Almost 75% of people will deal with hemorrhoids at some point in their life. That’s not a rare condition-it’s common. But what most people don’t realize is that not all hemorrhoids are the same. There are two main types: internal hemorrhoids and hemorrhoids that form inside the rectum, covered by tissue without pain receptors, so they rarely hurt but often bleed, and external hemorrhoids and those that develop under the skin around the anus, packed with nerve endings, making them painful, itchy, and visible. Knowing the difference isn’t just academic-it changes how you treat them.
What Makes Internal Hemorrhoids Different
Internal hemorrhoids sit above the dentate line, deep inside the rectum. Because that area has no pain sensors, you won’t feel them unless they prolapse-meaning they push out through the anus. The most common sign? Bright red blood. You might see it on the toilet paper, in the bowl, or streaked on your stool. It’s usually painless, which is why many people ignore it. They think, "It’s just a little bleeding, it’ll go away."
But ignoring it can be risky. Internal hemorrhoids are graded on a scale from I to IV:
- Grade I: Bleeds, but doesn’t prolapse at all.
- Grade II: Pops out during bowel movements but slides back in on its own.
- Grade III: Comes out and stays out-you have to push it back in.
- Grade IV: Stays out permanently and can’t be pushed back. This one often causes serious discomfort and constant irritation.
These grades aren’t just labels-they guide treatment. A Grade I hemorrhoid might respond to diet changes. A Grade IV? You’re probably looking at surgery.
What Makes External Hemorrhoids Different
External hemorrhoids are right at the edge of the anus. They’re covered in skin, not mucous membrane. And that skin? Full of nerves. So when they swell, you feel it. Not just a little discomfort-real pain. Sitting becomes torture. Walking feels off. You might notice a soft, skin-colored lump. But the worst case? A thrombosed external hemorrhoid and a blood clot forms inside the swollen vein, turning it into a hard, purple or blue lump that throbs with pain.
Thrombosed hemorrhoids come on fast. One day, you’re fine. The next, you can’t sit down without wincing. This isn’t something that resolves on its own in a few days. If it’s been less than 72 hours, a quick outpatient procedure-making a tiny cut to drain the clot-can bring immediate relief. After that window, the body slowly reabsorbs the clot, but the pain lingers for weeks.
Why You Might Have Both
It’s not unusual to have both types at once. In fact, many people do. You might have a bleeding internal hemorrhoid and a painful external lump. That makes self-diagnosis tricky. If you’re seeing blood and feeling pain, is it one problem or two? Doctors often find both during exams. The key is not to assume-get checked. Mistaking an anal fissure for a hemorrhoid is common. Fissures cause sharp, tearing pain during bowel movements, not itching or swelling. And while hemorrhoids bleed, fissures rarely do. If your treatment isn’t working, it might be the wrong diagnosis.
What Causes Hemorrhoids?
Hemorrhoids aren’t caused by sitting too long on the toilet-though that doesn’t help. The real culprits are things that increase pressure on the veins in your rectum:
- Chronic constipation or diarrhea
- Straining during bowel movements
- Pregnancy (25-35% of pregnant women develop them)
- Obesity
- Heavy lifting
- Sitting for hours-especially on hard surfaces
It’s not about being "dirty" or "lazy." It’s about mechanics. When you strain, you squeeze the veins in your pelvis. Over time, they stretch, swell, and bulge. That’s hemorrhoids. The good news? You can prevent them.
Home Treatments That Actually Work
For mild cases, you don’t need drugs or surgery. Start here:
- Fiber: Aim for 25-30 grams a day. That’s not just "eat more veggies." Think oats, beans, lentils, chia seeds, and whole fruits like pears and apples with skin.
- Water: Drink 8-10 glasses daily. Fiber without water just makes things harder.
- Sitz baths: Soak in warm water (not hot) for 15-20 minutes, 2-3 times a day. It reduces swelling and soothes irritation.
- Witch hazel pads: These help with itching and inflammation. Keep them in the fridge for extra relief.
- Don’t sit too long on the toilet: Five minutes max. If you’re not going, get up. Use a footstool to raise your knees above your hips-it reduces rectal pressure by 30%.
Over-the-counter creams with hydrocortisone can help with itching, but don’t use them for more than a week. Long-term use can thin the skin. And forget the "miracle cures" you see online. No cream, oil, or supplement has been proven to shrink hemorrhoids permanently.
When You Need Medical Help
Home care works for mild cases. But if you’re still bleeding after a week, or the pain won’t go away, it’s time to see a doctor. Here’s when to act:
- Bleeding that doesn’t stop
- Dizziness or weakness (signs of blood loss)
- Changes in bowel habits (new constipation, diarrhea, or narrow stools)
- Pain that wakes you up at night
- A lump that won’t go away or keeps growing
Rectal bleeding can be a sign of something serious-like colorectal cancer or inflammatory bowel disease. Never assume it’s just hemorrhoids. Get it checked.
Minimally Invasive Procedures
If home care doesn’t work, doctors have several options that don’t require full surgery:
- Rubber band ligation: A tiny rubber band is placed around the base of the internal hemorrhoid. It cuts off blood flow. The tissue shrinks and falls off in about a week. It’s 90% effective for Grades I-III. You might feel pressure or mild cramping for a day or two.
- Sclerotherapy: A chemical solution is injected into the hemorrhoid. It scars the tissue and shrinks it. Less effective than banding, but good for bleeding.
- Infrared coagulation: A brief burst of heat seals the blood vessels. Often used for smaller hemorrhoids.
These are quick, done in the office, and you can usually go back to work the same day. No anesthesia needed.
Surgery: The Last Resort
For severe cases-Grade IV prolapse, recurrent thrombosed hemorrhoids, or when other treatments fail-surgery is the most reliable fix.
- Hemorrhoidectomy: The hemorrhoid is completely cut out. It’s the gold standard. Success rate? 95%. But recovery takes 2-4 weeks. Pain is real, and you’ll need prescription painkillers.
- Stapled hemorrhoidopexy: Instead of removing the tissue, it’s pulled back up and stapled. Less pain than traditional surgery, but higher chance of recurrence. Best for prolapse, not bleeding.
Recovery after surgery isn’t fun. But if you’ve been suffering for months, it’s worth it. And if you follow post-op advice-high fiber, no straining, sitz baths-you’re far less likely to get them back.
Prevention Is the Best Treatment
Studies show that if you stick to healthy habits after treatment, recurrence drops from 50% to just 5-10%. That’s huge. Here’s how:
- Keep your fiber intake at 30g/day. That’s your new baseline.
- Drink water before you feel thirsty. Dehydration is a silent trigger.
- Move. Walk daily. Even 20 minutes helps circulation.
- Don’t hold it in. When you feel the urge, go.
- For pregnant women: Sleep on your left side. It takes pressure off major veins.
It’s not about perfection. It’s about consistency. One bad bowel movement won’t ruin you. But months of ignoring your diet? That will.
Can hemorrhoids turn into cancer?
No, hemorrhoids do not turn into cancer. But rectal bleeding-a common symptom of hemorrhoids-can also be a sign of colorectal cancer. That’s why any new or persistent bleeding should be evaluated by a doctor. Don’t assume it’s just hemorrhoids. Get checked.
Do hemorrhoids go away on their own?
Mild hemorrhoids can improve with home care in a few days. Swelling and bleeding from external hemorrhoids often reduce with sitz baths and fiber. But they rarely disappear completely without treatment. If symptoms last more than a week, or keep coming back, you need a better plan.
Is it safe to use witch hazel on hemorrhoids?
Yes, witch hazel is safe and effective for temporary relief of itching and swelling. Use alcohol-free pads or a diluted solution. Don’t use it as a cure-it helps symptoms, but doesn’t shrink the hemorrhoid. Avoid applying it directly with cotton balls if the skin is broken.
Can I exercise with hemorrhoids?
Yes, but avoid heavy lifting and straining. Walking, swimming, and cycling are fine. In fact, movement helps prevent constipation and improves circulation. If you’re doing weightlifting or intense core workouts, you might aggravate them. Adjust your routine until symptoms improve.
Why do hemorrhoids hurt more at night?
At night, blood flow increases to the pelvic area as your body rests. If you’ve been sitting all day, swelling builds up. Lying down can also increase pressure on the area, especially if you sleep on your back. A warm sitz bath before bed and sleeping on your side can help reduce nighttime discomfort.
Are hemorrhoids more common in women?
Yes, especially during pregnancy. Hormonal changes and pressure from the growing uterus increase vein swelling. About 1 in 3 pregnant women develop them. After childbirth, they often improve, but not always. Women are also more likely to delay seeking help due to embarrassment, which can make symptoms worse.
If you’ve been living with hemorrhoids for months, you’re not alone. But you don’t have to live with the pain. Start with fiber and water. See a doctor if it doesn’t improve. And remember-this isn’t something to be ashamed of. It’s a medical condition, not a personal failing. Treat it like one.