Everyone has veins in their anus, and these veins tend to strain under pressure. When this pressure causes the veins to swell and bulge, like varicose veins, the result is hemorrhoids.

Some people also call them piles. There are two kinds of hemorrhoids: internal (within the lining of the anus and lower rectum) and external (forming under the skin of the anus).

Hemorrhoids can be caused by straining to move the bowels, by sitting for extended periods on the toilet, or by regularly lifting heavy objects. Certain physical conditions, such as pregnancy, obesity, and liver disease, may also contribute.

Hemorrhoids are more common than most people think, affecting nearly half of adults older than 50.

Internal and external hemorrhoids have different symptoms.

For internal hemorrhoids, the patient may experience:

  • Painless bleeding (found on the stool or toilet paper) from the rectum, due to the veins being scratched or broken
  • Swollen vein(s) pushing through the anus, also called prolapse

For external hemorrhoids, the patient may experience:

  • Discomfort and itching around the anus
  • One or more hard lumps near the anus (from blood clots)

After reviewing symptoms, your doctor will examine your bottom for signs of hemorrhoids, including lumps, swelling, small tears, leakage, and actual hemorrhoids.

For internal hemorrhoids, your doctor will likely perform a digital exam – inserting a gloved finger inside the anus.

Other procedures may include:

  • Anoscopy – A hollow tube with a light (anoscope) is inserted into the anus to view the lining of the anus and lower rectum.
  • Sigmoidoscopy – A flexible tube (sigmoidoscope) is inserted through the anus, and using a tiny camera at its tip, the doctor examines the last two feet of the colon, or lower large intestine.
  • Colonoscopy – A long, flexible tube equipped with a tiny video camera is inserted into the rectum through the anus, enabling the doctor to view the entire colon. If abnormalities such as polyps are detected, they can be removed for examination during the process.

Lifestyle modifications such as attentive hygiene, eating more fiber, and drinking lots of fluids may ease mild hemorrhoid discomfort. Over-the-counter stool softeners, creams, ointments, suppositories, and pads also may help.

If hemorrhoids are painful and/or cause persistent bleeding, one of the following procedures may be necessary:

Minimally invasive procedures:

  • External hemorrhoid thrombectomy – removing a painful blood clot (thrombosis) within an external hemorrhoid, under local anesthesia.
  • Rubber band ligation – placing a rubber band around the base of an internal hemorrhoid to cut off its blood supply, causing it to wither and fall off.
  • Sclerotherapy – injecting a chemical solution into the hemorrhoid that cuts its blood supply.
  • Coagulation (infrared or electrical) – a tool sends infrared light or electrical currents into internal hemorrhoids, cutting circulation so they shrink.


  • Hemorrhoidectomy – cutting out severe or recurring external hemorrhoids or prolapsing internal hemorrhoids.
  • Hemorrhoid stapling – a stapling tool removes internal hemorrhoidal tissue and pulls prolapsing hemorrhoids back into the anus.

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