The anus (where solid wastes are expelled from the body) is surrounded by blood vessels. When these blood vessels become enlarged and uncomfortable, they are called hemorrhoids. Hemorrhoids can occur inside the anal canal (internal) or outside the anal canal (external). Sometimes when internal hemorrhoids enlarge, they extend to the outside and appear to be external hemorrhoids.


Usually, external hemorrhoids appear as a painful lump around the anus. This is because a blood clot has formed in the hemorrhoid. It can be uncomfortable, but it only bleeds if the clot opens and drains.

Internal hemorrhoids, on the other hand, commonly produce bleeding. Blood may appear on toilet paper, in the toilet bowl or on the surface of the stool. Sometimes mucus is also seen on toilet paper or stool. Internal hemorrhoids are sometimes painful if they extend outside the anus, or if the blood vessels are clotted (called thrombosed hemorrhoids).

  • First degree: the hemorrhoids remain inside at all times
  • Second degree: the hemorrhoids extend out of the rectum during a bowel movement but return on their own
  • Third degree: the hemorrhoids extend out during a bowel movement but can be pushed back inside
  • Fourth degree: the hemorrhoid is always outside


Causes and Risk Factors

Constipation, diarrhea or straining when going to the bathroom can cause hemorrhoids.


When bleeding is present, it is important to rule out more serious conditions. Hemorrhoids do not become cancer, but some forms of cancer can cause symptoms similar to those of hemorrhoids. A doctor may use an anoscope to evaluate hemorrhoids.


Treatment of external hemorrhoids depends on when a patient sees a doctor. The clot can be removed with an almost painless nonsurgical office procedure if the patient sees a doctor within a day or two of first feeling the discomfort.

If the patient waits three or more days, medical treatment will resolve the discomfort, but relief may take up to a week. Nonsurgical treatments include:

  • Resting in bed with the legs elevated
  • Hydrocortisone creams
  • Warm sitz baths

Any treatment can leave a small tag of skin. The skin tags are not harmful. Hemorrhoids and skin tags do not become cancer.

Internal hemorrhoids, in their least severe form, can be treated at home with the same methods used for external hemorrhoids. Second-degree internal hemorrhoids can be treated with nonsurgical office procedures. Third- and fourth-degree hemorrhoids may require surgical removal. A conventional hemorrhoidectomy is an inpatient procedure requiring a hospital stay of several days and a painful recovery period. As an alternative, the Anorectal Disorders Program offers an outpatient surgery, called procedure for prolapse and hemorrhoids (PPH), which generally provides immediate and nearly painless relief from severe internal hemorrhoids, as compared to traditional hemorrhoid surgery.