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.
Aliza Efraimov
I had a thrombosed external hemorrhoid last year and let me tell you-it felt like someone was stabbing me with a hot fork every time I sat down. I waited three days before going to the ER because I was too embarrassed. The doctor just made a tiny cut, squeezed out the clot, and I felt like a new person. No surgery, no weeks of pain. Just a quick fix and a lot of sitz baths. If you’re suffering, don’t wait. It’s not shameful-it’s just anatomy gone wrong.
Also, I started using a footstool and my bowel movements went from ‘battle royale’ to ‘peaceful morning ritual.’ Game changer.
And yes, I now recommend it to everyone. Even my dog looks at me funny when I put it next to the toilet, but who cares?
Stop suffering in silence. You’re not weird. You’re human.
Also, witch hazel pads are my spirit animal now. 🧘♀️💧
Nisha Marwaha
From a colorectal physiology standpoint, the dentate line serves as a critical neuroanatomical demarcation between visceral (internal) and somatic (external) innervation, which explains the differential pain perception. Internal hemorrhoids, being innervated by autonomic fibers, are often asymptomatic until vascular engorgement leads to mucosal erosion and bleeding-typically presenting as intermittent, bright red hematochezia. External hemorrhoids, by contrast, are densely populated with somatic nociceptors, rendering them exquisitely sensitive to mechanical stress, thrombosis, or inflammatory mediators.
Thrombosis occurs due to venous stasis and increased intraluminal pressure, often precipitated by straining or prolonged sitting. The clinical hallmark is a tender, bluish nodule with acute onset. Early intervention (<72h) with incision and evacuation is the gold standard for symptomatic relief. Delayed management often results in fibrotic skin tags, which, while benign, can perpetuate hygiene challenges and irritation.
Furthermore, the efficacy of rubber band ligation (RBL) for Grades II–III hemorrhoids exceeds 90% in randomized trials, with recurrence rates under 15% at 12 months. This is superior to sclerotherapy or infrared coagulation, which have higher retreatment burdens. Lifestyle modifications-particularly fiber intake ≥25g/day and pelvic floor neuromuscular re-education-are foundational for long-term remission.
Bottom line: Hemorrhoids are not a diagnosis of failure. They’re a biomechanical signal. Listen to your body. Optimize your posture. Don’t let stigma delay care.
Tamar Dunlop
As someone who has lived in three countries and seen how cultural attitudes toward bodily functions vary wildly, I can tell you this: in many parts of the world, discussing hemorrhoids is still considered taboo-so much so that people suffer in silence for years. In Canada, we have universal healthcare, yet even here, patients delay seeing a doctor because they’re ashamed. It breaks my heart.
I once had a patient-a 68-year-old woman-who waited five years because she thought it was ‘just a pimple.’ By the time she came in, she had a Grade IV prolapse and was anemic. We did a hemorrhoidectomy. She cried after surgery-not from pain, but because she said, ‘I didn’t know it could be fixed so easily.’
Let’s normalize this. Talk about it. Share your story. Your silence might be someone else’s reason to keep suffering. And yes, the footstool? I bought one for my entire family. We call it ‘The Throne.’ It’s become a joke. But it’s also a lifeline.
Doctors don’t judge. They help. Please, if you’re reading this and you’re scared-reach out. You’re not alone.
Samar Khan
OMG I JUST HAD A THROMBOSIS 😭😭😭 I thought I was dying. My butt looked like a bruised grape. I cried in the shower. Then I Googled it and found this post. THANK YOU. I went to urgent care and they drained it. It was PAINFUL but worth it. Now I’m on a fiber kick and I bought a footstool. Also, I’m never sitting on the toilet scrolling again. 🚫📱💩 #HemorrhoidWarrior #WitchHazelIsMyBestFriend 💕
Russell Thomas
So let me get this straight-you wrote a 2,000-word essay on hemorrhoids, but didn’t mention that the real problem is that we live in a society that makes people sit on toilets like they’re in a cult? Like, why are we all just… sitting there? For hours? With our knees at hip level? We’re not cows. We’re not designed to squat on porcelain.
And yet here we are. Eating fiber like it’s a religious obligation while still sitting like a depressed sloth.
Also, I’ve seen people use those ‘miracle’ hemorrhoid creams that cost $80 and say ‘instant relief.’ Bro. It’s Vaseline with a fancy label. You’re not healing. You’re just masking the screaming of your veins.
And yes, I’ve had both. Internal bleeding? Check. External lump that felt like a walnut trying to escape? Double check.
Stop buying into the wellness industrial complex. Just eat beans. Sit on a stool. Move. And if it doesn’t get better? Go see a doctor. Not a YouTube influencer. A real one. With a stethoscope. And no glitter.
Joe Kwon
I really appreciate how thorough this breakdown is. As someone who’s had chronic constipation due to IBS, I’ve battled hemorrhoids on and off for years. Rubber band ligation was a lifesaver for me-mild discomfort for a couple days, and then I was back to normal. What helped me most was realizing it wasn’t a personal failure. It was a biomechanical issue. Same as a sprained ankle.
I also started using a Squatty Potty. It’s not glamorous, but my bowel movements went from ‘struggle session’ to ‘effortless.’ I even convinced my mom to get one. She said, ‘I didn’t know my butt needed a ladder.’
And yeah, the footstool thing? It’s not weird. It’s biomechanics. Your body isn’t broken. Your posture is.
Also, if you’re over 45 and haven’t had a colonoscopy? Do it. Even if you think it’s just hemorrhoids. Better safe than sorry. I’m glad this post emphasized that.
Nicole K.
People need to stop being lazy. If you eat junk food, sit all day, and then wonder why your butt is bleeding-guess what? You brought this on yourself.
It’s not rocket science. Eat veggies. Drink water. Get up and walk. Stop scrolling on the toilet like it’s your job.
I’ve never had hemorrhoids, and I never will, because I don’t live like a sloth. You want to fix it? Stop making excuses. It’s not a medical mystery. It’s a choice.
And no, you don’t need a footstool. Just stop being so entitled to your bad habits.
Also, if you’re over 45 and haven’t had a colonoscopy? You’re asking for trouble. But not because of hemorrhoids-because you’re ignoring your health like a child.
Just… try being responsible for once.
Fabian Riewe
Just wanted to say thank you for this. I was so embarrassed to even search for this stuff, but your post made me feel like it was okay to care. I’ve had internal hemorrhoids for years-mostly Grade II-and I thought I just had to live with it.
I started doing sitz baths every night and added flaxseed to my smoothies. Within two weeks, the bleeding stopped. No magic, no miracle cream-just consistency.
Also, I bought a footstool. My partner thought I was nuts. Now he uses it too. We call it ‘The Peaceful Poop Chair.’
And yeah, I went to the doctor last month. He didn’t even blink. Just said, ‘Nice job taking care of yourself.’ That meant more than I can say.
If you’re reading this and you’re scared? You’re not alone. We’ve all been there. You’ve got this. 💪🩹
Amy Cannon
As someone who has spent the last decade navigating the healthcare systems of both the United States and the United Kingdom, I feel compelled to offer a nuanced perspective on the matter of hemorrhoidal pathology and its societal perception.
It is, in fact, a fascinating intersection of public health, cultural stigma, and biomedical efficacy. The prevalence of hemorrhoids-approximately 75% of the population-is not merely a medical anomaly; it is a reflection of modern sedentary lifestyles, dietary deficiencies, and the commodification of convenience over biomechanical health.
Moreover, the reluctance to seek professional care is not a failure of willpower, but rather a systemic failure of patient education and empathetic communication in clinical settings. Too often, patients are met with dismissive language, or worse, silence.
It is imperative that we, as a society, normalize the conversation around anorectal health with the same urgency we apply to cardiovascular or metabolic wellness.
And yes, the footstool. It is not a gimmick. It is a biomechanical intervention supported by peer-reviewed literature. I have one in my bathroom. I have one in my mother’s. I even gifted one to my sister-in-law, who laughed, then cried, then thanked me.
There is dignity in prevention. There is grace in asking for help. And there is no shame in a little stool.
With warm regards, and a very well-used sitz bath,
Amy
Himanshu Singh
This post saved my life. I had a thrombosed one and was too scared to go to the doc. Read this, went to urgent care, they popped it in 5 mins. No big deal. Now I eat broccoli like it’s my job. And I use a footstool. My wife thinks I’m weird but I don’t care. My butt is happy now. 🙌💩 #HemorrhoidHero