Hemorrhoids
 National Digestive Diseases Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

What are hemorrhoids? 

Hemorrhoids are swollen and inflamed veins 

around the anus or in the lower rectum. The 

rectum is the last part of the large intestine 

leading to the anus. The anus is the opening 

at the end of the digestive tract where bowel 

contents leave the body. 

External hemorrhoids are located under 

the skin around the anus. Internal hemorrhoids develop in the lower rectum. Internal 

hemorrhoids may protrude, or prolapse, 

through the anus. Most prolapsed hemorrhoids shrink back inside the rectum on their 

own. Severely prolapsed hemorrhoids may 

protrude permanently and require treatment. 

Internal hemorrhoid 

Rectum 

Anus 

External hemorrhoid 

Hemorrhoids 

What are the symptoms of 

hemorrhoids? 

The most common symptom of internal 

hemorrhoids is bright red blood on stool, 

on toilet paper, or in the toilet bowl after 

a bowel movement. Internal hemorrhoids 

that are not prolapsed are usually not painful. Prolapsed hemorrhoids often cause pain, 

discomfort, and anal itching. 

Blood clots may form in external hemorrhoids. A blood clot in a vein is called a 

thrombosis. Thrombosed external hemorrhoids cause bleeding, painful swelling, or a 

hard lump around the anus. When the blood 

clot dissolves, extra skin is left behind. This 

skin can become irritated or itch. 

Excessive straining, rubbing, or cleaning 

around the anus may make symptoms, such 

as itching and irritation, worse. 

Hemorrhoids are not dangerous or life 

threatening. Symptoms usually go away 

within a few days, and some people with 

hemorrhoids never have symptoms. 
               

           

            

           

           

               

              

               

         

         

           

                 

             

                  

         

               

             

     

          

           

               

              

       

               

        

             

           

             

             

         

      

             

               

             

              

             

                

   

               

            

       

       

                 

               

           

               

         

         

             

               

            

       

                 

              

              

       

How common are 

hemorrhoids? 

About 75 percent of people will have hemorrhoids at some point in their lives.1 Hemorrhoids are most common among adults ages 

45 to 65.2 Hemorrhoids are also common in 

pregnant women. 

What causes hemorrhoids? 

Swelling in the anal or rectal veins causes 

hemorrhoids. Several factors may cause this 

swelling, including 

• chronic constipation or diarrhea 

• straining during bowel movements 

• sitting on the toilet for long periods of 

time 

• a lack of fiber in the diet 

Another cause of hemorrhoids is the weakening of the connective tissue in the rectum 

and anus that occurs with age. 

Pregnancy can cause hemorrhoids by increasing pressure in the abdomen, which may 

enlarge the veins in the lower rectum and 

anus. For most women, hemorrhoids caused 

by pregnancy disappear after childbirth. 

1Baker H. Hemorrhoids. In: Longe JL, ed. Gale 

Encyclopedia of Medicine. 3rd ed. Detroit: Gale; 2006: 

1766–1769. 

2Chong PS, Bartolo DCC. Hemorrhoids and fissure 

in ano. Gastroenterology Clinics of North America. 

2008;37:627–644. 

How are hemorrhoids 

diagnosed? 

The doctor will examine the anus and rectum 

to determine whether a person has hemorrhoids. Hemorrhoid symptoms are similar to 

the symptoms of other anorectal problems, 

such as fissures, abscesses, warts, and polyps. 

The doctor will perform a physical exam to 

look for visible hemorrhoids. A digital rectal 

exam with a gloved, lubricated finger and an 

anoscope—a hollow, lighted tube—may be 

performed to view the rectum. 

A thorough evaluation and proper diagnosis 

by a doctor is important any time a person 

notices bleeding from the rectum or blood 

in the stool. Bleeding may be a symptom of 

other digestive diseases, including colorectal 

cancer. 

Additional exams may be done to rule out 

other causes of bleeding, especially in people 

age 40 or older: 

• Colonoscopy. A flexible, lighted tube 

called a colonoscope is inserted through 

the anus, the rectum, and the upper part 

of the large intestine, called the colon. 

The colonoscope transmits images of 

the inside of the rectum and the entire 

colon. 

• Sigmoidoscopy. This procedure is 

similar to colonoscopy, but it uses a 

shorter tube called a sigmoidoscope and 

transmits images of the rectum and the 

sigmoid colon, the lower portion of the 

colon that empties into the rectum. 

• Barium enema x ray. A contrast material called barium is inserted into the 

colon to make the colon more visible in 

x-ray pictures. 

2  Hemorrhoids 
           

           

        

             

             

        

                

             

         

              

            

             

            

         

                   

      

             

             

       

           

   

               

           

                  

         

       

         

              

          

     

  

     

             

        

               

           

           

            

           

              

         

      

             

              

       

            

       

          

           

     

        

       

         

             

       

How are hemorrhoids 

treated? 

At-home Treatments 

Simple diet and lifestyle changes often 

reduce the swelling of hemorrhoids and 

relieve hemorrhoid symptoms. Eating a 

high-fiber diet can make stools softer and 

easier to pass, reducing the pressure on hemorrhoids caused by straining. 

Fiber is a substance found in plants. The 

human body cannot digest fiber, but fiber 

helps improve digestion and prevent constipation. Good sources of dietary fiber are 

fruits, vegetables, and whole grains. On 

average, Americans eat about 15 grams of 

fiber each day.3 The American Dietetic 

Association recommends 25 grams of fiber 

per day for women and 38 grams of fiber per 

day for men.3 

Doctors may also suggest taking a bulk 

stool softener or a fiber supplement such 

as psyllium (Metamucil) or methylcellulose 

(Citrucel). 

Other changes that may help relieve hemorrhoid symptoms include 

• drinking six to eight 8-ounce glasses of 

water or other nonalcoholic fluids each 

day 

• sitting in a tub of warm water for
 

10 minutes several times a day
 

• exercising to prevent constipation 

• not straining during bowel movements 

3Slavin JL. Position statement of the American 

Dietetic Association: health implications of dietary 

fiber. Journal of the American Dietetic Association. 

2008;108(10):1716–1731. 

Over-the-counter creams and suppositories 

may temporarily relieve the pain and itching 

of hemorrhoids. These treatments should 

only be used for a short time because longterm use can damage the skin. 

Medical Treatment 

If at-home treatments do not relieve symptoms, medical treatments may be needed. 

Outpatient treatments can be performed in 

a doctor’s office or a hospital. Outpatient 

treatments for internal hemorrhoids include 

the following: 

• Rubber band ligation. The doctor 

places a special rubber band around the 

base of the hemorrhoid. The band cuts 

off circulation, causing the hemorrhoid 

to shrink. This procedure should be 

performed only by a doctor. 

• Sclerotherapy. The doctor injects a 

chemical solution into the blood vessel 

to shrink the hemorrhoid. 

• Infrared coagulation. The doctor uses 

heat to shrink the hemorrhoid tissue. 

Large external hemorrhoids or internal hemorrhoids that do not respond to other treatments can be surgically removed. 

3  Hemorrhoids 
         

             

         

     

       

       

           

               

     

         

         

       

             

             

           

         

         

         

           

           

         

                          

What foods have fiber? 

Examples of foods that have fiber include 

Beans, cereals, and breads Fiber 

1/2 cup of navy beans 9.5 grams 

1/2 cup of kidney beans 8.2 grams 

1/2 cup of black beans 7.5 grams 

Whole-grain cereal, cold 

1/2 cup of All-Bran 9.6 grams 

3/4 cup of Total 2.4 grams 

3/4 cup of Post Bran Flakes 5.3 grams 

1 packet of whole-grain cereal, hot 3.0 grams 

(oatmeal, Wheatena) 

1 whole-wheat English muffin 4.4 grams 

Fruits 

1 medium apple, with skin 3.3 grams 

1 medium pear, with skin 4.3 grams 

1/2 cup of raspberries 4.0 grams 

1/2 cup of stewed prunes 3.8 grams 

Vegetables 

1/2 cup of winter squash 2.9 grams 

1 medium sweet potato with skin 4.8 grams 

1/2 cup of green peas 4.4 grams 

1 medium potato with skin 3.8 grams 

1/2 cup of mixed vegetables 4.0 grams 

1 cup of cauliflower 2.5 grams 

1/2 cup of spinach 3.5 grams 

1/2 cup of turnip greens 2.5 grams 

Source: U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines 

for Americans, 2005. 

4  Hemorrhoids 
     

      

  

  

       

      

  

  

  

  

           

        

  

  

  

  

       

           

              

             

       

           

         

           

         

      

           

         

               

               

           

             

          

         

       

           

       

         

     

           

           

           

           

             

           

         

     

             

       

Points to Remember 

• Hemorrhoids are swollen and 

inflamed veins around the anus or 

in the lower rectum. 

• Hemorrhoids are not dangerous or 

life threatening, and symptoms usually go away within a few days. 

• A thorough evaluation and proper 

diagnosis by a doctor is important 

any time a person notices bleeding 

from the rectum or blood in the 

stool. 

• Simple diet and lifestyle changes 

often reduce the swelling of hemorrhoids and relieve hemorrhoid 

symptoms. 

• If at-home treatments do not relieve 

symptoms, medical treatments may 

be needed. 

Hope through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK) 

sponsors research to improve treatment for 

people with digestive disorders, including 

hemorrhoids and constipation. Researchers 

are studying new drugs and surgical procedures to treat or prevent hemorrhoids. 

Participants in clinical trials can play a more 

active role in their own health care, gain 

access to new research treatments before 

they are widely available, and help others 

by contributing to medical research. For 

information about current studies, visit 

www.ClinicalTrials.gov. 

For More Information 

American College of Gastroenterology 

P.O. Box 342260 

Bethesda, MD 20827–2260 

Phone: 301–263–9000 

Internet: www.acg.gi.org 

American Gastroenterological Association 

4930 Del Ray Avenue 

Bethesda, MD 20814 

Phone: 301–654–2055 

Fax: 301–654–5920 

Email: member@gastro.org 

Internet: www.gastro.org 

American Society of Colon and Rectal 

Surgeons 

85 West Algonquin Road, Suite 550 

Arlington Heights, IL 60005 

Phone: 847–290–9184 

Fax: 847–290–9203 

Email: ascrs@fascrs.org 

Internet: www.fascrs.org 

Acknowledgments 

Publications produced by the Clearinghouse 

are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet 

was reviewed by Adil E. Bharucha, M.B.B.S., 

M.D., Mayo Clinic, Rochester, MN. 

5  Hemorrhoids 
            

               

         

          

    

  

  

  

  

  

       

             

           

          

               

             

            

   

           

           

            

           

       

     

       

     

               

         

           

          

             

             

           

       

            

                 

            

             

               

                

                   

             

     

 

You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov. 

This publication may contain information about 

medications. When prepared, this publication 

included the most current information available. 

For updates or for questions about any medications, 

contact the U.S. Food and Drug Administration 

toll-free at 1–888–INFO–FDA (1–888–463–6332) or 

visit www.fda.gov. Consult your doctor for more 

information. 

The U.S. Government does not endorse or favor any 

specific commercial product or company. Trade, 

proprietary, or company names appearing in this 

document are used only because they are considered 

necessary in the context of the information provided. 

If a product is not mentioned, the omission does not 

mean or imply that the product is unsatisfactory. 

National Digestive Diseases 

Information Clearinghouse 

2 Information Way 

Bethesda, MD 20892–3570 

Phone: 1–800–891–5389 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: nddic@info.niddk.nih.gov 

Internet: www.digestive.niddk.nih.gov 

The National Digestive Diseases Information 

Clearinghouse (NDDIC) is a service of the 

National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). The 

NIDDK is part of the National Institutes of 

Health of the U.S. Department of Health 

and Human Services. Established in 1980, 

the Clearinghouse provides information 

about digestive diseases to people with 

digestive disorders and to their families, 

health care professionals, and the public. 

The NDDIC answers inquiries, develops and 

distributes publications, and works closely 

with professional and patient organizations 

and Government agencies to coordinate 

resources about digestive diseases. 

This publication is not copyrighted. The Clearinghouse 

encourages users of this publication to duplicate and 

distribute as many copies as desired. 

This publication is available at 

www.digestive.niddk.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 11–3021

November 2010 

The NIDDK prints on recycled paper with bio-based ink.