If you’ve never had a hemorrhoid, consider yourself lucky—and don’t be surprised if your luck runs out at some point. About 40% of adults get these swollen blood vessels in or around their rectum, and while they don’t always cause symptoms, when they do, it can be very, very unpleasant.
When Shivana Pemberton, 31, of Auckland, New Zealand, has a flare-up it’s so painful that she can barely walk, particularly after having a bowel movement. “The last time when I went to the toilet and I did a poo, I bled so much I had to have my husband shower me,” Pemberton tells SELF. “I couldn’t even walk to the shower myself. He had to literally carry me…because I couldn’t do anything. It was awful.”
Not everyone has hemorrhoid symptoms that extreme, but it can happen. Here’s a primer on why you can get these painful, inflamed blood vessels and the main symptoms to look for.
What causes hemorrhoids?
The blood vessels that line your anus are there for a reason and can help “maintain good anorectal health,” Pooja Singhal, MD, an American Gastroenterological Association spokesperson, tells SELF. They basically cushion your anal sphincter—a ring of muscles that really is a marvel of anatomical engineering if you stop to think about it—to keep stuff from leaking out while you go about your day. But when they get irritated or swollen, that’s a problem. “Hemorrhoids are very, very common,” Dr. Singhal says. Women are more likely to report having them, but men may get them just as often (or maybe even more), some research suggests.
Anything that increases pressure in your abdomen, like pregnancy, weight lifting, or medical conditions like liver disease or high blood pressure can cause hemorrhoids, as can chronic diarrhea, constipation (all that pushing!), or sitting on the toilet more than is strictly necessary.
Falen Gotler, 40, made that mistake and it led to her first run-in with hemorrhoids in her 20s. “I just sat on the toilet too long and it’s funny now because I’m like, This is ridiculous that I did that,” she tells SELF. “But at the time I was younger and didn’t know any better.” Whether you are just chilling, reading, or scrolling through your phone, spending too much time on the can is bad for, well, your can. “If you are sitting on the toilet…that just puts a lot of pressure and leads to swelling,” Dr. Singhal says.
What are the symptoms of hemorrhoids?
Here’s what to look for if you think you might have this problem:
1. Rectal bleeding after you poop
This one is a biggie. Hemorrhoids are famous for causing bright red blood in stool, particularly after a bowel movement. The good news is that the bleeding itself tends to be painless (though the swollen veins are not). You might see it on the toilet paper after wiping, coating your poop, or even filling the toilet bowl. (This is one that freaks people out the most, but we’ll get to what to do if you’re worried something more serious is going on in a moment.)
2. A swollen lump in or around your anus
Hemorrhoids can be internal (inside your rectum) or external (forming bumps under your skin near the anus). Hemorrhoids are sometimes called piles, which is related to the Latin word pila, for “ball.” If you’ve ever felt these bumps, you’ll understand that name. Either type can prolapse, meaning they bulge outside your bum hole. They may eventually go back inside (it’s okay to gently push them in if you can) or they may hang down, like one person on Reddit described as “a bunch of grapes” and not go away. (In general, hemorrhoid symptoms tend to flare-up and then subside, but it can be hard to predict when you’ll feel better. “Mine normally last five days and then the next day the pain’s just gone,” says Pemberton.)
3. Itching
This happens because the inflammation and irritation can release histamine, which is the naturally occurring urge-to-scratch chemical. Other things that can make this sensation worse are mucus or bits of poop that got missed when wiping. You might have constant itching throughout the day, Dr. Singhal says, or it might get worse when you poop because the pressure in the area increases. Friction (scrubbing too hard with toilet paper, for example) or excess moisture in the area can make your butt feel even more itchy.
4. Pain
This symptom varies depending on what kind of hemorrhoid you have. There are generally two types of sensations, Dr. Singhal says. One tends to be dull and milder and is caused by the swollen and uncomfortable blood vessels. The other is pretty extreme, “like severe pain where they can’t walk and sit.” Little blood clots can sometimes form in those swollen blood vessels on the outside and cause what’s called a thrombosed hemorrhoid, which results in severe, unrelenting pain. While they aren’t dangerous, they may “require urgent evaluation to get relief,” Dr. Singhal says. A doctor can remove them, although they may resolve on their own (if you can stand to wait that long).
5. Trips to the bathroom that are unpleasant, to say the least
If your symptoms ramp up when you go No. 2, that could be a sign too. “I dread going to the toilet,” Pemberton says. “You’ve got an exposed vessel and then you’ve got poo passing across it and it’s just so painful.” You may also sometimes feel like something—in this case, a swollen vein—is prolapsing, or bulging out of your body, when you poop. “When people are passing stool, there’s [sometimes] tissue coming out while they’re defecating,” Dr. Singhal says.
What to do if you’re worried it’s something more serious.
It’s natural for your health anxiety to go off the charts after you look down at a toilet bowl full of bright red blood. Just remember that this symptom could mean a lot of different things. Some are relatively harmless or easy to fix, like you’ve been eating foods—for example, beets—that can stain everything red and fool you into thinking you’re bleeding.
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Others are more serious than hemorrhoids but treatable, like an ulcer, an anal fissure, a polyp, or a medication (like an NSAID or blood thinner) that can cause bleeding as a side effect. In some cases, blood in your poop can be a sign of colon, rectal, or anal cancer.
In the past, doctors might dismiss bleeding, particularly in younger people, as “just a hemorrhoid” but that is starting to change. “Because of the rates of increase in colorectal cancer and colorectal polyps in younger people, we don’t take any kind of bleeding lightly,” Dr. Singhal says. So that means that if you have hemorrhoid symptoms, you should get it checked out by your doc. “My biggest advice would be to not ignore blood in stool and get an evaluation,” says Dr. Singhal, who sees people in their 20s, 30s, and 40s with this symptom all the time.
“I just scoped a 40-year-old male yesterday…who runs the marathon and does a lot of weightlifting,” she says. He had blood in his stool and it turned out that he did have hemorrhoids—as you might expect because they really are so common—but he also had a polyp in his rectum that could have become cancerous over time. “Fortunately, we removed it; it’s not going to turn into cancer and that’s great,” Dr. Singhal says. “But that’s just an example from yesterday.”
If there is blood in your stool that is visible to your naked eye or on the toilet paper after wiping, “I definitely request and strongly recommend that you go see your doctor and at least get a rectal exam done,” she says.
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