Hemorrhoids

What they are, how they’re evaluated, treatment options, and what to do next

What are hemorrhoids?

Hemorrhoids—sometimes called piles—are swollen blood vessels and supporting tissue in or around the anus and lower rectum. They are common and may cause symptoms, but hemorrhoids do not always need treatment. [1]

There are two main types:

• Internal hemorrhoids are inside the rectum. They may cause painless, bright-red bleeding with a bowel movement or tissue that bulges through the anal opening, called a prolapse.
• External hemorrhoids are beneath the skin around the anus. They may cause itching, tenderness, swelling, or a firm, painful lump. A blood clot in an external hemorrhoid can cause sudden, significant pain. [1, 2]

Straining, constipation or diarrhea, sitting on the toilet for a long time, and low-fiber eating patterns may contribute. Pregnancy, aging, and repeated heavy lifting can also increase the likelihood of hemorrhoids. [1]

How are hemorrhoids found?

A healthcare provider will ask about your symptoms, bowel habits, diet, medicines, and medical history. They may examine the skin around the anus and, when appropriate, perform a gloved-finger rectal examination. An anoscope—a short instrument used to view the anal canal and lower rectum—may be used to look for internal hemorrhoids. [2]

Further examination, such as a colonoscopy, may be recommended depending on your symptoms, age, screening history, family history, or other risk factors. This helps evaluate for other possible causes of bleeding or bowel changes. Rectal bleeding should not automatically be attributed to hemorrhoids: other conditions, including inflammatory bowel disease and colorectal cancer, can also cause bleeding. [2, 3]

How are hemorrhoids treated?

Treatment depends on the type and severity of symptoms. Many people improve with changes that make bowel movements easier and reduce straining.

At-home steps

• Gradually add fiber-rich foods such as vegetables, fruit, beans, and whole grains. A fiber supplement may be an option; ask your healthcare professional or pharmacist whether it is appropriate for you.
• Drink adequate fluids, unless a healthcare professional has told you to limit fluids.
• Avoid straining and try not to sit on the toilet longer than needed. Respond to the urge to have a bowel movement.
• A warm sitz bath may help ease discomfort. Gently clean the area and avoid rubbing.
• Over-the-counter creams or suppositories may briefly ease itching or discomfort. Follow the product directions and check with a healthcare professional or pharmacist if you have questions. Many products are intended for short-term use; seek advice if symptoms persist after about a week or the product irritates your skin. [3, 4]

The American Society of Colon and Rectal Surgeons recommends adequate fiber and fluid intake and counseling on bowel habits as initial treatment for symptomatic hemorrhoids. [4]

Office procedures or surgery

If symptoms continue despite home care, a provider may discuss an office procedure. Options for some internal hemorrhoids include rubber-band ligation, sclerotherapy, or infrared treatment. Larger, prolapsing, or persistent hemorrhoids may sometimes require surgery. The best option depends on the examination and your individual situation. [3, 4]

What are the next steps?

1. Arrange an appointment if you have rectal bleeding, a new lump, repeated discomfort, or symptoms that are not improving. Your provider can check whether hemorrhoids are the cause and whether you need additional evaluation.
2. Track your symptoms. Note when bleeding or pain occurs, bowel habits, stool consistency, and any medicines or supplements you use.
3. Bring your medication list and information about prior colonoscopies, colorectal cancer screening, or relevant family history.
4. Ask about a bowel-care plan—including fiber, fluids, constipation treatment, and whether an examination or procedure is appropriate.
5. Follow up if symptoms persist, return, or worsen.

When to seek medical care urgently

Seek urgent medical care for heavy or ongoing rectal bleeding, severe anal pain with bleeding, or bleeding accompanied by abdominal pain, fever, or diarrhea. Call 911 or go to an emergency department if bleeding is severe or you feel faint, confused, unusually weak, or short of breath. [3]

Set up an appointment

Call Digestive Healthcare of Georgia to set up an appointment with a provider. Call the office serving your area:

• Atlanta: (404) 355-3200
• Cartersville or Jasper: (706) 253-7340
• Fayetteville: (770) 719-3240
• Newnan: (678) 326-4812
• Ellijay: (706) 253-5514
• Woodstock, Marietta, or Canton: (404) 425-5570

The practice lists appointments by arrangement. When calling, ask which location is appropriate and confirm appointment availability. [5]

Sources

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Definition & Facts of Hemorrhoids.
2. NIDDK. Diagnosis of Hemorrhoids.
3. NIDDK. Symptoms & Causes of Hemorrhoids and Treatment of Hemorrhoids.
4. Hawkins AT, et al. American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Diseases of the Colon & Rectum. 2024.
5. Digestive Healthcare of Georgia. Contacts & Locations.

This information is for general education and does not replace medical advice, diagnosis, or treatment. Your healthcare provider can recommend care based on your symptoms and health history.