Hemorrhoids, also called piles, are enlarged veins in your rectum and anus. For some, they don’t cause symptoms. But for others, they can lead to itching, burning, bleeding, and discomfort, especially when sitting down.

There are two types of hemorrhoids:

  • Internal hemorrhoids develop in your rectum.
  • External hemorrhoids develop around the anal opening, beneath the skin.

Both internal and external hemorrhoids can become thrombosed hemorrhoids. This means that a blood clot forms inside the vein. Thrombosed hemorrhoids aren’t dangerous, but they can cause severe pain and inflammation.

Internal, external, and thrombosed hemorrhoids can all bleed. Read on to learn more about why this happens and what you can do for relief.

Straining or passing a particularly hard stool can damage the surface of a hemorrhoid, causing it to bleed. This can happen with both internal and external hemorrhoids. In some cases, a thrombosed hemorrhoid can burst if it becomes too full, resulting in bleeding.

Blood from a hemorrhoid will look bright red on a piece of toilet paper.

A bleeding hemorrhoid is usually a sign of irritation or damage to the wall of the hemorrhoid. This should resolve on its own over time, but there are several things you can do at home to speed up the process and soothe any discomfort.

However, if there is no clear source of bleeding or if the bleeding doesn’t go away within a week, see your doctor. Experts note that hemorrhoids are often self-diagnosed, which can be dangerous. Many medical conditions, including cancer and inflammatory bowel disease (IBD), can have similar symptoms. It’s important to receive a proper diagnosis from your doctor.

Home treatment

If you have been diagnosed with a hemorrhoid that’s itchy or painful, start by gently cleaning the area and reducing inflammation:

  • Take a sitz bath. This involves soaking your anal area in a few inches of warm water. For extra relief, you may add some Epsom salts to the water. Learn more about sitz baths.
  • Use moist wipes. Toilet paper can be rough and irritating to external hemorrhoids. Try using a moist towelette instead. Look for something like these, available on Amazon, that don’t have any added fragrance or irritants.
  • Use a cold pack. Wrap a cold pack with a towel and sit on it to reduce inflammation and calm the area. Apply for no longer than 20 minutes at a time.
  • Avoid straining or sitting on the toilet for long periods of time. This can put more pressure on hemorrhoids.
  • Use an over-the-counter product. You can also apply a topical cream to external hemorrhoids or use a medicated suppository for internal hemorrhoids. Amazon carries both creams and suppositories.

Next, try to soften your stools to keep your digestive system in good working order and reduce your risk of further irritation or damage to a bleeding hemorrhoid:

  • Stay hydrated. Drink plenty of water throughout the day to avoid constipation.
  • Eat fiber. Try to gradually add more high-fiber foods into your diet, such as whole grains, vegetables, and fresh fruit. This can help to prevent constipation and irregular stools.
  • Take a stool softener. If you’re constipated, try taking an over-the-counter stool softener, available on Amazon.
  • Add a fiber supplement to your routine. If you find yourself needing some extra help to keep things moving, you can also take a fiber supplement, such as methylcellulose or psyllium husk. You can buy fiber supplements online.
  • Maintain daily physical activity. Staying active tends to lessen constipation.
  • Try Miralax (polyethylene glycol). This product is typically safe to take on a regular basis. It pulls water into your digestive tract to help soften stool.

If you’re still noticing blood or a lot of discomfort after a week of home treatments, you may need to revisit your doctor for additional treatment.

Medical treatment

If home treatments aren’t providing any relief, there are several surgical treatments that can help. Many of them can be done in the office and don’t require general anesthesia.

These include:

  • Rubber band ligation. Rubber band ligation involves applying a tiny rubber band to the base of an internal hemorrhoid. This restricts blood flow, eventually causing the hemorrhoid to shrivel up and fall off.
  • Sclerotherapy. This involves injecting a medicated solution into the hemorrhoid and has results similar to those of rubber band ligation.
  • Bipolar, laser, or infrared coagulation. This method causes an internal hemorrhoid to lose its blood supply so that it eventually withers away.
  • Electrocoagulation. An electrical current dries up the hemorrhoid, causing it to eventually fall off.

If your bleeding hemorrhoids are larger or more severe, your doctor may recommend more advanced treatment, such as more extensive surgery. They may also recommend this if you have a prolapsed hemorrhoid. These happen when an internal hemorrhoid starts to hang out of the anus. Your doctor will be able to recommend which procedure may be best for you based on the type and severity of your hemorrhoids.

These approaches often involve general or regional anesthesia, as well as a potential stay overnight in the hospital:

  • Hemorrhoidectomy. This involves surgically removing a prolapsed internal or complicated external hemorrhoid.
  • Hemorrhoidopexy. A surgeon will attach a prolapsed hemorrhoid back into your rectum using surgical staples. This procedure also changes the blood supply to the hemorrhoid, causing them to shrink.
  • DG-HAL (Doppler guided hemorrhoid artery ligation). This procedure uses ultrasound to show hemorrhoid blood flow. The blood supply to the hemorrhoid is cut off causing the hemorrhoid to shrink. However, this procedure leads to a high reoccurrence rate for severe hemorrhoids.

It’s best to see a doctor if you’re noticing blood. While it could be due to a hemorrhoid, it could also be a sign of something more serious, such as colorectal cancer.

A doctor will likely start by confirming that hemorrhoids are the source of the blood you’ve noticed. To do this, they’ll either examine the area for external hemorrhoids or insert a gloved finger to check for internal hemorrhoids.

If it’s still not clear where the blood’s coming from, they may recommend a colonoscopy, which involves inserting a small, lighted camera into your colon while you are sedated. This will help them check for any signs of other conditions that could be causing the bleeding.

Make sure to tell them if you have any of the following symptoms in addition to bleeding:

  • changes in stool consistency or color
  • changes in bowel movement habits
  • weight loss
  • anal pain
  • fever
  • dizziness
  • lightheadedness
  • abdominal pain
  • nausea or vomiting

Hemorrhoids can bleed when they become damaged or irritated. Usually, this bleeding and irritation can resolve with home treatment. But if you continue to notice bleeding after a week of home care, it’s best to follow up with a doctor for further evaluation and care.

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