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Symptoms

Symptoms of hemorrhoids differ depending on where they develop.

External hemorrhoids

People may not notice small external hemorrhoids, although many times itching, burning, and irritation are present. If the anal area is tender or skin tags are present, a person might not be able to clean the area well. (Skin tags are extra skin that remains stretched out of shape after an external hemorrhoid goes down.) Stool hidden in the folds of the skin tag causes irritation and itching. This sets up a cycle of discomfort because scratching, rubbing, and excessive cleaning around the anus cause more irritation and burning.
A person might also notice streaks of bright red blood on the toilet paper after straining to pass a stool.
Rarely, a vein inside an external hemorrhoid may break and bleed when there is a sudden increase in pressure on the vein. If the vein breaks and blood pools under the skin, it may form a hard, painful lump. This is called a clotted hemorrhoid.

  • The pain may be so great that a person cannot sit or walk. The lump, resembling a blood blister, may be visible at the anal opening.
  • If the skin covering the lump breaks open, the hemorrhoid bleeds. If the clot is cut open (excised) and removed by a doctor, the person will feel immediate relief from intense pain, and the remaining soreness should go away in a few days.

Internal hemorrhoids

The most common symptom of internal hemorrhoids is rectal bleeding. You may notice bright red streaks of blood on the toilet paper or bright red blood in the toilet bowl after having a normal bowel movement. Blood may be visible on the surface of the stool.
Other symptoms of internal hemorrhoids may include:

  • Itching. Itching around the anus is a frequent complaint, because internal hemorrhoids often seep mucus, which can cause itching.
  • Skin irritation. Large hemorrhoids that bulge from the anus may secrete mucus, causing mild skin irritation.
  • Discomfort. The person may still feel the urge to pass stool right after having a bowel movement. This uncomfortable feeling is caused by the bulging of the hemorrhoid in the end portion of the large intestine (anal canal). In general, the larger the hemorrhoid, the greater the discomfort.
  • Pain. Large hemorrhoids that bulge from the anus may become painful if they swell and are squeezed by the muscles that control the opening and closing of the anus. Severe pain may be a sign that the blood supply to the hemorrhoid is being cut off (strangulated hemorrhoid) and emergency treatment is needed.

Rectal bleeding, recent changes in bowel habits, and rectal pain are also symptoms of colon or rectal cancer. People who have these symptoms, especially those age 50 or older, should talk to their health professional.

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