What are the symptoms of hemorrhoids?

Symptoms of external hemorrhoids may include painful swelling or a hard lump near the anus, which may be a blood clot. Symptoms of internal hemorrhoids include bleeding (bright red blood on stool or toilet paper), and itching. An internal hemorrhoid may protrude through the anus, and cause pain and irritation. Some individuals with hemorrhoids have no symptoms.

Hemorrhoid symptoms can resemble other conditions, including fissures, fistula, abscesses, or irritation and itching, called pruritis ani. Constipation and diarrhea may exacerbate hemorrhoids, or cause similar symptoms. Consulting your physician when you have any of these symptoms, such as blood in stool, is important to determine the exact cause of your symptoms.

Painless rectal bleeding on toilet paper or in the toilet bowl is the most common symptom.

Hemorrhoids are usually not painful. Pain can occur with thrombosed hemorrhoids or with hemorrhoids that can suddenly not be reposited in the anal canal.

Another symptom is the protrusion of hemorrhoids after a bowel movement. In this case the hemorrhoids either spontaneously go back in or have to be pushed in manually.

Small hemorrhoids cannot be seen but can bleed after a hard bowel movement/straining or after frequent bowel movements. Hemorrhoids that protrude out after a bowel movement often go back in spontaneously. Occasionally they have to be manually pushed in. Hemorrhoids that protrude out and do not go back in can sometimes get large and form a clot. These are called thrombosed prolapsed hemorrhoids.

 External hemorrhoids can have the following symptoms:
• A grape-like lump on the anus
• Itching and soreness in and around the anus
• Blood on underwear, toilet paper, the surface of the stool, or in the toilet bowl.

Internal Medicine Specialist Dr. Keri Peterson explains the most common symptoms of internal and external hemorrhoids. Watch Dr. Peterson's video for information on health and wellness.

The symptoms most often associated with hemorrhoids include itching, burning, pain, inflammation, irritation, swelling, bleeding, and seepage. Pain is usually worse with defecation. A person with hemorrhoids may also notice bright red blood on the surface of the stool, on the toilet tissue, and/or in the toilet bowl.

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Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching, also called pruritus ani, have similar symptoms and are incorrectly referred to as hemorrhoids. Anal fissures are cuts or tears occurring in the anus. An anal fistula is a small tunnel with an internal opening in the anal canal and an external opening in the skin near the anus. It forms when an anal abscess that's drained (either on its own or via surgery) does not heal completely. An anal abscess is a collection of pus in the deep tissues surrounding the anus.

Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.

Hemorrhoid symptoms usually depend on the location.

Internal hemorrhoids: Internal hemorrhoids cannot be seen or felt. Straining or irritation from passing stool can injure a hemorrhoid's delicate surface and cause it to bleed. Individuals may notice small amounts of bright red blood on toilet tissue or in the toilet bowl water. Because internal anal membranes lack pain-sensitive nerve fibers, these hemorrhoids usually do not cause discomfort. Occasionally, straining can push an internal hemorrhoid through the anal opening. If a hemorrhoid remains displaced (called prolapsed), it can cause pain and irritation. Internal hemorrhoids may not be noticed since they do not cause pain and discomfort.

External hemorrhoids: External hemorrhoids tend to be painful. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), causing severe pain, swelling, and inflammation. External hemorrhoids can itch or bleed when irritated.

When internal and external hemorrhoids occur at the same time, they are referred to as mixed hemorrhoids.

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Bleeding during bowel movements, itching and rectal pain are the most common hemorrhoid symptoms.

External hemorrhoids

Rectal pain occurs mainly with external hemorrhoids. Blood may pool under the skin, forming a hard, painful lump. This is called a thrombosed, or clotted, hemorrhoid. You might also notice streaks of blood on the toilet paper after straining to pass a stool.

Internal hemorrhoids

The most common symptom of internal hemorrhoids is rectal bleeding. You may find bright red streaks of blood on the toilet paper or bright red blood in the toilet bowl after having a normal bowel movement. Blood also may be visible on the surface of the stool.

Other symptoms of internal hemorrhoids may include:

• Itching. This is a frequent complaint, because internal hemorrhoids often seep mucus, which can irritate the anal skin and cause itching.
• Skin irritation. Large hemorrhoids that bulge from the anus may secrete mucus, causing mild irritation.
• Discomfort. You may still feel the urge to pass stool right after having a bowel movement. This uncomfortable feeling is caused by the bulging of the hemorrhoid in the end portion of the large intestine (anal canal). In general, the larger the hemorrhoid, the greater the discomfort.
• Pain. Most internal hemorrhoids are not painful. But large hemorrhoids that bulge from the anus may become painful if they swell and are squeezed by the muscles that control the anus. Severe pain may be a sign that the blood supply to the hemorrhoid is being cut off (strangulated hemorrhoid). Emergency treatment is needed.

Rectal bleeding and pain and recent changes in bowel habits are also symptoms of colon, rectal or anal cancer. People who have these symptoms, especially those age 50 or older or those with a family history of colon cancer, need to talk to their doctors.

Other conditions with symptoms similar to hemorrhoids include:

• Anal fissure or anal fistula.
• Anorectal abscess.
• Colon polyp.
• Inflammatory bowel disease, particularly Crohn's disease.
• Rectal prolapse.