Hemorrhoids, also called piles, happen when clusters of veins in your rectum or anus get swollen (or dilated). When these veins swell, blood pools and causes the veins to expand outward into the membranes around your rectal and anal tissue. This can become uncomfortable or painful.

Hemorrhoids aren’t always visible. But when they expand, they can look like red or discolored bumps or lumps.

There are four types of hemorrhoids:

Most hemorrhoids aren’t serious and you may not notice them. In fact, less than 5 percent of people who get hemorrhoids have symptoms. Even less need treatment.

Hemorrhoids aren’t that uncommon. At least three of every four adults will get them at one point in their life. But see your doctor right away if your hemorrhoids are causing you pain, or disrupting your normal activities and bowel movements.

Internal hemorrhoids are found in your rectum. They can’t always be seen because they’re too deep in your anus to be visible.

Internal hemorrhoids aren’t normally serious and tend to go away on their own.

Sometimes internal hemorrhoids can swell and stick out of your anus. This is known as a prolapsed hemorrhoid.

There aren’t any nerves that detect pain in your rectum, so you may not always notice internal hemorrhoids. But they can cause symptoms if they grow larger, including:

  • pain or discomfort
  • itching
  • burning
  • noticeable lumps or swelling near your anus

Feces traveling through your rectum can also irritate an internal hemorrhoid. This can cause bleeding that you may notice on your toilet tissue.

See your doctor if an internal hemorrhoid causes you a lot of pain or discomfort.

A prolapsed hemorrhoid occurs when internal hemorrhoids swell and stick out of your anus. A doctor may assign a grade to a prolapsed hemorrhoid based on how far it sticks out:

  • Grade one: Not prolapsed at all.
  • Grade two: Prolapsed, but will retract by themselves. These may only prolapse when you put pressure on your anal or rectal area, such as by straining when you have a bowel movement, and then return to their normal position afterward.
  • Grade three: Prolapsed, and you have to push it back in yourself. These may need to be treated so that they don’t become too painful or infected.
  • Grade four: Prolapsed, and you can’t push it back in without a lot of pain. These will usually need to be treated to prevent pain, discomfort, or further complications.

Prolapsed hemorrhoids look like swollen red lumps or bumps outside your anus. You may be able to see them if you use a mirror to examine this area. Prolapsed hemorrhoids may have no other symptom than the protrusion, or they may cause pain or discomfort, itchiness, or burning.

In some cases, you may need surgical treatment to remove or correct a prolapsed hemorrhoid so that they don’t cause you any pain or complications.

External hemorrhoids occur on your anus, directly on the surface of where your bowel movements come out. They’re not always visible, but are sometimes seen as lumps on the anal surface.

External hemorrhoids aren’t usually a serious medical issue. But see your doctor if they cause pain or discomfort that interrupts your daily life.

The symptoms of external hemorrhoids are essentially the same as those of internal ones. But since they’re located on the outside of your rectal area, you may feel more pain or discomfort when you sit down, do physical activities, or have a bowel movement.

They’re also easier to see when they swell, and the bluish color of the dilated veins is visible beneath the anal skin surface.

See your doctor if an external hemorrhoid causes you pain or discomfort.

A thrombosed hemorrhoid contains a blood clot (thrombosis) within the hemorrhoid tissue. They may appear as lumps or swelling around your anus.

Thrombosed hemorrhoids are essentially a complication of a hemorrhoid, in which a blood clot forms.

Blood clots can happen in both internal and external hemorrhoids, and the symptoms may include:

  • intense pain and itchiness
  • swelling and redness
  • bluish color around area of hemorrhoid

See your doctor as soon as possible if you notice increasing pain, itchiness, or inflammation around your rectal and anal area. Thrombosed hemorrhoids need to be treated quickly to prevent complications from a lack of blood supply to your anal or rectal tissue.

Anything that puts pressure or strain on your anus or rectum can cause the veins to dilate. Some common causes and risk factors include:

  • being overweight
  • straining while having a bowel movement
  • having diarrhea or constipation
  • not having regular bowel movements
  • sitting for a long time
  • being pregnant or giving birth
  • not eating enough fiber in your diet
  • using too many laxatives
  • getting older, as tissues lose strength and elasticity as you age

Internal hemorrhoids can become prolapsed hemorrhoids if you continue to do any of these things that may have caused your hemorrhoid in the first place.

External hemorrhoids are more likely to become thrombosed, although there’s no specific risk factor known to cause this to happen.

See your doctor if you start to notice pain and discomfort around your anus, especially when you sit or have a bowel movement.

Seek emergency medical attention if you notice any drastic worsening of your symptoms or any of these other symptoms, especially if they’re interfering with your daily activities:

  • feeling extremely itchy around your anus
  • burning around your anus
  • noticeable lumps or swelling near your anus
  • bluish discoloration of your skin near areas of swelling

Your doctor may perform one or more tests to examine the anal or rectal area for hemorrhoids:

  • Looking at the anus or rectum for visible signs of hemorrhoids. A doctor should be able to easily diagnose an external or prolapsed internal hemorrhoid through a visual examination.
  • Doing a digital rectal exam. The doctor will insert a finger covered with a lubricated glove into the anus or rectum to feel for signs of hemorrhoids with the fingers.
  • Using an imaging scope to look at the inside of your rectum to examine for internal hemorrhoids. This usually consists of inserting a thin tube with the light on the end into your rectum. Tools used for this diagnosis may include an anoscope or sigmoidoscope.

Treatment may vary by type, degree of prolapse, or severity of your symptoms.

Here are some home remedies to try if your symptoms aren’t too severe:

  • Use an over-the-counter hemorrhoid cream or witch hazel solution to relieve swelling and pain.
  • Take pain medications, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol), to reduce pain.
  • Use a cold compress (an ice pack or even just a frozen vegetable bag wrapped in a thin towel) to relive pain and swelling.
  • Sit in warm water for 10 to 15 minutes. You can either fill a bathtub with warm water or use a sitz bath.

In some cases, your hemorrhoids may need to be removed to prevent pain and long-term complications. Some procedures for removal include:

Complications of hemorrhoids are rare. If they do happen, they may include:

  • Strangulation. Arteries feeding fresh blood to the hemorrhoid can become blocked, preventing blood supply from reaching the hemorrhoid. This can cause extremely intense and unbearable pain.
  • Anemia. If hemorrhoids bleed too much, they can deprive your red blood cells of oxygen. This can cause fatigue, shortness of breath, headaches, and dizziness as the blood supply carries less oxygen around your body.
  • Prolapse. Prolapsed hemorrhoids can cause pain or discomfort when you sit or pass a bowel movement.
  • Blood clots. Thrombosis is more likely to be a complication of an external hemorrhoid. Blood clots can cause increasingly unbearable pain and itching.
  • Infection. Bacteria can get into hemorrhoids that are bleeding and infect the tissue. Untreated infections can sometimes cause serious complications, such as tissue death, abscesses, and fever.

Hemorrhoids can be uncomfortable or even painful, but most of the time you won’t experience any noticeable symptoms, and complications are very rare.

Internal or external hemorrhoids that don’t prolapse or thrombose are more likely to heal without causing any symptoms or complications. Prolapsed and thrombosed hemorrhoids are much more likely to cause discomfort or increase your risk of complications.

Seek emergency medical attention if your hemorrhoids cause pain and discomfort, or if you notice any symptoms like bleeding or prolapse. Hemorrhoids that are treated quickly have a better chance of healing without causing any further complications.