Signs and symptoms of hemorrhoids may include:

• Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl
• Itching or irritation in your anal region
• Pain or discomfort
• Hemorrhoids protruding from your anus
• Swelling around your anus
• A sensitive or painful lump near your anus
• Leakage of feces

Hemorrhoid symptoms usually depend on the location. Internal hemorrhoids lie inside the rectum. You can't see or feel these hemorrhoids, and they usually don't cause discomfort. But straining or irritation when passing stool can injure a hemorrhoid's delicate surface and cause it to bleed. Occasionally, straining can push an internal hemorrhoid through the anal opening. This is known as a protruding or prolapsed hemorrhoid and can cause pain and irritation.

External hemorrhoids are under the skin around your anus. When irritated, external hemorrhoids can itch or bleed. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), resulting in severe pain, swelling and inflammation.

When to see a doctor
Bleeding during bowel movements is the most common sign of hemorrhoids. But rectal bleeding can occur with other digestive diseases, including colorectal cancer and anal cancer. Don't assume that bleeding is coming from hemorrhoids without consulting a doctor. Your doctor can do a physical examination and perform other tests to diagnose hemorrhoids and rule out more serious conditions or diseases. You should also seek medical advice if your hemorrhoids cause pain, bleed frequently or excessively, or don't improve with home remedies.

If your hemorrhoid symptoms began along with a marked change in bowel habits or if you're passing black, tarry or maroon stools, blood clots or blood mixed in with the stool, consult your doctor without delay. These types of stools can signal more extensive bleeding elsewhere in your digestive tract.

Seek emergency care if you experience large amounts of rectal bleeding, lightheadedness, dizziness or faintness.

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The veins around your anus tend to stretch under pressure and may bulge or swell. Swollen veins — hemorrhoids — can develop from an increase in pressure in the lower rectum. Factors that might cause increased pressure include:

• Straining during bowel movements
• Sitting for long periods of time on the toilet
• Chronic diarrhea or constipation
• Obesity
• Pregnancy
• Anal intercourse

It's also possible to inherit a tendency to develop hemorrhoids. Hemorrhoids are more likely as you get older because the tissues that support the veins in your rectum and anus can weaken and stretch with aging.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Complications of hemorrhoids are rare but include:

• Anemia. Chronic blood loss from hemorrhoids may cause anemia, in which you don't have enough healthy red blood cells, resulting in fatigue and weakness.
• Strangulated hemorrhoid. If blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be "strangulated," which can cause extreme pain and lead to tissue death (gangrene).

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Because talking about hemorrhoids can be embarrassing, many people are reluctant to see a doctor about the condition. But it's a good idea to consult a doctor any time you experience rectal bleeding, to make sure you don't have a more serious digestive disease. Start by talking to your regular doctor. If you have other signs and symptoms, such as a change in bowel habits or abdominal pain, your doctor may refer you to one or more specialists. These might include a doctor with expertise in the digestive system (gastroenterologist) or a colon and rectal surgeon, for evaluation and treatment.

You can help your doctor by being prepared with as much information as possible. Here are some suggestions to help you get ready for your appointment.

• Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance.
• Write down any symptoms you're experiencing and how long you've noticed them.
• Write down key personal information, including typical bowel habits and diet, especially your fiber intake.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Write down questions to ask your doctor.

What to expect from your doctor
Your doctor may ask:

• When did your symptoms first occur?
• What are your typical bowel habits?
• How much fiber does your diet contain?
• Has anyone in your family ever had hemorrhoids or cancer of the colon, rectum or anus?

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Your doctor may be able to see if you have external hemorrhoids simply by looking. For internal hemorrhoids, he or she will insert a rubber-gloved finger into your rectum. Because internal hemorrhoids are often too soft to be felt in a rectal examination, your doctor may also examine the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope. These are flexible, lighted tubes that allow your doctor to see into your anus and rectum.

Your doctor may want to do a more extensive examination of your entire colon using colonoscopy. This might be recommended if:

• Your signs and symptoms suggest you might have another digestive disease
• You have risk factors for colorectal cancer
• You're over age 50 (age 45 if you're black) and haven't had colonoscopy within 10 years

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Most of the time, treatment for hemorrhoids involves steps that you can take on your own, such as lifestyle modifications. But sometimes medications or surgical procedures are necessary.

Medications
If your hemorrhoids produce only mild discomfort, your doctor may suggest over-the-counter creams, ointments, suppositories or pads. These products contain ingredients, such as witch hazel or hydrocortisone, that can relieve pain and itching, at least temporarily.

Don't use an over-the-counter cream or other product for more than a week unless directed by your doctor. They can cause side effects, such as skin rash, inflammation and skin thinning.

Minimally invasive procedures
If a blood clot has formed within an external hemorrhoid, your doctor can easily remove the clot with a simple incision, which may provide prompt relief.

For persistent bleeding or painful hemorrhoids, your doctor may recommend another minimally invasive procedure. These treatments can be done in your doctor's office or other outpatient setting.

• Rubber band ligation. Your doctor places one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation. The hemorrhoid withers and falls off within a few days. This procedure — called rubber band ligation — is effective for many people. Hemorrhoid banding can be uncomfortable and may cause bleeding, which might begin two to four days after the procedure but is rarely severe.
• Injection (sclerotherapy). In this procedure, your doctor injects a chemical solution into the hemorrhoid tissue to shrink it. While the injection causes little or no pain, it may be less effective than rubber band ligation.
• Coagulation (infrared, laser or bipolar). These techniques use laser or infrared light or heat. They cause small, bleeding, internal hemorrhoids to harden and shrivel. While coagulation has few side effects, it's associated with a higher rate of hemorrhoids coming back (recurrence) than is the rubber band treatment.

Surgical procedures
If other procedures haven't been successful or you have large hemorrhoids, your doctor may recommend a surgical procedure. Surgery can be performed on an outpatient basis or you may need to stay in the hospital overnight.

• Hemorrhoidectomy. Your surgeon removes excessive tissue that causes bleeding. Various techniques may be used. The surgery may be done with a local anesthetic combined with sedation, a spinal anesthetic or a general anesthetic. Hemorrhoidectomy is the most effective and complete way to remove hemorrhoids, but it also has the highest rate of complications. These may include temporary difficulty emptying your bladder and urinary tract infections related to this difficulty.  Most people experience some pain after the procedure. Medications can be used to relieve your pain. Soaking in a warm bath also helps.
• Stapling. This procedure, called stapled hemorrhoidectomy or stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. Stapling generally involves less pain than hemorrhoidectomy and allows an earlier return to work. Compared with hemorrhoidectomy, however, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus. Talk with your doctor about what might be the best option for you.

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You can temporarily relieve the mild pain, swelling and inflammation of most hemorrhoidal flare-ups with the following self-care measures:

• Use topical treatments. Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a topical numbing agent.
• Keep the anal area clean. Bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Soap isn't necessary and may aggravate the problem. Gently drying the area with a hair dryer after bathing can minimize moisture, which can cause irritation.
• Soak regularly in a warm bath. Do this several times daily.
• Apply cold. Apply ice packs or cold compresses on the anus to relieve swelling.
• Use a sitz bath with warm water. A sitz bath fits over the toilet. You can get one at a medical supply store or some pharmacies.
• Don't use dry toilet paper. Instead, to help keep the anal area clean after a bowel movement, use moist towelettes or wet toilet paper that doesn't contain perfume or alcohol.
• Take oral medications. You can use acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin, others) temporarily to help relieve your discomfort.

These self-care measures may relieve the symptoms, but they won't make the hemorrhoid disappear. See your doctor if you don't get relief in a few days, or sooner if you have severe pain or bleeding.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:

• Eat high-fiber foods. Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can cause hemorrhoids or worsen symptoms from existing hemorrhoids. Add fiber to your diet slowly to avoid problems with gas.
• Drink plenty of fluids. Drink six to eight glasses of water and other liquids (not alcohol) each day to help keep stools soft.
• Consider fiber supplements. Most people don't get enough of the recommended amount of fiber — 20 to 35 grams a day — in their diet. Studies have shown that over-the-counter fiber supplements, such as Metamucil and Citrucel, improve overall symptoms and bleeding from hemorrhoids. These products help keep stools soft and regular. If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause constipation or make constipation worse.
• Don't strain. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.
• Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.
• Exercise. Stay active to reduce pressure on veins, which can occur with long periods of standing or sitting, and to help prevent constipation. Exercise can also help you lose excess weight that may be contributing to your hemorrhoids.
• Avoid long periods of standing or sitting. Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.