Key Points about Hemorrhoids (Piles)

  • Hemorrhoids can develop inside the anus (internal) or on the outside of the anus (external).
  • Hemorrhoids are a common condition, especially as people age or during pregnancy.
  • There are several effective, over-the-counter remedies for hemorrhoids, including topical creams, pain relievers or sitz bath.
  • Some people with hemorrhoids will need a surgical procedure to cut off blood flow to the hemorrhoid or remove the hemorrhoid.
Common related conditions
Anal Fissure Anal Fistula Bloody Stool Colorectal Polyps Gallstones Irritable Bowel Syndrome


Hemorrhoids – also known as piles – are veins in the anus and lower rectum that become swollen. Internal hemorrhoids develop inside the rectum, while external hemorrhoids develop in the skin around the anus. Hemorrhoids are a common condition, affecting about 75% of adults. 

Hemorrhoids causes 

There are a number of causes of hemorrhoids, including:

  • Anal intercourse
  • Chronic (long-lasting) diarrhea or constipation
  • Low fiber in your diet
  • Obesity
  • Pregnancy
  • Prolonged periods of sitting on the toilet
  • Regular lifting of heavy objects, such as weights or occupational (job) lifting
  • Straining while having bowel movements

Hemorrhoids risk factors

The two main risk factors for developing hemorrhoids are increased age and being pregnant. Both can cause the tissues that support the rectum and anus veins to weaken and stretch.

Hemorrhoids symptoms

The signs and symptoms of hemorrhoids depend on the type of hemorrhoids you have. Symptoms of external hemorrhoids include:

  • Bleeding from or around the anus
  • Itching or irritation around your anus
  • Pain or discomfort
  • Swelling around the anus

Internal hemorrhoids don’t tend to cause as many symptoms, and you’ll usually only notice you have one during a bowel movement. Symptoms of internal hemorrhoids include:

  • Pain and irritation, due to a hemorrhoid that is pushed through the anus during a bowel movement
  • Painless bleeding while having a bowel movement

Hemorrhoids diagnosis

Your gastroenterologist may use one or more of the following diagnostic tools to diagnose your hemorrhoids:

Digital examination. In this test, your doctor inserts a gloved, lubricated finger into your rectum. Your doctor then uses their finger to feel for any unusual growths or abnormalities.

Visual inspection. Your specialist may use a specialized instrument with a light on the end to carefully inspect your anus for abnormalities.

Colonoscopy. If you have hemorrhoids and certain risk factors for colon cancer – such as a family history or being over age 40 – your doctor may recommend you also undergo a colonoscopy to examine your entire colon for anything unusual.

Hemorrhoids treatment

Treatment for hemorrhoids typically includes a combination of the following remedies:

Diet modification. Your specialist will encourage you to eat more fruits, vegetables and whole grain foods to help add more fiber to your diet. Extra fiber can help soften your stool so you don’t have to strain when having a bowel movement.

Topical treatments. Applying an over-the-counter hemorrhoid cream, using a suppository with hydrocortisone or applying pads with witch hazel or a numbing agent can be effective, over-the-counter treatments to give you relief while your hemorrhoids heal.

Bath soak. Your specialist may recommend soaking your anal area in plain, warm water two or three times a day for 10 minutes each time. A sitz bath can also help provide relief.

Pain medication. Taking over-the-counter pain medication, such as Tylenol, aspirin or ibuprofen, can help reduce associated pain while your hemorrhoid heals.

External hemorrhoid thrombectomy. If your external hemorrhoid has turned into a painful blood clot (thrombosis), your specialist can remove the hemorrhoid to provide you with immediate pain relief. Your specialist will perform a thrombectomy under local anesthesia, which means numbing only the affected area.

Rubber band ligation. If your hemorrhoid is very painful or bleeding, your specialist may recommend rubber band ligation. In this procedure, your doctor places one or two tiny rubber bands around the base of the hemorrhoid. Because its blood circulation is cut off, the hemorrhoid dies and falls off within a week.

Coagulation. Your specialist may use infrared, laser or bipolar coagulation directed at the hemorrhoid. This causes the hemorrhoid to harden, shrivel and fall off.

Hemorrhoidectomy. In some cases, your specialist may recommend you undergo a procedure to surgically remove the hemorrhoid.

When should I seek care?

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing a gastroenterologist for more specialized treatment.

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