Signs of mild and severe hemorrhoids: 5 tips to recognize internal and external hemorrhoids early

Hemorrhoids are more common than many people think: about 1 in 20 adults suffer from them, and nearly half of people over 50 experience this condition. However, symptoms such as anal itching, pain when sitting, or bright red blood after a bowel movement often cause anxiety but lead to reluctance to seek medical attention.

Understanding the signs of hemorrhoids, knowing how to identify hemorrhoids early, and distinguishing mild hemorrhoids from other digestive issues will help you take proactive and appropriate action, preventing the condition from silently progressing. In the article below, Tiptory will point out the common symptoms of hemorrhoids and when to see a doctor—especially since rectal bleeding is not always due to hemorrhoids.

Part 1: How to accurately identify signs of hemorrhoids

Tip 1: Observe swollen hemorrhoids around the anus

Check the anal area for swollen lumps

• Hemorrhoids occur when the vascular tissues in the anus or lower rectum become swollen and distended. Hemorrhoids can be located inside the rectum or form under the skin around the anus.

• Signs of external hemorrhoids are often one or more firm, sensitive lumps near the anus. Patients may experience itching, burning pain, or discomfort, especially when sitting, walking, and during bowel movements.

• Internal hemorrhoids are usually painless unless they prolapse outside. When prolapsed, patients may feel a sensation of fullness, wetness, pain, or difficulty cleaning after a bowel movement.

Do not conclude based solely on swollen lumps

• To accurately identify hemorrhoids, it's necessary to consider concomitant symptoms such as anal itching, pain during bowel movements, the appearance of lumps, or bright red blood after defecation.

• These symptoms can also be related to anal fissures, abscesses, or other digestive conditions. Therefore, it should not be assumed that every lump or bleeding is hemorrhoids.

Monitor and seek medical attention at the right time

• With mild hemorrhoids, symptoms may improve by avoiding straining, not sitting on the toilet for too long, drinking enough water, and increasing fiber in the diet.

• Patients should see a doctor if there is severe pain, sudden purple swelling, rectal bleeding, or if symptoms do not improve after about a week of home care.

Tip 2: Is pain during bowel movements hemorrhoids?

Monitor pain sensation during bowel movements

• Burning pain or discomfort during bowel movements can be one of the signs of hemorrhoids, especially when external hemorrhoids are swollen, a blood clot forms, or internal hemorrhoids have prolapsed.

• Straining hard increases pressure on the anal and rectal area, making already damaged hemorrhoids more prone to swelling and pain. Those with mild hemorrhoids should avoid forceful straining or prolonged sitting on the toilet.

Pay attention to the feeling of incomplete evacuation

• Prolapsed hemorrhoids can cause a sensation of fullness in the anus or a persistent urge to have a bowel movement even after defecating. However, this symptom alone is not enough to identify hemorrhoids, as constipation and some rectal conditions can also cause similar symptoms.

• If you cannot have a bowel movement, you should stand up, move around gently, and try again when you feel a natural urge. Do not continue to strain as this can worsen hemorrhoid symptoms.

Seek medical attention if symptoms are unusual

• Patients should seek medical attention if they experience severe pain, rectal bleeding, persistent changes in bowel habits, or always feel incomplete evacuation. A doctor can determine the cause and rule out anal fissures, abscesses, or other colorectal conditions.

Tip 3: Is blood in the stool hemorrhoids?

Observe the color and location of blood

• One of the common signs of hemorrhoids is bright red blood appearing after a bowel movement. Blood may be on toilet paper, coating the stool, or dripping into the toilet bowl.

• Painless bleeding is often associated with internal hemorrhoids. If accompanied by itching, burning pain, or small lumps around the anus, the likelihood of hemorrhoids may be higher. However, these symptoms alone are not sufficient to accurately identify hemorrhoids.

Do not assume all bleeding is hemorrhoids

• Blood in the stool can also be caused by anal fissures, inflammatory bowel disease, polyps, or colorectal cancer. Therefore, even if mild hemorrhoids are suspected, patients should still see a doctor when rectal bleeding occurs for the first time, recurs, or has an unknown cause.

• Seek emergency care if bleeding is heavy or continuous, with blood clots, dizziness, fainting, pale skin, severe abdominal pain, or black, tarry stools. These could be signs of gastrointestinal bleeding and should not be self-treated at home.

Tip 4: Identifying hemorrhoids around the anus

Observe lumps around the anus

• Signs of external hemorrhoids can be one or more small lumps under the skin around the anus. Hemorrhoids vary in size, are usually skin-colored or slightly pink, and can cause itching, pain, swelling, or discomfort when sitting.

• Prolapsed internal hemorrhoids can also form a soft, protruding mass at the anal opening, especially after a bowel movement. However, merely resembling a "cluster of grapes" is not enough to identify hemorrhoids, as skin tags, abscesses, and some other anal lesions can look similar.

Recognizing signs of thrombosed hemorrhoids

• Sudden, firm, very painful, and dark blue or purple swelling can indicate thrombosed external hemorrhoids, which occur when a blood clot forms inside the hemorrhoid.

• Patients should seek early medical attention, especially if the pain is severe or symptoms have appeared within approximately 72 hours. The doctor will assess whether to pursue conservative treatment or perform a procedure to remove the blood clot.

Do not try to puncture or squeeze hemorrhoids

• Do not use a needle, squeeze, or try to push a painful, swollen lump back inside, as this can cause bleeding, infection, and worsen the injury.

• Seek immediate medical attention if the swollen mass turns black, bleeds heavily, discharges pus, is accompanied by fever, or rapidly increasing pain. These are no longer typical manifestations of mild hemorrhoids and require direct medical examination.

Tip 5: Relieve hemorrhoid swelling and pain correctly

Check for swelling around the anus

• External hemorrhoids can cause the anal area to swell, become painful, or sensitive to touch, especially after a bowel movement or prolonged sitting. This is one of the common signs of external hemorrhoids.

• A firm, tight, suddenly painful, and dark purple lump may suggest thrombosed external hemorrhoids. This condition requires early medical evaluation, rather than attempting to puncture or squeeze the hemorrhoid yourself.

Apply a cold compress to reduce discomfort

• Wrap an ice pack in a soft cloth and gently place it on the anal area for about 10–15 minutes at a time. Do not apply ice directly to the skin, as it can cause frostbite and damage the swollen area.

• This can be done several times a day if it feels comfortable. This is only a temporary measure to relieve pain and swelling, not a substitute for treating the underlying cause.

Soak the anus in warm water

• Sit in a warm bath or sitz bath for about 10–15 minutes, 2–3 times a day and after bowel movements if needed. The water should be comfortably warm, not too hot, and no soap or chemicals are necessary.

• After soaking, gently pat dry with a soft towel, avoiding rubbing. This method can help relax the anal area and soothe the symptoms of mild hemorrhoids.

Be cautious with over-the-counter medications

• Hemorrhoid creams, suppositories, or wipes can temporarily relieve itching, pain, and swelling. Choose products based on the advice of a pharmacist or doctor and use them according to the instructions on the label.

• Hydrocortisone-containing medications should not be used long-term as they can thin the skin. Products containing vasoconstrictors like phenylephrine are also not suitable for everyone, especially those with heart disease, high blood pressure, thyroid disease, or enlarged prostate.

• Avoid wet wipes with alcohol, fragrances, or harsh detergents as they can further irritate the anal area.

See a doctor if swelling and pain do not subside

• To accurately identify hemorrhoids, patients should seek medical attention if the swollen lump is severely painful, bleeding, discharging fluid, accompanied by fever, or does not improve after about a week of home care.

Part 2: Causes and who is most susceptible to hemorrhoids

Note 1: Bowel habits increase the risk of hemorrhoids

Evaluate bowel habits

• Straining hard, sitting on the toilet for too long, and frequently delaying bowel movements increase pressure on the vascular tissues in the anus and rectum. These are common factors that cause or worsen hemorrhoid symptoms.

• The risk increases significantly if the patient frequently experiences constipation, has hard, dry stools, difficulty passing stools, or has to strain a lot. Chronic diarrhea can also cause irritation and contribute to hemorrhoid progression.

Recognize inappropriate habits

• Observe whether each bowel movement involves sitting for a long time, straining, or always feeling incomplete evacuation. Avoid bringing phones or books into the bathroom as this can prolong toilet time.

• If you cannot have a bowel movement after a few minutes, stand up, move around gently, and try again when your body has a clear urge. Forceful straining only increases pressure in the anal area.

Prevent constipation and reduce straining

• Drink plenty of water, eat more vegetables, fruits, whole grains, and gradually increase fiber to help soften stools, making them easier to pass.

• Stay active, go to the bathroom as soon as you feel the urge, and place your feet on a low stool when defecating to promote a more favorable posture. These changes are especially helpful for those with mild hemorrhoids.

Monitor for signs of prolapsed hemorrhoids

• Prolonged straining can cause internal hemorrhoids to prolapse through the anal opening. The patient may notice a soft mass protruding during defecation; the hemorrhoid may sometimes retract on its own or need to be managed according to doctor's instructions.

• Prolapsed hemorrhoids are not always an emergency. However, urgent medical attention is needed if the hemorrhoid cannot be reinserted, is severely painful, swollen, turns dark purple, or bleeds heavily, as there is a risk of strangulated hemorrhoids or blood clot formation.

• Do not rely on ointments to identify hemorrhoids yourself or try to push a painful, swollen lump back inside. Medical examination helps determine the degree of hemorrhoid prolapse and choose a safe treatment method.

Note 2: Constipation increases the risk of hemorrhoids

Recognize symptoms of constipation

• Constipation is more than just infrequent bowel movements. Common symptoms include fewer than 3 bowel movements per week, hard, dry stools, excessive straining, difficult bowel movements, or a frequent sensation of incomplete evacuation.

• Chronic constipation makes patients more likely to strain to pass stool quickly. Repeated pressure on the anal and rectal area can cause or exacerbate hemorrhoid symptoms.

Do not strain if you cannot have a bowel movement

• If you sit for a few minutes but cannot have a bowel movement, you should stand up, move around gently, and try again when you feel the urge. Do not continue to strain or sit on the toilet for too long, as this habit increases the risk of swelling and prolapsed hemorrhoids.

• A feeling of blockage or incomplete evacuation can be due to constipation, but it can also be related to prolapsed hemorrhoids and other anorectal conditions. Therefore, this is not the sole basis for identifying hemorrhoids.

Soften stools through daily habits

• Gradually increase fiber intake from vegetables, fruits, beans, and whole grains; also drink enough water to prevent fiber from making stools drier.

• Stay active and go to the bathroom as soon as you feel the urge. People with mild hemorrhoids can place their feet on a low stool when on the toilet to promote a comfortable bowel movement posture and reduce straining.

See a doctor if constipation is prolonged

• Seek medical attention if constipation does not improve, recurs frequently, or is accompanied by abdominal pain, vomiting, weight loss, rectal bleeding, or black stools. Do not self-administer laxatives long-term without guidance from a healthcare professional.

Note 3: Does prolonged sitting cause hemorrhoids?

Distinguish between sitting for work and sitting on the toilet

• Prolonged sitting at a desk or in a vehicle can increase feelings of pressure, heaviness, and discomfort in the anal area, especially if hemorrhoid symptoms are already present. However, current evidence is not sufficient to confirm that prolonged sitting for work directly causes hemorrhoids.

• A clearer risk factor is sitting on the toilet for too long, especially when accompanied by straining. This posture increases pressure on the vascular tissues in the anus and can cause hemorrhoids to swell or prolapse.

Assess daily sitting time

• Office workers, drivers, or sedentary individuals should pay attention if they frequently sit for many continuous hours and experience anal itching, swelling, pain, or bright red blood after a bowel movement.

• These symptoms can help identify hemorrhoids, but are not sufficient for self-diagnosis as many other anorectal conditions can cause similar symptoms.

Actively break up sitting time

• Every 30–60 minutes, stand up, walk around, or do light exercises for a few minutes. This habit helps reduce prolonged pressure on the pelvic area and also supports bowel motility and prevents constipation.

• When driving long distances, take advantage of stops to rest and exercise when it is safe to do so. People with mild hemorrhoids should also use soft seating, maintain a comfortable posture, and avoid continuous sitting if they are experiencing pain.

Shorten time spent in the bathroom

• Only go to the bathroom when you feel the urge, do not bring your phone or read books while sitting on the toilet. If you cannot have a bowel movement after a few minutes, stand up and try again later instead of straining.

• If pain, swelling, or bleeding persists despite changes in habits, the patient should see a doctor to accurately determine the cause and severity of the condition.

Note 4: Distinguishing hemorrhoids from other anal conditions

Understand the factors causing hemorrhoids

• Hemorrhoids are primarily associated with prolonged increased pressure in the anus and rectum. Common factors include constipation, chronic diarrhea, straining during defecation, prolonged sitting on the toilet, pregnancy, old age, and frequent heavy lifting.

• There is currently no reliable evidence that anal infection directly forms hemorrhoids. However, infection can cause swelling, pain, itching, or discharge—symptoms that are easily mistaken for hemorrhoid signs.

Do not assume all symptoms are hemorrhoids

• Anal fissures often cause severe burning pain during defecation and may be accompanied by bright red blood.

• Anal abscesses can cause a hot, red, continuously painful lump, sometimes accompanied by fever or pus discharge. This condition needs early examination and treatment; do not self-apply hemorrhoid medication.

• Anal fistulas, inflammatory bowel disease, polyps, and colorectal cancer can also cause bleeding or discomfort around the anus. Therefore, observing symptoms at home alone is not enough to accurately identify hemorrhoids.

Seek medical attention if warning signs appear

• Seek early examination if the pain rapidly increases, accompanied by fever, swelling, warmth, redness, pus discharge, recurrent bleeding, changes in bowel habits, or if symptoms do not improve after about a week.

• Even if mild hemorrhoids are suspected, patients should not ignore first-time or unexplained rectal bleeding. A correct diagnosis helps avoid using the wrong medication and missing conditions that require treatment.

Note 5: Recognizing hemorrhoids during pregnancy

Understand why pregnancy increases the risk of hemorrhoids

• As the fetus grows, the enlarging uterus puts additional pressure on the pelvic veins. Hormonal changes and constipation during pregnancy also make the vascular tissues around the anus more prone to swelling.

• Straining during bowel movements and the labor process can cause or exacerbate hemorrhoid symptoms during pregnancy. Common symptoms include itching, pain, swelling around the anus, a protruding lump, or bright red blood after defecation.

Reduce constipation and avoid straining

• Eat fiber-rich foods such as vegetables, fruits, legumes, and whole grains. Drink enough water as advised by your doctor and maintain physical activity suitable for pregnancy.

• Go to the toilet as soon as you feel the urge, avoid straining, and do not sit on the toilet for too long. These are important measures to help control mild hemorrhoids in pregnant women.

Soothe symptoms at home

• You can apply a cold compress using an ice pack wrapped in a cloth for about 10–15 minutes or soak the anal area in warm water to reduce swelling, pain, and discomfort.

• Keep the anal area clean and dry, and avoid using wipes with alcohol or fragrance. Do not use creams, suppositories, laxatives, or pain relievers without consulting your obstetrician.

Consult a doctor if abnormalities occur

• Pregnant women should inform their doctor if they suspect they have hemorrhoids during pregnancy, especially if symptoms are persistent, painful, or if hemorrhoids prolapse.

• Seek immediate medical attention if there is heavy bleeding, dizziness, fever, severe pain, or black stools. Rectal bleeding is not always caused by hemorrhoids, so the correct cause needs to be investigated.

Part 3: Effective home remedies for hemorrhoids

Method 1: Using witch hazel to relieve hemorrhoid discomfort

Understand the correct effects of witch hazel

• Witch hazel has astringent properties and is often used in some products for mild hemorrhoids. The product can help temporarily soothe itching, burning, and irritation around the anus.

• There is currently no strong scientific evidence that witch hazel can shrink hemorrhoids or cure the condition. Therefore, it is only a supportive measure to reduce symptoms, not a replacement for addressing constipation and bowel habits.

Use gently and correctly

• Choose alcohol- and fragrance-free products to minimize irritation. Apply a small amount to a soft cotton pad and gently dab it on the skin outside the anus; do not rub, apply deep into the anal canal, or insert the cotton pad inside.

• Wipes or creams containing witch hazel can be used according to package directions. Wash hands before and after use, and keep the anal area clean and dry.

Monitor skin reactions

• Discontinue use if burning, rash, swelling, redness, or increased itching occurs. People with sensitive skin should test a small amount before wider application.

• Pregnant women, those using multiple topical medications, or those with open lesions around the anus should consult a doctor before use.

Do not ignore abnormal signs

• Witch hazel does not help determine the cause of hemorrhoid symptoms. If there is severe pain, a swollen and hard lump, rectal bleeding, or symptoms lasting longer than a week, the patient should see a doctor for an accurate diagnosis of hemorrhoids and to rule out other conditions.

Method 2: Using over-the-counter hemorrhoid creams

Understand the limitations of hemorrhoid creams

• Over-the-counter creams can temporarily reduce pain, itching, and swelling in cases of mild hemorrhoids, but they do not completely eliminate hemorrhoids or treat all causes of anal bleeding.

• Symptom relief after applying medication is also not sufficient for a diagnosis of hemorrhoids. Do not delay medical examination for abnormal signs simply because you feel better.

Creams containing hydrocortisone

• Hydrocortisone is a corticosteroid that can reduce inflammation, itching, and swelling around the anus for a short period.

• Use externally as directed on the label and generally not for more than 7 days without consulting a doctor. Prolonged use can thin the skin, cause irritation, or mask infections.

Products containing lidocaine

• Lidocaine is a local anesthetic that temporarily helps reduce pain and burning sensations caused by external hemorrhoids.

• Do not apply to abraded or heavily bleeding skin, or use in excess of the recommended dose. Discontinue use if the treated area becomes red and swollen, develops a rash, or experiences abnormal widespread numbness.

Medications containing vasoconstrictors

• Some creams, ointments, or suppositories containing phenylephrine have a temporary vasoconstricting effect, which can reduce swelling and discomfort.

• People with high blood pressure, heart disease, thyroid disease, diabetes, or enlarged prostate should consult a doctor or pharmacist before use. Anal suppositories are not suitable for all symptoms, and their effectiveness may vary between individuals.

Safe medication use

• Clean and gently dry the anal area before application. Use the appropriate amount, frequency, and duration as indicated on the label; do not combine multiple products with the same active ingredient.

Pregnant women, breastfeeding mothers, children, or those taking other medications should consult a healthcare professional before treatment.

• Pregnant women, breastfeeding mothers, children, or those taking other medications should consult a healthcare professional before treatment.

Know when to see a doctor

• You should see a doctor if hemorrhoid symptoms do not improve after about a week, recur frequently, or are accompanied by severe pain, fever, pus discharge, a swollen purplish lump, or rectal bleeding.

• If there is heavy bleeding, dizziness, fainting, or black stools, urgent medical attention is required instead of continuing self-medication.

Method 3: Stool softening to reduce pain from hemorrhoids

Prioritize natural stool softening

• Hard, dry stools cause patients to strain excessively, increasing pressure on the anus and making hemorrhoid symptoms such as pain, swelling, or bleeding more severe.

• Increase fiber intake from green vegetables, fruits, legumes, and whole grains. Increase gradually to limit bloating, and drink enough water for the fiber to be effective.

• Regular exercise, going to the toilet as soon as the urge arises, and avoiding sitting on the toilet for too long also help facilitate easier bowel movements.

Consider fiber supplements

• If diet does not provide enough fiber, you can ask your doctor or pharmacist about soluble fiber like psyllium. This is a commonly recommended measure to help soften stools, reduce straining, and limit bleeding from mild hemorrhoids.

• When using, drink enough water and increase the dose as directed. Using too much too quickly can cause bloating or worsen constipation.

Use stool softeners correctly

• Stool softeners like docusate can be considered for short periods when stools are hard and dry, but evidence of their effectiveness in treating constipation is limited.

• If constipation does not improve, a doctor or pharmacist may recommend more suitable osmotic laxatives. Do not self-medicate for prolonged periods, combine multiple types, or exceed the dose indicated on the label.

• Pregnant women, individuals with heart disease, kidney disease, unexplained abdominal pain, or those taking other medications should consult a healthcare professional before use.

Monitor for signs requiring medical attention

• Stool softeners only help reduce straining, they do not help diagnose hemorrhoids and do not cure them.

• You should see a doctor if constipation is prolonged, anal pain is severe, bleeding recurs, stools are black, there is unexplained weight loss, or changes in bowel habits.

Method 4: Avoiding irritation when suffering from hemorrhoids

Choose soft, unscented toilet paper

• Rough, scented, or colored toilet paper can exacerbate itching and burning in an already inflamed anal area. People with hemorrhoid symptoms should choose soft, white, and unscented paper.

• Wipe gently from front to back or blot instead of rubbing. Do not try to wipe many times to achieve a "squeaky clean" feeling, as friction can cause hemorrhoids to swell and bleed.

Gentle hygiene after bowel movements

• The anal area can be washed with clean water or warm water, then patted dry with a soft cloth. Avoid strong water pressure sprays or inserting a washing nozzle deep into the anus.

• If using wet wipes, choose alcohol-free, unscented, and free of harsh detergents. Do not use dry cotton wool to wipe directly as fibers can stick and cause irritation.

Avoid easily irritating products

• Avoid using scented soaps, feminine washes, deodorants, or topical medications with unknown ingredients around the anus. These products do not treat hemorrhoids and can worsen itching and burning.

If burning, rash, or redness occurs after using a new product, discontinue use and gently rinse with clean water.

Wear breathable and well-fitting clothing

• Tight clothing does not directly cause hemorrhoids but can increase friction, retain moisture, and make the anal area more uncomfortable.

• Choose breathable cotton underwear, change clothes when damp, and avoid overly tight clothing during the stage where mild hemorrhoids are causing itching or pain.

See a doctor if irritation does not improve

• Anal itching does not always help diagnose hemorrhoids as it can also be related to dermatitis, fungal infections, pinworms, or other anal conditions.

• You should see a doctor if itching is prolonged, pain increases, there is discharge, an unusual odor, or rectal bleeding.

Method 5: Choosing appropriate underwear for hemorrhoids

Prioritize breathable cotton underwear

• Soft cotton underwear is highly absorbent, helping to keep the anal area ventilated and preventing moisture buildup. This can reduce friction, dampness, and the sensation of itching and burning when hemorrhoid symptoms appear.

• Choose well-fitting underwear without rough seams or bands that constrict the buttocks and anal area.

Avoid tight clothing

• Overly tight underwear and thongs can rub directly against the anal area, making already swollen and painful hemorrhoids more uncomfortable.

• Synthetic fabrics do not directly cause hemorrhoids but can retain more heat and moisture in some individuals. If you frequently sweat or experience irritation, switch to soft, breathable materials.

Keep the anal area clean and dry

• Change underwear daily and immediately after strenuous activity or when clothes become damp. Wash with mild, unscented products and rinse thoroughly to prevent detergent residue from causing irritation.

• After bathing or defecating, gently wash with clean water and then pat dry. Do not rub vigorously or use perfumed powder, perfumes, or deodorants around the anus.

Understand the correct role of clothing

• Wearing loose-fitting clothing only helps reduce irritation, it does not make hemorrhoids disappear and cannot be used to diagnose hemorrhoids.

• If hygiene and clothing changes have been made but the symptoms of mild hemorrhoids persist, pain increases, or are accompanied by bleeding, the patient should see a doctor to determine the cause.

Method 6: Soaking the anus to relieve hemorrhoid pain

Prepare the soaking water correctly

• Fill a clean bathtub or specialized sitz bath with warm water. The water level only needs to be sufficient to cover the anal area; do not use overly hot water as it can cause burns and irritate the skin.

• Do not add soap, shower gel, salt, essential oils, or antiseptic solutions. There is no reliable evidence that adding witch hazel to the sitz bath helps treat hemorrhoids better, while additives can cause irritation.

Soak the anal area for 10–15 minutes

• Sit and relax in warm water for about 10–15 minutes each time. This can be done 2–3 times a day or after bowel movements if it feels comfortable.

• Warm water can help relax the anal muscles and temporarily soothe pain, itching, or spasms when hemorrhoid symptoms are present.

Gently dry after soaking

• Stand up slowly to avoid slipping or dizziness. Use a clean, soft towel to pat dry; do not rub the anal area.

• Clean the bathtub or sitz bath after each use and do not share it with others to limit infection.

Understand the correct effects of warm water soaking

• Anal soaking only helps temporarily relieve symptoms, it does not make hemorrhoids disappear and cannot be used to diagnose hemorrhoids.

• If mild hemorrhoids do not improve after about a week, or if severe pain, fever, pus discharge, or rectal bleeding occurs, the patient should see a doctor instead of continuing self-care.

Method 7: When to seek medical attention for hemorrhoids?

See a doctor if home treatment is ineffective

• Individuals with hemorrhoid symptoms should seek medical attention if symptoms do not improve after about a week of home care, recur frequently, or interfere with sitting, walking, and bowel movements.

• Do not continue to self-medicate with creams or suppositories for prolonged periods. Some products only temporarily relieve symptoms and can cause irritation or thin the skin if used incorrectly.

Do not assume bleeding is always due to hemorrhoids

• Rectal bleeding can be related to hemorrhoids but can also stem from anal fissures, inflammatory bowel disease, polyps, or colorectal cancer.

• Patients should see a doctor if bleeding occurs for the first time, recurs, or is of unknown cause, even if mild hemorrhoids are suspected. A doctor can perform an anal-rectal examination and order appropriate tests to accurately diagnose hemorrhoids.

Identify emergency cases

• Seek immediate medical attention if there is heavy or continuous bleeding, blood clots, dizziness, fainting, pale skin, severe pain, fever, pus discharge, or tarry black stools.

• Prolapsed hemorrhoids that cannot be pushed back in, are swollen and hard, or have turned dark purple also require urgent examination due to the risk of strangulation or thrombosis.

Treatment according to disease severity

• Doctors often prioritize dietary adjustments, stool softening, reducing straining, and short-term medication for mild cases.

• If internal hemorrhoids bleed or prolapse persistently, in-office procedures such as rubber band ligation, sclerotherapy, or infrared coagulation may be considered.

Surgery is usually reserved for large hemorrhoids, severe prolapse, selected cases of thrombosed external hemorrhoids, or when less invasive methods are ineffective. Not everyone with hemorrhoids requires surgery.

Method 8: Increase fiber to reduce hemorrhoid-related constipation

Consume enough fiber daily

• Fiber helps soften stools, increases stool bulk, and facilitates easier bowel movements. By reducing constipation and straining, a high-fiber diet can improve bleeding and other symptoms of hemorrhoids.

• Adults typically need around 22–34 grams of fiber per day, depending on age and gender. There's no need to reach this goal immediately; gradually increase fiber intake to allow your digestive system to adapt.

Prioritize fiber-rich foods

• Add green vegetables, suitable fruits with skins, legumes, oats, brown rice, whole-grain bread, and whole-grain cereals to your daily meals.

• Start with small changes like adding vegetables to main meals, eating whole fruits instead of juice, and replacing some refined grains with whole grains.

Increase fiber gradually

• If your current diet is low in fiber, gradually increase the amount over several days or weeks. Increasing fiber too quickly can cause bloating, gas, and discomfort.

• Drink enough water when increasing fiber. Insufficient water can still lead to dry, hard stools, making it difficult to improve mild hemorrhoids.

Consider fiber supplements

• If it's difficult to meet your fiber needs through food, consult your doctor or pharmacist about soluble fiber supplements like psyllium. Take the correct dosage, mix with enough water, and avoid taking it at the same time as certain other medications unless directed.

• People with intestinal narrowing or blockage, unexplained abdominal pain, or difficulty swallowing should not self-administer fiber supplements.

Monitor your body's response

• Record the frequency of bowel movements, stool consistency, and the degree of straining. Soft, well-formed stools passed without effort indicate that your diet is appropriate.

• Dietary changes help support treatment but cannot confirm a hemorrhoid diagnosis on their own. If you experience rectal bleeding, severe pain, or prolonged constipation, you should seek medical attention.

Method 9: Drink enough water to reduce constipation

Stay adequately hydrated throughout the day

• Drinking enough water helps fiber work effectively and keeps stools soft, making bowel movements easier. Reducing dry stools and straining can improve some symptoms of hemorrhoids like pain or bleeding during defecation.

• Water needs vary depending on individual health, weather, activity level, pregnancy, and underlying medical conditions. You can monitor your urine color: pale yellow usually indicates adequate hydration.

Prioritize suitable beverages

• Plain water should be the primary choice. You can also supplement water from soups, broths, milk, or water-rich foods if they fit your diet.

• There's no need to force yourself to drink too much in a short time. Distribute your water intake evenly throughout the day and drink more when exercising or in hot weather.

• People with heart disease, kidney disease, or those advised to restrict fluids should follow the fluid intake recommended by their doctor.

Consider prune juice

• Prune juice contains sorbitol and some fiber, which can help soften stools and relieve constipation in some individuals.

• Start with a small amount to monitor your reaction. Drinking too much can cause bloating, abdominal pain, or diarrhea; sugar content should also be noted for people with diabetes.

Combine water with fiber and exercise

• Drinking water alone is often not enough to treat constipation. It should be combined with fiber-rich foods, regular exercise, going to the bathroom when needed, and avoiding prolonged straining.

• These measures help control mild hemorrhoids but cannot be used to diagnose them. Seek medical attention if constipation is prolonged, pain is severe, or rectal bleeding occurs.

Method 10: Exercise to reduce constipation and hemorrhoids

Maintain regular physical activity

• Physical activity can promote bowel motility, reduce the time stools remain in the colon, and prevent constipation. Easier bowel movements mean less straining and reduced pressure on the anal area.

• A brisk walk for about 20–30 minutes daily is a simple option suitable for many. If you're new to exercise, start with 10 minutes and gradually increase as your fitness improves.

Aim for appropriate exercise goals

• Adults should aim for at least 150 minutes of moderate-intensity physical activity per week, such as brisk walking, light cycling, or swimming.

• If you have a sedentary job, stand up and walk around for a few minutes every 30–60 minutes. This habit can aid digestion and reduce the feeling of pressure in the anal area when experiencing symptoms of hemorrhoids.

Choose exercises that don't increase discomfort

• When hemorrhoids are swollen, painful, or bleeding, prioritize walking, gentle stretching, and exercises that are within your capacity.

• Temporarily reduce heavy lifting or exercises that require holding your breath, bracing, and straining forcefully. When lifting objects, breathe evenly and use proper technique to limit increased abdominal pressure.

Combine with diet and bowel habits

• Exercise alone cannot replace drinking enough water, eating a fiber-rich diet, and going to the bathroom as soon as you feel the urge. Combining these measures will be more effective in controlling constipation and mild hemorrhoids.

• Exercise is not a way to diagnose or cure hemorrhoids. If exercise increases pain, causes rectal bleeding, or if symptoms persist, you should stop exercising and seek medical attention.

Do not self-treat hemorrhoids with essential oils

Avoid applying essential oils to the anus

• Do not mix peppermint oil, tea tree oil, or other essential oils into a sitz bath or apply them directly to the anal area. The skin there is very sensitive; essential oils can cause burning, contact dermatitis, or allergic reactions.

• Olive oil does not eliminate the risk of irritation, and there is no reliable evidence that essential oil mixtures can cure hemorrhoids. When experiencing symptoms of hemorrhoids, prioritize warm water soaks, keep the anal area dry, and avoid straining.

Consult a healthcare professional before taking medication

• A doctor or pharmacist can recommend suitable creams, suppositories, fiber supplements, or constipation medications for individual cases of mild hemorrhoids.

• Do not self-administer multiple products at once or use them beyond the duration specified on the label. Medications only help relieve temporary symptoms and do not replace identifying the precise cause.

Differentiate between internal and external hemorrhoids

• Internal hemorrhoids are located inside the anal canal and are usually not visible externally. Typical symptoms include bright red bleeding, often without pain; hemorrhoids only prolapse when severely swollen.

• External hemorrhoids form under the skin around the anus and can easily cause swelling, itching, pain, or a firm lump. Thrombosed external hemorrhoids can cause severe pain and a bluish-purple swollen lump.

Do not self-diagnose based solely on pain

• Pain during bowel movements can be caused by prolapsed hemorrhoids or thrombosed external hemorrhoids, but it is also common in anal fissures, abscesses, and many other conditions. Therefore, pain alone is not sufficient to diagnose hemorrhoids.

• Do not insert fingers or instruments into the anus to examine yourself. Seek medical attention if pain is prolonged, there is bleeding, a swollen purple lump, fever, pus discharge, or symptoms do not improve after about a week.

References

1. Hawkins, A. T., Davis, B. R., Bhama, A. R., Fang, S. H., Dawes, A. J., Feingold, D. L., Lightner, A. L., Paquette, I. M., and Sylla, P. (2024). The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Diseases of the Colon & Rectum, 67(5), 614–623.
2. Alonso-Coello, P., Guyatt, G., Heels-Ansdell, D., Johanson, J. F., Lopez-Yarto, M., Mills, E., and Zhuo, Q. (2005). Laxatives for the treatment of hemorrhoids. Cochrane Database of Systematic Reviews, (4), CD004649.
3. Lohsiriwat, V. (2012). Hemorrhoids: From basic pathophysiology to clinical management. World Journal of Gastroenterology, 18(17), 2009–2017.
4. Sun, Z., and Migaly, J. (2016). Review of hemorrhoid disease: Presentation and management. Clinics in Colon and Rectal Surgery, 29(1), 22–29.
5. Mott, T., Latimer, K., and Edwards, C. (2018). Hemorrhoids: Diagnosis and treatment options. American Family Physician, 97(3), 172–179.
6. Gallo, G., Martellucci, J., Sturiale, A., Clerico, G., Milito, G., Marino, F., Cocorullo, G., Giordano, P., Mistrangelo, M., and Trompetto, M. (2020). Consensus statement of the Italian Society of Colorectal Surgery: Management and treatment of hemorrhoidal disease. Techniques in Coloproctology, 24(2), 145–164.
7. National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Hemorrhoids: Definition and facts; symptoms and causes; diagnosis; treatment. National Institutes of Health, U.S. Department of Health and Human Services.
8. National Health Service. (2023). Piles (haemorrhoids): Symptoms, self-care and medical treatment. NHS.
9. American College of Obstetricians and Gynecologists. (2022). Problems of the digestive system during pregnancy. ACOG.

Content edited by: Rowan Hudson Le.

Information reviewed and verified by expert: Emily Johnson.