Hemorrhoids are swollen and inflamed veins in your anus and lower rectum. Hemorrhoids are very common. By age 50, at least half of adults have experience about hemorrhoids. Based on location, there are three types of hemorrhoids: 1. Internal hemorrhoids, which locates inside the rectum; 2. External hemorrhoids, which locates under the skin around the anus; 3. Mixed hemorrhoids, which locates inside and outside of the rectum. Pictures below are endoscopic views of hemorrhoids from inside the rectum.

Causes and Risk Factors

The common ones are:

  • Straining during bowel movements
  • Sitting or standing for long periods of time
  • Constipation
  • Diarrhea
  • Obesity
  • Pregnancy
  • Anal intercourse
  • Anal infections
  • Certain diseases, such as liver cirrhosis

Symptoms and Signs

The most common ones may include:

  • Anal itching
  • Anal pain
  • Painless bleeding. Small amounts of bright red blood might be seen on the toilet paper or dripping into the toilet bowl.
  • Painful bowel movements
  • One or more hard tender lumps near the anus
  • Swelling around your anus
  • Leakage of stool

Diagnosis and Treatment

Diagnosis is based on clinical presentation with one or more of the following tests:

Treatments for hemorrhoids are based on the type, symptoms, causes, and the patient’s preferences. There are many methods available to treat hemorrhoids. The most common ones are:

  • Life style modifications
  • Stool softeners
  • Hemorrhoid creams to help reduce pain and swelling
  • Sitz baths can increase blood supply and aid in healing
  • Infrared coagulation
  • Endoscopic rubber band ligation
  • Surgical hemorrhoidectomy
  • Minimal invasive procedure: Hemorrhoids banding with CRH system


  1. PubMed.
  2. Wikipedia.
  3. Mayo clinic online health information.
  4. Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
  5. The Little Black Book of Gastroenterology-by David W. Hay.
  6. Principles of Clinical Gastroenterology by Tadataka Yamada, et al.