by EBSCO Medical Review Board


Hemorrhoids are swollen veins. They are found in and around the anus and lower rectum. External hemorrhoids grow under the skin around the anus. Internal ones grow inside the anus.

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The exact cause not known. It may be due to:

  • Chronic constipation that results in straining during bowel movements
  • A buildup of pressure or fluid inside the belly, such as from pregnancy or health problems

Risk Factors

This problem is more common in older adults. Other things that may raise the risk are:

  • Having any of the problems that cause hemorrhoids
  • Having other family members who have hemorrhoids
  • Sitting on the toilet for long periods of time
  • Chronic coughing
  • Chronic diarrhea
  • Obesity
  • Long term use of enemas or laxatives
  • Liver disease


Some people may not have symptoms. Others may have problems that range from mild to severe. Common ones are:

  • Bleeding, which may be seen:
    • On stool
    • On toilet paper
    • In the toilet bowl
  • Anal itching and burning
  • Swelling and pain during bowel movements
  • Sensitive lumps around the anus


The doctor will ask about your symptoms and health history. A physical exam may be done. It will focus on the anal area. An anoscope may be used to see internal structures. This is often enough to make the diagnosis.


The goal of treatment is to ease symptoms and promote healing.

Initial Treatments

Initial treatments may be:

  • Supportive care, such as warm baths or cold packs
  • Lifestyle changes, such as a high-fiber diet and drinking plenty of fluids
  • Medicines to ease pain, such as:
    • Ointments, creams, and suppositories applied to the skin
    • Over the counter pain relievers taken by mouth


Procedures may be done when other methods are not helpful. Options are:

  • Rubber band ligation—places a rubber band around the base of the hemorrhoid to cut off blood flow to it until it withers away
  • Sclerotherapy—injects a chemical mix near the vein to scar and shrink the vein
  • Coagulation therapy—uses electricity, laser, or infrared light to shrink the tissue
  • Hemorrhoidectomy—uses surgery to remove the hemorrhoid


To lower the risk of this problem:

  • Do not strain or read while having a bowel movement.
  • Treat constipation.
  • Drink plenty of fluids during the day.
  • Eat a high fiber diet.


American Gastroenterological Association 

American Society of Colon and Rectal Surgeons 


Canadian Association of Gastroenterology 

The College of Family Physicians of Canada 


Hemorrhoids. American Society of Colon and Rectal Surgeons website. Available at: Accessed October 22, 2020.

Hemorrhoids. EBSCO DynaMed website. Available at: Accessed October 22, 2020.

Hemorrhoids. Merck Manual Professional Version website. Available at: Accessed October 22, 2020.

Jacobs D. Clinical practice. Hemorrhoids. N Engl J Med. 2014 Sep 4;371(10):944-951.

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