Why Do I Have A Hemorrhoid? Causes And What To Do

Hemorrhoids are swollen veins in the lower rectum or around the anus, and they are one of the most common reasons adults in the United States see a doctor for rectal symptoms. They form when pressure inside these veins rises, causing the vein walls to stretch and the surrounding tissue to swell. The most common triggers are chronic constipation, straining during bowel movements, and sitting on the toilet for long periods. Hemorrhoids are not a sign of cancer, and they are not caused by sitting on cold surfaces or by “bad blood” — both are myths. Most cases improve with simple changes to fiber, fluids, and bathroom habits.

Why Do I Have A Hemorrhoid? Causes And What To Do

Hemorrhoids happen when the veins in your anal canal get squeezed, stretched, or inflamed. Everyone has these veins — they help cushion the anal canal and assist with bowel control. They only become a problem when they swell or slide out of place.

Several things raise the pressure inside those veins:

• Straining during a bowel movement, often from constipation
• Chronic diarrhea, which irritates the anal lining and increases pressure
• Sitting on the toilet too long, especially while scrolling on a phone
• Pregnancy, from both increased pelvic pressure and hormonal changes
• Low-fiber diets, which lead to hard, small stools
• Heavy lifting or other activities that increase abdominal pressure
• Obesity and a sedentary lifestyle
• Aging, because the supporting tissues around the anal canal weaken over time

There is also a genetic component. If a parent had hemorrhoids, your risk is somewhat higher, though researchers have not identified a single gene responsible.

What does not cause hemorrhoids: sitting on concrete, cold floors, or metal benches. Spicy food does not cause them either, though it can make existing symptoms feel worse for some people. These ideas persist but are not supported by clinical evidence.

What Is the Difference Between Internal and External Hemorrhoids?

Internal hemorrhoids sit inside the rectum, above the point where pain-sensitive nerves end. External hemorrhoids sit just outside the anal opening, under skin that is packed with nerve endings. That difference explains why the two feel so different.

Internal hemorrhoids often cause no pain at all. The most common sign is bright red blood on toilet paper or in the bowl. They can also prolapse — push through the anal opening — which may feel like a lump or a sense of incomplete emptying.

External hemorrhoids are the ones that hurt. They can itch, burn, or throb, especially when sitting. If a blood clot forms inside one (a thrombosed hemorrhoid), the pain can be sudden and severe. The lump may look blue or purple and feel firm.

Doctors classify internal hemorrhoids into four grades based on how far they prolapse:

• Grade I — Bleeding only, no prolapse
• Grade II — Prolapse during a bowel movement, returns on its own
• Grade III — Prolapse that needs to be pushed back in manually
• Grade IV — Prolapsed and cannot be pushed back in

Grades I and II are by far the most common. Grades III and IV usually need a procedure.

What Symptoms Should Make You See a Doctor?

Rectal bleeding is the symptom that most often brings people in, and it is the one that deserves a medical evaluation. Bright red blood is typical of hemorrhoids, but it is also a sign of other conditions — including colorectal cancer, inflammatory bowel disease, and anal fissures. You cannot tell the difference on your own.

See a doctor if you have:

• Bleeding that is new, persistent, or heavier than a few streaks
• Blood that is dark, maroon, or mixed with stool
• Pain that is severe or getting worse
• A lump that is hard, purple, and very painful
• Weight loss, fatigue, or a change in bowel habits lasting more than a few weeks
• Any rectal bleeding after age 45, or earlier if you have a family history of colorectal cancer

This is not about scaring you. Most rectal bleeding turns out to be benign. But the only way to know is an exam. A digital rectal exam takes seconds and can rule out many serious causes. Depending on your age and history, your doctor may also recommend a colonoscopy.

What Actually Helps Hemorrhoids Heal?

The first-line treatment for most hemorrhoids is not a cream or a pill. It is changing what happens in the bathroom. Soft, well-formed stools pass without straining, and that removes the pressure that keeps hemorrhoids swollen.

What helps:

• Fiber. Aim for 25 to 30 grams per day from food, or use a fiber supplement such as psyllium. Increase slowly and drink plenty of water, or you may get gas and bloating.
• Fluids. Water helps fiber do its job. There is no single correct number, but pale yellow urine is a reasonable sign of adequate hydration.
• Sitz baths. Sitting in warm water for about 10 to 15 minutes, a few times a day, can ease pain and itching. This is widely recommended and generally helpful, though formal trials are limited.
• Don’t linger. Keep bathroom visits short. Bring a book or phone and you will sit longer than you need to.
• Don’t delay. When you feel the urge, go. Waiting makes stool harder.
• Move. Regular physical activity helps keep bowels regular.

Over-the-counter options include hydrocortisone creams (short-term use only — usually no more than a week, since longer use can thin the skin) and numbing agents like lidocaine. Witch hazel pads can soothe irritation. These treat symptoms, not the underlying cause.

Prescription options exist for more persistent cases. A doctor may prescribe a stronger topical steroid or a nitrate ointment, though nitrate ointments can cause headaches in some people.

When Are Procedures Needed?

Procedures are for hemorrhoids that keep bleeding, keep prolapsing, or cause significant pain — not for every case. Many people never need one.

For internal hemorrhoids, common office-based options include rubber band ligation, in which a tiny band cuts off blood flow and the hemorrhoid shrinks and falls off over several days. Other options include sclerotherapy (injecting a chemical that shrinks the tissue), infrared coagulation, and electrocoagulation. Rubber band ligation is generally considered the most effective office treatment for grades I to III, though it can cause some discomfort and, rarely, bleeding.

For a thrombosed external hemorrhoid, a doctor may make a small incision and remove the clot. This works best within the first 48 to 72 hours of symptom onset, when pain is usually worst. After that window, the clot often resolves on its own and the procedure may not be worth the risk.

Surgery (hemorrhoidectomy) is reserved for large or recurrent hemorrhoids that do not respond to other treatments. It is more effective than office procedures for advanced cases but has a longer, more painful recovery. A newer procedure called stapled hemorrhoidopexy causes less postoperative pain but has a higher rate of recurrence.

Can You Prevent Hemorrhoids From Coming Back?

You cannot guarantee they will never return, but you can lower the odds. The same habits that treat hemorrhoids also prevent them.

Keep stools soft. Get fiber from food when you can — beans, lentils, whole grains, fruits, and vegetables are the best sources. Drink water throughout the day. Do not strain, and do not sit on the toilet longer than you need to. Stay active. If you lift weights, exhale on the effort rather than holding your breath, which reduces abdominal pressure.

If you are pregnant, hemorrhoids are common, especially in the third trimester. They often improve after delivery. Talk to your doctor before using any medication during pregnancy, since some topical treatments are not recommended.

One clarification worth knowing: hemorrhoids are not caused by sitting on a hard surface. They are caused by pressure from inside, not from outside. The chair is not the problem. The straining is.