Hemorrhoids are one of the most common digestive problems in the United States, and they affect millions of adults every year. Most people can manage the condition with simple measures, but when bleeding becomes one of the symptoms most people are naturally alarmed. While the sight of blood after a bowel movement can truly be unsettling, in most cases it can be explained by simple irritation and can be treated by similar methods.

What Are Hemorrhoids?

Hemorrhoids are swollen veins in the rectum or anus that develop when increased pressure causes these blood vessels to stretch beyond their normal capacity. While nearly every adult will experience hemorrhoids at some point, many people don’t realize they have them until symptoms become noticeable. The swelling process resembles what happens with varicose veins in the legs, but the location makes hemorrhoids far more problematic since they interfere with normal bowel function and daily comfort.

The location where hemorrhoids develop determines both the symptoms they cause and how they’re treated. Internal hemorrhoids form inside the rectum, where fewer nerve endings mean they often go unnoticed until distinct symptoms begin to present. External hemorrhoids develop under the skin around the anus, where abundant nerve endings make them much more painful and noticeable. When blood pools within external hemorrhoids and forms clots, the condition becomes even more painful and may require immediate medical attention.

Bleeding and Other Symptoms

The difference in location between internal and external hemorrhoids explains why some people experience painless bleeding while others deal with intense discomfort but no visible blood. Internal hemorrhoids typically cause bright red bleeding that appears on toilet paper or drips into the toilet bowl because the swollen tissue becomes fragile and tears easily when stool passes over it. Since internal hemorrhoids develop in an area with fewer nerve endings, this bleeding often occurs without pain, which can make it particularly startling when people first notice it.

External hemorrhoids are more likely to cause pain, itching, and swelling that makes sitting uncomfortable rather than bleeding. The abundant nerve endings around the anus mean that even small external hemorrhoids can cause significant discomfort during bowel movements or when sitting for extended periods. When external hemorrhoids do bleed, it usually happens after the tissue has become severely irritated or when a blood clot forms inside the hemorrhoid.

Beyond bleeding, hemorrhoids can cause a range of other symptoms that vary depending on their type and severity. Itching and irritation around the anal area are common with both types, though external hemorrhoids tend to cause more intense itching. Many people also notice lumps or swelling near the anus that may be tender to touch. Some hemorrhoids can prolapse, meaning they protrude outside the anus during bowel movements, which may require manual repositioning afterward.1

Treatment Options for Bleeding Hemorrhoids

The good news about bleeding hemorrhoids is that they respond to the same treatments used for non-bleeding hemorrhoids, since the bleeding typically results from irritation of already swollen tissue rather than a separate condition requiring different care. Treatment approaches range from simple home remedies that can provide immediate relief to medical procedures that address the underlying problem permanently. The choice of treatment depends on the severity of symptoms, how long the hemorrhoids have persisted, and whether conservative measures have been effective:

At-Home Treatments

    • Sitz baths: Soaking in warm water for 10-15 minutes several times daily helps reduce swelling, relieves pain, and promotes healing of irritated tissue. Adding Epsom salt can enhance the soothing effect.
    • Topical treatments: Over-the-counter creams, ointments, and suppositories containing ingredients like hydrocortisone, witch hazel, or lidocaine can reduce inflammation and provide temporary pain relief.
    • Dietary modifications: Increasing fiber intake through high-fiber foods or supplements like psyllium helps soften stools and reduce straining during bowel movements, which prevents further irritation of hemorrhoidal tissue.
    • Lifestyle adjustments: Staying hydrated, avoiding prolonged sitting, and not delaying bowel movements when the urge arises can help prevent hemorrhoids from worsening.

    Medical Procedures

      • Rubber band ligation: Rubber band ligation is a highly effective in-office procedure that involves placing small elastic bands around the base of internal hemorrhoids to cut off their blood supply. The banded hemorrhoid typically shrinks and falls off within a week, with minimal discomfort during the procedure. This procedure can be repeated if necessary for multiple hemorrhoids.
      • Sclerotherapy: Sclerotherapy involves injecting a chemical solution directly into hemorrhoidal tissue, causing the blood vessels to collapse and shrink. The treated hemorrhoid gradually decreases in size over 7-10 days as the injected solution causes the vessel walls to stick together and close off blood flow.
      • Infrared coagulation: Infrared coagulation uses focused infrared light to create controlled scar tissue that cuts off blood flow to internal hemorrhoids. The heat from the infrared light causes the hemorrhoid to shrink and eventually disappear as the scar tissue forms and blocks circulation to the affected area.2
      • Hemorrhoidectomy: Hemorrhoidectomy is a surgical procedure that involves the complete removal of large, prolapsed, or severely symptomatic hemorrhoids that haven’t responded to other treatments. This option is typically reserved for the most severe cases and requires a longer recovery period than other procedures.

      Get Treatment from Cary Gastro

      Dealing with bleeding hemorrhoids can be uncomfortable and stressful, but you don’t have to manage the problem alone. The experienced gastroenterologists at Cary Gastro understand that hemorrhoid symptoms can significantly impact your daily life and quality of life. Our team provides compassionate, professional care using the latest treatment techniques. We take the time to evaluate your specific situation and develop a personalized treatment plan that addresses both your immediate symptoms and overall digestive health. (Please note, however, that for external hemorrhoids, Cary Gastro is able to only treat those that are smaller, not requiring surgical intervention. In cases where the external hemorrhoids are too large to treat, we will refer patients to a surgeon for care.)

      Whether you’re experiencing bleeding hemorrhoids or any other digestive concern, Cary Gastro is here to help you find relief and restore your comfort. Our comprehensive approach to digestive health means we can address the full range of gastrointestinal issues that may be affecting your wellbeing. Don’t let hemorrhoid symptoms continue to disrupt your life when effective treatments are available. Contact our team today to request an appointment and take the first step toward lasting relief from your hemorrhoid symptoms.



      1https://hemorrhoidcentersamerica.com/anal-rectal-problems/rectal-bleeding/
      2      https://www.aafp.org/pubs/afp/issues/2018/0201/p172.html