Most people think hemorrhoids are just a minor annoyance - something you get from sitting too long or eating too little fiber. But if you’ve had one, you know it’s more than that. It can make sitting painful, bowel movements stressful, and even your daily routine feel like a chore. The truth is, hemorrhoids are common - about 75% of people will deal with them at some point in their lives. And while they’re rarely dangerous, they can be incredibly uncomfortable. The key to feeling better isn’t just guessing what you have - it’s understanding whether you’re dealing with internal or external hemorrhoids, and what actually works to treat them.
What Are Internal Hemorrhoids?
Internal hemorrhoids form inside the rectum, above a line called the dentate line. This area has very few pain-sensing nerves, so even when they swell, you might not feel pain - at least not at first. Instead, the most common sign is bright red blood on the toilet paper, in the bowl, or streaked on your stool. It’s usually not messy, but it’s startling enough to make anyone rush to Google.
These aren’t lumps you can see or feel from the outside. They’re hidden, which is why many people don’t realize they have them until they bleed. Internal hemorrhoids are graded from I to IV based on how much they prolapse (protrude) during bowel movements:
- Grade I: Bleeds but doesn’t prolapse.
- Grade II: Prolapses during straining but pops back in on its own.
- Grade III: Prolapses and needs to be pushed back in by hand.
- Grade IV: Stays outside permanently and can’t be pushed back.
If you’re dealing with Grade III or IV, you’ll likely feel pressure, fullness, or a sense that you haven’t fully emptied your bowels. That’s not just discomfort - it’s your body telling you something’s wrong.
What Are External Hemorrhoids?
External hemorrhoids sit under the skin around the anus. Unlike internal ones, they’re surrounded by sensitive nerves. That means even a small swelling can feel like a sharp, throbbing pain. You might notice a soft, skin-colored lump near your anus, or - if it’s thrombosed - a hard, purple or blue lump that hurts badly.
A thrombosed external hemorrhoid happens when a blood clot forms inside the swollen vein. It comes on suddenly. One minute you’re fine, the next you can’t sit down without wincing. These are the ones people rush to the ER for. The pain peaks within 48 hours and usually starts to ease after a few days, but the lump can stick around for weeks.
Itching, burning, and swelling are also common. And unlike internal hemorrhoids, external ones don’t usually cause bleeding - unless they rupture or get irritated from wiping too hard.
Can You Have Both at the Same Time?
Yes - and it’s more common than you think. Many people have a mix of internal and external hemorrhoids. That’s why symptoms can be confusing. You might bleed (internal) but also feel a painful lump (external). Or you might think it’s just a skin tag, but it’s actually a prolapsed internal hemorrhoid that’s now hanging outside.
This overlap is why self-diagnosis often fails. People assume all rectal bleeding is hemorrhoids. But bleeding can also signal something more serious - like anal fissures, colon polyps, or even colorectal cancer. Fissures, for example, cause a sharp, tearing pain during bowel movements, not just itching or swelling. If your symptoms don’t improve with basic care, or if you’re over 45 and haven’t had a colonoscopy, don’t guess. See a doctor.
What Causes Hemorrhoids?
Hemorrhoids aren’t caused by one thing - they’re the result of pressure. Constant pressure on the veins in your rectum and anus makes them swell. Common triggers include:
- Chronic constipation or straining during bowel movements
- Long periods sitting on the toilet (yes, scrolling on your phone counts)
- Obesity
- Pregnancy (up to 35% of pregnant women develop them)
- Heavy lifting
- Chronic diarrhea
Here’s something most people don’t realize: the way you sit on the toilet matters. Sitting with your knees level with your hips increases pressure on your rectal veins. But if you put your feet on a small stool - so your knees are higher than your hips - you reduce that pressure by about 30%. It’s a simple fix that can prevent flare-ups.
Treatment: What Actually Works
Not every hemorrhoid needs surgery. Most mild cases improve with lifestyle changes and over-the-counter care. But you need to be consistent.
Home Care for Mild Cases
- Increase fiber: Aim for 25-30 grams daily. That’s about 2 cups of cooked beans, 1 cup of oatmeal, 1 apple with skin, and a handful of almonds. Fiber softens stool so you don’t strain.
- Drink water: At least 8-10 glasses a day. Fiber without enough water can make constipation worse.
- Sitz baths: Sit in warm (not hot) water for 15-20 minutes, 2-3 times a day. It reduces swelling and soothes irritation.
- Witch hazel pads or hydrocortisone cream: These help with itching and inflammation. Don’t use hydrocortisone for more than a week without talking to a doctor.
- Avoid straining: If you don’t have a bowel movement within 5 minutes, get up. Don’t force it.
Minimally Invasive Procedures
If home care doesn’t help, your doctor might suggest one of these office-based treatments - all done without general anesthesia.
- Rubber band ligation: A tiny band is placed around the base of the internal hemorrhoid. It cuts off blood flow. The hemorrhoid shrinks and falls off in about a week. It’s 90% effective for Grades I-III. You might feel pressure or mild cramping for a day or two.
- Sclerotherapy: A chemical solution is injected into the hemorrhoid, causing it to scar and shrink. Less effective than banding but good for smaller hemorrhoids.
- Infrared coagulation: Heat is applied to the hemorrhoid to destroy the tissue. Usually requires multiple sessions.
Thrombosed External Hemorrhoids
If you have a painful, hard lump that appeared suddenly, you might have a thrombosed hemorrhoid. If you get to a doctor within 72 hours, they can make a small cut to remove the clot. It’s quick, local numbing only, and gives almost immediate pain relief. After that, sitz baths and pain relievers help the area heal.
Surgery for Severe Cases
For Grade IV hemorrhoids, recurrent cases, or when other treatments fail, surgery may be needed.
- Hemorrhoidectomy: The hemorrhoid is surgically removed. It’s the most effective option - 95% success rate - but recovery takes 2-4 weeks. Pain is significant for the first week, and you’ll need prescription pain meds.
- Stapled hemorrhoidopexy: The prolapsed tissue is lifted and stapled back into place. Less pain than traditional surgery, but higher chance of recurrence.
Don’t let fear of surgery stop you. Modern techniques are far better than they were 20 years ago. And if you’ve been suffering for months, the relief is worth it.
What Doesn’t Work
There are tons of online products claiming to “cure” hemorrhoids overnight: herbal ointments, teas, supplements, and even “miracle” devices. None of these are backed by science. The American Gastroenterological Association warns against them. They might soothe symptoms temporarily, but they don’t fix the root problem.
And don’t ignore warning signs. If you have:
- Bleeding that doesn’t stop
- Dark or black stool
- Unexplained weight loss
- Changes in bowel habits
- Dizziness or fatigue (signs of anemia from blood loss)
- see a doctor. These aren’t typical hemorrhoid symptoms. They could mean something else is going on.
Prevention: The Real Long-Term Fix
Hemorrhoids come back - a lot. Studies show that if you don’t change your habits, there’s a 50% chance they’ll return within a year. But if you stick to these habits, recurrence drops to 5-10%.
- Keep eating fiber-rich foods every day - don’t just do it when you’re having symptoms.
- Stay active. Walk daily. Avoid sitting for long periods.
- Use a footstool when you poop. It’s not weird - it’s smart.
- Don’t delay bowel movements. Holding it in increases pressure.
- If you’re pregnant, do pelvic floor exercises. They help reduce pressure on your rectal veins.
Most people wait months before seeing a doctor because they’re embarrassed. One survey found 68% of people waited over six months. That’s long enough for a small problem to become a big one. There’s no shame in this. Doctors see this every day. The sooner you get help, the less invasive the treatment will be.
Can hemorrhoids turn into cancer?
No, hemorrhoids do not turn into cancer. But rectal bleeding - a common symptom of hemorrhoids - can also be a sign of colorectal cancer. That’s why it’s critical to get persistent bleeding checked out, especially if you’re over 45 or have a family history of colon cancer. A doctor can tell the difference with a simple exam or colonoscopy.
Is it safe to use over-the-counter creams long-term?
No. Hydrocortisone creams should not be used for more than a week without medical advice. Long-term use can thin the skin around the anus, making irritation worse. Witch hazel pads are safer for ongoing use, but they only treat symptoms - not the cause. If you still need them after a week, it’s time to see a doctor.
Do hemorrhoids go away on their own?
Mild cases often improve within a few days with home care - especially if you increase fiber and water. But the swollen veins don’t fully disappear unless treated. Without lifestyle changes, they’ll likely come back. Think of it like a sprained ankle: rest helps, but if you keep running on it, it won’t heal.
Can I exercise with hemorrhoids?
Yes - but avoid heavy lifting or activities that strain your abdomen, like intense weightlifting or cycling on rough terrain. Walking, swimming, and yoga are excellent. Exercise helps prevent constipation and reduces pressure on your rectal veins. Just make sure you’re not holding your breath or pushing too hard during workouts.
Are hemorrhoids more common in men or women?
They affect both genders equally overall. But women are more likely to develop them during pregnancy due to increased pressure on pelvic veins. Men are more likely to develop them from heavy lifting or prolonged sitting at desk jobs. So it’s less about gender and more about lifestyle and physical stress on the area.
When to See a Doctor
You don’t need to suffer silently. If home care doesn’t help after a week, or if you’re experiencing:
- Severe pain that doesn’t improve
- Excessive bleeding
- A lump that won’t go away
- Changes in bowel habits
- Signs of infection (fever, pus, worsening redness)
- it’s time to see a specialist. A colorectal surgeon or gastroenterologist can give you a clear diagnosis and a plan that actually works. Don’t wait until it’s unbearable. Early treatment means less pain, less recovery time, and a faster return to normal life.