Hemorrhoids are common, but rectal bleeding, itching or pain should never be ignored. Learn how to recognize piles, relieve symptoms at home, understand medical treatments and know when further investigation may be needed.

Written and Reviewed by Dr. Md Noman Islam Nirob, MBBS

Medical information reviewed against clinical guidance. Last reviewed: October 2026.

Hemorrhoids: Quick Summary

What are they?

Enlarged or symptomatic vascular cushions in or around the anus.

Common symptoms

Bright-red bleeding, itching, swelling and tissue prolapse.

First-line care

Fiber, adequate fluids, constipation management and avoiding straining.

When to seek care

New bleeding, severe pain, persistent symptoms or warning signs.

Key takeaway: Many cases improve without surgery. However, rectal bleeding should not automatically be assumed to be hemorrhoids.

What Are Hemorrhoids?

Hemorrhoids, commonly called piles, are normal vascular structures that help the anus maintain continence. They become a problem when they enlarge, bleed, prolapse or develop complications.

People sometimes delay seeking care because they feel embarrassed discussing anal symptoms. There is no need to feel ashamed. These symptoms are common, and an appropriate examination can help identify the cause and guide treatment.

Internal Hemorrhoids

Internal hemorrhoids develop inside the anal canal. They commonly cause painless, bright-red bleeding during or after a bowel movement. More advanced cases may protrude through the anus.

External Hemorrhoids

External hemorrhoids develop beneath the skin around the anal opening. They may cause swelling, itching, irritation or difficulty cleaning the area. If a blood clot forms, the lump can become suddenly and severely painful.

Important distinction

Sharp pain during defecation may indicate an anal fissure rather than uncomplicated hemorrhoids. A painful lump may be a thrombosed external hemorrhoid. Fever with worsening anal pain may indicate an infection and needs urgent assessment.

Symptoms of Hemorrhoids

Bright-red blood on toilet paper or on the surface of stool.
Itching, burning or irritation around the anus.
A lump or swelling near the anal opening.
Tissue protruding during bowel movements.
Mucus discharge or difficulty maintaining anal hygiene.
Pain or tenderness, particularly with external thrombosis.

Symptoms alone cannot confirm the diagnosis. Rectal bleeding may also occur with anal fissures, inflammatory bowel disease, colorectal polyps and colorectal cancer.

Read our related guide: Hematochezia: Causes of Bright-Red Rectal Bleeding.

Grades of Internal Hemorrhoids

Grade	Description
Grade I	No prolapse outside the anus.
Grade II	Prolapses during defecation but returns spontaneously.
Grade III	Prolapses and requires manual reduction.
Grade IV	Permanently prolapsed and cannot be reduced.

These grades describe internal hemorrhoid prolapse. Treatment depends on symptoms, examination findings and individual circumstances, not grade alone.

What Causes Hemorrhoids?

Hemorrhoidal disease is associated with changes in the supporting tissues of the anal canal and factors that contribute to straining or increased pressure.

Chronic constipation and hard stools.
Repeated straining during defecation.
Prolonged sitting on the toilet.
Low dietary fiber intake.
Pregnancy and childbirth.
Aging and weakening of supporting tissues.
Chronic diarrhea or frequent bowel movements.
Excess body weight and some activities that increase abdominal pressure.

Addressing constipation is important because hard stools and straining can aggravate symptoms.

Natural Treatment for Hemorrhoids

For uncomplicated hemorrhoids, conservative treatment is usually the first step. The aim is to make bowel movements easier, reduce straining and soothe irritation. Home remedies can improve symptoms, but they do not reliably eliminate every prolapsing or enlarged hemorrhoid.

1. Increase Dietary Fiber

Fiber helps soften stools and can reduce straining and bleeding. Choose vegetables, fruits, oats, whole grains, beans and lentils.

Increase fiber gradually to reduce bloating.

2. Consider Ispaghula Husk

Psyllium, also called ispaghula husk, is a bulk-forming fiber supplement that can help regulate stool consistency.

Use it according to product instructions with sufficient fluid. It is not suitable for everyone, especially people with suspected bowel obstruction or swallowing difficulties.

Read the Ispaghula Husk Guide →

3. Drink Adequate Fluids

Drink enough fluid to support comfortable bowel movements, especially when increasing fiber. Follow medical advice if you have a prescribed fluid restriction.

4. Try a Warm Sitz Bath

Sitting in comfortably warm water for 10–15 minutes may temporarily ease itching and discomfort. Avoid hot water and harsh additives.

5. Improve Toilet Habits

Respond to the urge to defecate, avoid straining and do not sit on the toilet longer than necessary. Avoid routinely using your phone while defecating.

6. Protect the Skin

Clean gently with water and pat dry. Avoid aggressive wiping, fragranced products and harsh antiseptics that may worsen irritation.

Do Herbal Remedies Cure Piles?

Claims that garlic, lemon juice, herbal oils or homemade mixtures cure hemorrhoids are not supported by strong clinical evidence. Applying irritating substances to sensitive anal tissue can cause burning, dermatitis or further injury.

Choose measures with a reasonable evidence base, such as fiber and appropriate bowel-habit changes, rather than relying on a supposed natural cure.

A practical example

Imagine someone who notices a small amount of bright-red blood after repeatedly passing hard stools. Improving fiber intake, using an appropriate fiber supplement and avoiding straining may help if hemorrhoids are the cause. However, new, persistent, recurrent or unexplained bleeding still needs medical assessment. Improvement after home treatment does not prove the diagnosis.

Medical Treatment for Hemorrhoids

Not every patient needs prescription medicine, a procedure or surgery. Treatment should match the symptoms, examination findings and severity.

1. Treat Constipation

If dietary changes are insufficient, a clinician or pharmacist may recommend an appropriate laxative, such as polyethylene glycol, depending on age, medical history and other medicines.

2. Use Topical Medicines Carefully

Some creams contain local anesthetics, protectants or mild corticosteroids that may temporarily relieve pain, itching or irritation. Evidence varies between products.

Follow the product instructions and seek professional advice if symptoms persist. Prolonged use of steroid-containing preparations can thin or irritate the skin.

3. Manage Pain Safely

Paracetamol may be appropriate for short-term pain relief when used according to the label and individual contraindications. Codeine can worsen constipation. If rectal bleeding is present, seek advice before taking ibuprofen or other NSAIDs, particularly if bleeding is substantial or you use anticoagulants.

4. Rubber Band Ligation

A clinician places a small elastic band around suitable internal hemorrhoidal tissue to reduce its blood supply. The tissue subsequently shrinks and separates.

This procedure is commonly used for symptomatic grade I and II internal hemorrhoids and selected grade III cases that have not responded to conservative treatment. It is not suitable for every external hemorrhoid.

5. Sclerotherapy and Infrared Coagulation

These office-based procedures can help selected patients with internal hemorrhoids. Sclerotherapy involves injecting a substance into the tissue, while infrared coagulation uses heat to promote shrinkage.

6. Surgery

Excisional hemorrhoidectomy may be recommended for selected patients with large external hemorrhoids, combined internal and external disease, advanced prolapse or persistent symptoms despite less invasive treatment.

Other procedures may be appropriate in specific circumstances. Discuss expected benefits, postoperative pain, recovery time and recurrence with the treating surgeon.

Clinical principle

Persistent symptoms do not automatically mean surgery is necessary. Examination helps determine whether conservative treatment, an office-based procedure or surgery is the most appropriate next step.

How Are Hemorrhoids Diagnosed?

Assessment usually includes a medical history and physical examination. Depending on the presentation, the clinician may perform an anal inspection, digital rectal examination and anoscopy.

Further investigation may be appropriate when bleeding is unexplained, anemia is suspected, bowel habits have changed, or age, family history or screening status raises concern for colorectal disease.

When Is Colonoscopy Needed?

Colonoscopy is not necessary for every person with hemorrhoids. It may be recommended when no clear source of bleeding is identified, symptoms persist despite treatment, alarm features are present or colorectal cancer screening is due.

Hemorrhoids do not cause colon cancer, but both conditions can occur in the same person. Finding hemorrhoids does not automatically exclude another cause of bleeding.

When Should You Seek Medical Help?

Seek emergency care

Heavy or continuous rectal bleeding.
Large blood clots, fainting, marked weakness or dizziness associated with bleeding.
Severe or rapidly worsening anal pain.
Severe pain with fever, spreading redness or signs of serious infection.

Arrange a prompt medical assessment

New or unexplained rectal bleeding.
Bleeding that keeps returning or does not resolve.
A persistent anal lump, repeated prolapse or worsening symptoms.
Unexplained weight loss, anemia, abdominal symptoms or a change in bowel habits.
A personal or family history that increases colorectal cancer risk.

Do not delay assessment because you assume the bleeding is caused by piles. The appropriate investigation depends on your symptoms and risk factors.

How to Prevent Hemorrhoids From Returning

Eat a consistent, fiber-rich diet.
Drink adequate fluids when medically appropriate.
Address chronic constipation or diarrhea.
Avoid straining and prolonged toilet sitting.
Maintain regular physical activity.
Seek medical advice when symptoms persist or change.

These habits can reduce symptoms and recurrence, although they cannot guarantee that hemorrhoids will never return.

Frequently Asked Questions About Hemorrhoids

Answers to common questions about piles, home remedies, bleeding and treatment.

Can hemorrhoids go away naturally?

Mild symptoms often improve with fiber, adequate hydration, constipation management and avoiding straining. Established prolapsing hemorrhoids may persist and sometimes require a procedure.

What is the best natural treatment for piles?

Increasing dietary fiber, keeping stools soft and avoiding straining are the most useful initial measures. A warm sitz bath may provide temporary relief, but it does not cure every hemorrhoid.

Is ispaghula husk effective for hemorrhoids?

Yes. It can help regulate stool consistency and reduce straining. Take it with the recommended amount of fluid and follow product instructions. Seek advice if you have swallowing difficulties or possible bowel obstruction.

Can hemorrhoids cause painless bleeding?

Yes. Internal hemorrhoids can cause painless bright-red bleeding. Other conditions can also cause painless bleeding, so new or unexplained bleeding should be assessed.

How long do hemorrhoids take to heal?

Mild symptoms may improve within days to a few weeks. Recovery depends on the type and severity of the condition. Persistent or worsening symptoms require reassessment.

Are hemorrhoid creams safe?

Some products offer temporary symptom relief. Use them according to the label and avoid prolonged use of steroid-containing creams without medical advice. Seek assessment if symptoms continue.

Can hemorrhoids be treated without surgery?

Many patients improve with conservative care. Selected internal hemorrhoids can also be treated with office-based procedures such as rubber band ligation. Surgery is reserved for appropriate cases.

Do hemorrhoids increase the risk of colon cancer?

No. Hemorrhoids are not considered a cause of colorectal cancer. However, both conditions can coexist, and rectal bleeding should not automatically be attributed to hemorrhoids.

Does everyone with hemorrhoids need a colonoscopy?

No. The decision depends on age, screening status, risk factors, symptoms and examination findings. Persistent bleeding, an unclear bleeding source or alarm symptoms may warrant further investigation.

Which doctor treats hemorrhoids?

A colorectal surgeon or appropriately experienced general surgeon can assess and treat hemorrhoids. A gastroenterologist may also evaluate rectal bleeding and determine whether further investigation is needed.

Can hemorrhoids return after treatment?

Yes. Symptoms can recur after home treatment, office procedures or surgery. Healthy bowel habits and constipation management may reduce recurrence but cannot eliminate the risk entirely.

The Bottom Line

Hemorrhoids are common and often improve with simple measures. Focus on fiber, appropriate hydration, comfortable bowel movements and avoiding straining. Medical treatments and procedures can help when symptoms persist.

Do not ignore rectal bleeding. New, persistent or unexplained bleeding, severe pain, anemia or changes in bowel habits deserve medical assessment.