhoids by the age of 50. Simple treatments, such as 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] There is also a very slight risk of other complications such as infection from an external hemorrhoid.[4]

Read more about hemorrhoids »

Signs of hemorrhoids

Hemorrhoids can form both inside the rectum and under the skin of the anus (external hemorrhoids). Internal and external hemorrhoids share some common symptoms; both types can bleed, for example. Other similarities include:[5]

  • 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. Due to this, both types of hemorrhoid may produce a bad smell

Leaking feces and anal mucus can also irritate the anus. This can cause the anus to itch, a condition known as pruritus ani.[6]

Signs of internal hemorrhoids

Internal hemorrhoids are the most common type of hemorrhoid. These swellings develop inside the anal canal.

Small hemorrhoids stay inside the anal canal and cannot be seen or felt by the person affected by them. Larger hemorrhoids may fall outside the anus in a process called prolapse, often during a bowel movement or while the buttocks are being wiped. Hemorrhoids which prolapse may go back inside the anal canal on their own or may be pushed back in by the affected person.

Read more about hemorrhoids ».

Internal hemorrhoids generally cause no pain. Noticeable signs and symptoms of internal hemorrhoids include:[7]

  • Bright red blood in feces, on toilet paper after wiping, or in the toilet bowl
  • Bodily tissue falling outside the anus, i.e., prolapse
  • Mucal or fecal discharge
  • A feeling of not having fully evacuated the bowels

Additional signs of a prolapsed internal hemorrhoid include:

  • Itching around the anus, i.e.,pruritus ani
  • A lump felt outside the anus

An internal hemorrhoid cannot be seen unless it prolapses. A prolapsed internal hemorrhoid has the following characteristics:[8]

  • Approximately the size of a grape
  • A rubbery texture
  • Soft to the touch
  • Skin colored or of 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 under the anal skin and become prominent on or around the outside of the anus. Signs and symptoms that a person may have external hemorrhoids include:[2][11]

  • Lumps around the anus
  • Itching around the anus, i.e. pruritus ani
  • Discomfort due to sensations felt around the anus
  • 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

External hemorrhoids have the following characteristics:[8]

  • A small lump just outside the anus
  • A rubbery texture
  • Skin colored or reddish appearance
  • There may be more than one

Signs of thrombosed hemorrhoids

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

  • Sudden onset of pain
  • Constant pain following sudden onset of pain

Thrombosed hemorrhoids have the following characteristics:

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

A thrombosed hemorrhoid will often hurt, but are not generally dangerous.

Signs of anal skin tags

Skin tags are not hemorrhoids, but they can be left behind after an external hemorrhoid has healed. Skin tags appear after 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 get confirmation of that.

Skin tags have the following characteristics:[7][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 and 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]

Read more about pregnancy complications »

Signs of hemorrhoids and other conditions

Some common signs of hemorrhoids include:

  • Bleeding from the anus
  • Pain around the anus
  • Anal itching
  • Lump near the anus
  • Bad smell around the anus

However, these signs can also occur in some 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 likely to be a brighter red because it comes directly from arteries or veins. The blood can be found:

  • On toilet paper after wiping
  • In the toilet bowl
  • On feces

Anal bleeding is a symptom of several other conditions, including:

Anal fissure, anal abscess and anal fistula

Bright red blood can also be a sign of an anal fissure, anal abscess and/or anal fistula.

  • An anal fissure is a small tear or sore in the skin of the anal canal
  • An anal abscess is a pocket near the anus filled with pus
  • An anal fistula is a tunnel that runs from the end of the bowel to the skin around the anus

Symptoms of these conditions that are not shared with hemorrhoids include:[16][17]

  • Anal fissure can cause sharp pain during and after passing a stool, while hemorrhoid pain is normally less severe
  • An anal abscess can cause a firm, warm, tender, non-thrombosed lump around the anus. Abscesses may sometimes cause fever
  • Anal fistula commonly forms after a previous abscess

Colorectal polyps

Polyps are another type of growth that can be found in similar parts of the body to hemorrhoids. A polyp in the colon or rectum can also cause bleeding. In the case of colorectal polyps, blood can sometimes be seen in the feces. If a person has polyps they may also experience:

  • Abdominal pain
  • Mucus from the anus
  • A change in bowel habits

Polyps are often non-cancerous growths when they are found in, e.g., colonoscopy screenings, but can also develop into colorectal cancer and should therefore be properly examined and treated by a medical doctor.[18]

Colon cancer and rectal cancer

Bleeding from the anus can also be a sign of colon cancer or rectal cancer. Symptoms of colorectal cancer include finding bright red blood on the rectum or dark blood mixed in with feces.

If a person has symptoms or suspects they may be affected by colorectal cancer, they should see a doctor immediately. Other signs of colorectal cancer include:[19][20][21]

  • Changes in bowel habits, such as having diarrhea or being constipated
  • 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

Colorectal cancer may not show early signs, so in the U.S. the current guidelines are that regular screening should begin at age 50.[22][23] For those at increased risk of colorectal cancer, e.g., people with a family history of the condition, doctors may recommend that screening begins at an earlier age, usually around 45.

The American Cancer Society even argues that regular screening should begin for everyone, not just high risk groups, once they reach 45 and even earlier for people with high risk for colon cancer.[24] In the United Kingdom, the National Health Service recommends regular screening from age 55. [24]

The conversation around these guidelines is continually evolving. It is generally recommended to see a physician for regular health check-ups and in case of any doubt, for a proper diagnostic work-up, even if someone is younger.

Read more about colorectal cancer »

Anal cancer

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 visible in feces. If a person has symptoms of anal cancer they should see a doctor immediately. Other signs of anal cancer include:[25][26]

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

Anal cancer is rare. The risk of a person in the U.S. being diagnosed with the condition at some point in their lifetime is about one in 500, which is much rarer than people affected by colorectal cancer.[^7]

Read more about anal cancer »

Pain around the anus

Hemorrhoids can be painful if a prolapsed hemorrhoid becomes trapped by the anal sphincter muscle or an external hemorrhoid becomes thrombosed. Other potential causes for pain in this part of the body include:

Anal abscess

Pain that is constant and very often throbbing around the anus is also 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.[27]

Anal fistula

An anal fistula may cause mild pain around the anus that comes and goes. The pain from anal fistulas is more pronounced when sitting down, having a bowel movement or when coughing. Anal fistulas most commonly form following an anal abscess.[27]

Anal cancer

Pain around the anus can also be a sign of anal cancer. If a person suspects they have symptoms of anal cancer, they should see a doctor immediately.

Anal itching

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

Anal fistula

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][28]

Pinworms

Pinworms are small parasites that can live in a human colon or rectum. These worms 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. These parasites affect children far more often than adults.[29]

Anal cancer

Anal itching can be a sign of anal cancer. Medical attention should be sought promptly in all cases where a person suspects any symptoms of anal cancer.

Other causes for anal itching

Anal itching can also be caused by:[30]

  • Irritants such as soap or laundry detergent
  • Not cleaning the anal area properly
  • Moisture from sweat
  • 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

Lump near the anus

External hemorrhoids and skin tags will feel like a small lump near the anus. Lumps can also appear around the anus as part of some other conditions, including:

Anal fissures

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]

Anal cancer

A lump near the anus could be a sign of anal cancer. Seek prompt medical attention in all cases where anal cancer is suspected.

Bad smell around the anus

Hemorrhoids can cause feces and mucus to leak out of the anus, which may lead to a foul smell. There may also be other causes for this though, among them:

Anal fistula or anal abscess

An anal fistula can result in a 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 abscess that often precedes an anal fistula.[17][28]

Proctitis and anusitis

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.[4][31]

Fecal incontinence and anal cancer

A bad smell could be caused by fecal incontinence, which can be a sign of anal cancer. 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.

Read more about 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.[32]

Read more about 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 feces
  • Changes in bowel habits, such as having diarrhea or being constipated
  • 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, i.e., pruritus ani
  • A lump near the anus
  • Mucus discharge
  • Changes 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.

Q: What are the signs that hemorrhoids are healing?
A: Signs that the hemorrhoids are improving generally include the swellings going down and a lessening of any additional symptoms, such as bleeding and itching. Skin tags may appear after an external hemorrhoid has resolved itself. Hemorrhoids experienced during pregnancy will usually go away after birth.

Read more about treatment for hemorrhoids »

Q: How can you avoid making your hemorrhoids flare up or getting worse? A.: Some of the following steps can make the symptoms of hemorrhoids less likely to persist:[2][7]

  • Eating fibre, for example, fruits and vegetables, or cereals
  • Drinking plenty of fluids, not including alcohol and caffeine
  • Avoiding co-codamol, a mixture of the two painkillers codeine and paracetamol, which often causes constipation as a side effect
  • Exercising regularly and maintaining a healthy weight
  • Avoiding long periods of sitting down

Read more about risk factors for hemorrhoids »

Q: Rectal prolapse vs prolapsed hemorrhoid: what is the difference?
A: A prolapsed hemorrhoid is when an internal hemorrhoid pushes down and extends out from the anus. A rectal prolapse is when the entire rectum, i.e. the end of the large intestine, or part of it bulges out of the anal opening.[10] A rectal prolapse should be examined by a doctor as soon as possible.

Q: What if a lump on the anus is not painful?
A: It is advisable to contact a doctor to check any lump on the anus. This is especially the case if the lumps are persistent and do not clear up after a couple of weeks, or if the lump is hard to the touch. A doctor should also be contacted if the lump comes along with any of the other symptoms reported in the above resource, especially bleeding from the anus.[33]

Q: Can stress cause hemorrhoids to flare up?
A: There is no evidence that stress is a trigger for hemorrhoids. However, the symptoms of hemorrhoids can be a cause of stress for some people.[34]


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