How to Manage Bleeding Hemorrhoids

For some people, hemorrhoids don’t cause symptoms. But for others, hemorrhoids can lead to itching, burning, bleeding, and discomfort, especially when you’re sitting down.

Hemorrhoids, also called piles, are enlarged veins in the rectum and anus. There are two types of hemorrhoids:

• Internal hemorrhoids. These develop in the rectum.
• External hemorrhoids. 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 generally aren’t dangerous, but they can cause severe pain and inflammation.

In rare cases, thrombosed hemorrhoids can cause serious rectal bleeding due to ulceration (breaking) and necrosis (cell death) of the surrounding skin. This requires immediate medical attention.

Straining or passing a particularly hard stool can damage the surface of a hemorrhoid, causing it to bleed. Blood from a hemorrhoid will look bright red on a piece of toilet paper.

Internal, external, and thrombosed hemorrhoids can all bleed. In some cases, a thrombosed hemorrhoid can burst if it becomes too full.

Read on to learn more about why this happens and what you can do to get relief from pain and discomfort.

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’s 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. For this reason, it’s important to receive a proper diagnosis from your doctor.

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

• Take a sitz bath. A sitz bath involves soaking your anal area in a few inches of warm water. For extra relief, you may add some Epsom salts to the water.
• Use moist wipes. Toilet paper can be rough and irritating to external hemorrhoids. Try using a moist towelette instead. Look for ones without added fragrance or irritants. You can shop for wipes online.
• Wipe with witch hazel. Using toilet paper with witch hazel or witch hazel pads can help soothe and decrease inflammation.
• 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. These products are usually applied several times per day and provide temporary relief with regular use. Typically they should provide relief within about 1 week, or you should speak to your doctor. Shop for creams and suppositories online.

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. Here are some tips:

• 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 prevent constipation and irregular stools.
• Get a constipation aid. If you’re constipated, try taking an over-the-counter suppository, hemorrhoid cream, or stool softener. However, if these don’t work after 1 week, follow up with your doctor. You can buy a stool softener online.
• 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, which start working within 1 to 3 days. You can buy fiber supplements online.
• Maintain daily physical activity. Staying active tends to lessen constipation over time.
• 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 and usually produces a bowel movement within 1 to 3 days.
• Listen to your body. Paying closer attention to your body’s cues and going to the bathroom when you feel the urge can help prevent constipation and straining.

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.

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, causing the hemorrhoid to shrivel up and fall off after around 3 to 10 days.
• Sclerotherapy. This involves injecting a medicated solution into the hemorrhoid and has results similar to those of rubber band ligation. Multiple injections are typically required and are administered every few weeks.
• Bipolar, laser, or infrared coagulation. This method causes an internal hemorrhoid to lose its blood supply so that it eventually withers away after 1 to 2 weeks.
• Electrocoagulation. An electrical current dries up the hemorrhoid, creating scar tissue and causing the hemorrhoid 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. Before surgery, a doctor may prescribe suppositories to be used once or twice per day.

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

• Hemorrhoidectomy. This approach 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.
• Doppler guided hemorrhoid artery ligation (DG-HAL). 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 recurrence rate for severe hemorrhoids.

It’s best to contact 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
• anal pain
• changes in bowel movement habits
• weight loss
• fever
• abdominal pain
• lightheadedness
• nausea or vomiting
• dizziness

You can book an appointment with a primary care doctor in your area using our Healthline FindCare tool.

However, while primary care doctors can usually provide treatment for hemorrhoids, you may need to visit a gastroenterologist or colorectal surgeon if you have severe hemorrhoids or experience any complications.

Gastroenterologists specialize in the treatment of conditions that affect the digestive tract, including hemorrhoids. They can perform colonoscopies and other procedures, such as rubber band ligation.

In severe cases where surgery is required, you may be referred to a colorectal surgeon, a physician that specializes in diseases that affect the colon, rectum, and anus.

With hemorrhoids, prevention often involves a combination of diet and lifestyle changes. In addition to staying physically active, eating a balanced diet, and drinking plenty of water, here are five ways to prevent hemorrhoids.

Maintain good personal hygiene

Keeping your rectal area clean is essential to preventing hemorrhoids, especially after a bowel movement.

Shower often and consider using a squirt bottle with warm water and moist toilet paper to gently wipe your anus. A bidet is another helpful option.

Avoid food triggers

Foods that contain little fiber should be on your “do not eat” list. This includes:

• dairy products (milk, cheese, and ice cream)
• white bread and bagels
• meat
• processed foods like fast food and frozen meals

In order to learn what your food triggers are, an elimination diet is a helpful option. You can also keep a journal to record the foods you’re eating and how your body reacts to them.

Wear cotton underwear

This will keep the area dry and help prevent moisture from forming.

Avoid lifting heavy objects

Lifting things like heavy boxes or groceries puts unnecessary pressure on the anal canal.

Make the toilet an entertainment-free zone

Spending too much time on the toilet, whether by using your phone or reading, places pressure on your rectum and anus. You should not spend more than 15 minutes on the toilet. You can set a timer for yourself if you’re easily distracted.

Hemorrhoids can bleed when they become damaged or irritated. Usually, this bleeding and irritation can resolve with home treatment.

However, 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 treatment.