What to Do About Hemorrhoid Pain, According to Gastroenterologists

Hemorrhoids are a health condition many people have at least heard of before. But despite a general public awareness of hemorrhoids, plenty of people are fuzzy on the details of what, exactly, these are and if hemorrhoids hurt.

Hemorrhoids (aka piles) are swollen, inflamed veins around the anus or the lower part of the rectum, according to the US's National Library of Medicine. They can generally be broken into two types: external hemorrhoids, which form under the skin around your anus, and internal hemorrhoids, which form in the lining of the anus and lower rectum. If that sounds painful to you, well, it can be. Other times, hemorrhoids just cause discomfort.

Hemorrhoids can occur for a variety of reasons, including straining when you poop, sitting on the toilet for long periods of time, chronic constipation or diarrhea, eating a low-fiber diet, aging, pregnancy, and regularly lifting heavy objects, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Unfortunately, hemorrhoids can and do happen — and sometimes they can be painful. Hemorrhoids can also cause bleeding, which can be startling to many. If you're experiencing hemorrhoid pain or you suspect you're dealing with hemorrhoids, it's normal to have questions. Here's what experts want you to know.

Ashkan Farhadi, MD, is a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA.

Arashdeep K. Litt, DO, is a gastroenterologist at The Center for Gastrointestinal Disorders.

"It depends," says Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, noting that a lot has to do with the location of the hemorrhoid.

"External hemorrhoids usually itch and bleed and may cause a dull ache," says Arashdeep K. Litt, MD, an internal medicine physician with Corewell Health.

Internal hemorrhoids are usually not painful, Dr. Farhadi says. However, if you have a prolapsed internal hemorrhoid, which is when the hemorrhoid has fallen through your anal opening, it can be painful, Dr. Litt says. "Significant pain could signal an anal fissure," Dr. Litt says. (In case you're not familiar with it, an anal fissure is a small tear in the thin tissue that lines the anus.)

Symptoms of hemorrhoids can vary depending on where they're located, the NIDDK says.

You might have these symptoms with external hemorrhoids:

Internal hemorrhoids might cause these signs:

Both internal and external hemorrhoids can cause bleeding. But the symptom is not to be overlooked. If you are bleeding during bowel movements or your hemorrhoids don't improve after a week of home care, Mayo Clinic suggests that you talk to a doctor. Hemorrhoids can also result in blood clots, called thrombosed hemorrhoids. This is what happens when a small blood clot develops in an external hemorrhoid, which can cause severe pain and sometimes bleeding, per Saint Luke's Health System. Thrombosed hemorrhoids typically go away on their own, but other times, if persistent, they can require medical attention and/or surgery.

That being said, "Don't assume rectal bleeding is due to hemorrhoids, especially if you have changes in bowel habits or if your stools change in color or consistency," Mayo Clinic states. "Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer." If you're unsure where the rectal bleeding is coming from, it's suggested that you seek medical care to determine the exact cause.

It's also recommended that you seek emergency care if you are experiencing large amounts of rectal bleeding, light-headedness, or dizziness.

If you're experiencing hemorrhoid pain, take comfort in knowing that the symptoms of hemorrhoids usually go away in a few days, the NIDDK says. However, Farhadi says they may last up to 10 days or longer, depending on how intense the hemorrhoid is. If your pain is worsening after a few days, it's recommended that you chat with a medical provider.

In some cases, you may need to see your doctor to have a procedure done or even surgery to make your hemorrhoid go away, Dr. Litt says.

There are a few things you can do to shrink hemorrhoids and ease symptoms. "Having softer bowel movements certainly will help," says Rudolph Bedford, MD, a gastroenterologist at Providence Saint John's Health Center in Santa Monica. (Softer bowel movements decrease friction against the hemorrhoid, reducing irritation and inflammation in the process.) He recommends making sure you get enough fiber in your diet and drink plenty of water to help soften your BMs.

You can also sit in a warm tub or a sitz bath to help decrease inflammation around the tissue in and around your anus, Dr. Bedford says. "Various medications such as Preparation H can help with discomfort," he adds.

Dr. Litt also recommends trying the following:

If you're still struggling with hemorrhoids, your doctor may recommend procedures like rubber-band ligation, electrocoagulation, or sclerotherapy, all of which cut off blood supply to the hemorrhoid, making it shrink or fall off.

In more severe cases, your doctor may suggest a hemorrhoidectomy (a type of surgery to remove large external hemorrhoids and prolapsing hemorrhoids) or hemorrhoid stapling (a procedure that removes internal hemorrhoid tissue and pulls a prolapsed internal hemorrhoid back into the anus), the NIDDK says.

Hemorrhoids are not usually considered dangerous. "They are more of an annoyance," Dr. Litt says. However, complicated hemorrhoids can cause blood loss and anemia, she says, and some types of hemorrhoids may cause pain and discomfort.

If you suspect you have a hemorrhoid, doctors recommend trying the methods mentioned above, like using a sitz bath or a hemorrhoid cream like Preparation H and seeing where that gets you. But if you're still having symptoms or your pain is worsening, Dr. Bedford says it's time to call your doctor.

Korin Miller is a writer specializing in general wellness, health, and lifestyle trends. Her work has appeared in Women's Health, Self, Health, Forbes, and more.