Enlarged hemorrhoids: Overview (2023)


We all have hemorrhoids. Hemorrhoids are normal “cushions” of tissue filled with blood vessels, found at the end of the rectum, just inside the anus. Together with a circular muscle called the anal sphincter, they help to control bowel movements. But when people talk about “having hemorrhoids,” they usually mean symptoms such as itching or bleeding caused by enlarged hemorrhoids. This condition is also known as “piles.”

Many people are ashamed of having enlarged hemorrhoids: They don’t like to talk about their symptoms, and might be reluctant to go to the doctor. Some might be afraid of having a physical examination or finding out that they have a serious illness. But seeing a doctor about your symptoms is important if you want to have the right treatment.


Hemorrhoid problems can cause various symptoms. These often include itching, mucus discharge or a burning sensation in the anus. Painless bleeding is common too. This can happen if hard stool damages the thin walls of the blood vessels in hemorrhoids. Bleeding from hemorrhoids is usually visible as bright red or red blood, on toilet paper or in the stool. If you have blood in your stool, it’s important to see a doctor rather than try to diagnose the problem yourself.

Swollen hemorrhoids might come out of the anus and can then be seen as soft lumps of tissue. This is called a protruding or prolapsed hemorrhoid. Sometimes hemorrhoids are confused with anal skin tags. These are small flaps of skin that grow around the anus and can cause similar symptoms.

Larger hemorrhoids generally lead to more severe symptoms. They can make it feel like something is pushing against the anus, or like there is something in that area, and sitting can be very uncomfortable. People might also feel like their bowel isn’t really empty, although they have just gone to the toilet. Mucus or stool might come out by accident too, particularly when passing wind. More severe hemorrhoids can be very painful.

Hemorrhoids can be classified according to how severe they are:

  • Grade 1: Slightly enlarged hemorrhoids that can’t be seen from outside the anus.

  • Grade 2: Larger hemorrhoids that sometimes come out of the anus, for example while passing stool or – less commonly – during other physical activities. They then go back inside again on their own.

  • Grade 3: Hemorrhoids that come out of the anus when you go to the toilet or do other physical activities, but don’t go back inside on their own. They can be pushed back inside, though.

  • Grade 4: Hemorrhoids that are always outside the anus and can no longer be pushed back inside. Usually, a small bit of the anal lining comes out of the anus too. This is also known as rectal prolapse.

    (Video) What are hemorrhoids / piles - 3D animation

Enlarged hemorrhoids: Overview (1)

Hemorrhoid tissue, cross-section view: normal (above) and enlarged (below)

Causes and risk factors

Increased pressure on the anal canal (the last section of the rectum) can cause hemorrhoids to become enlarged. Various factors might make this more likely. For example:

  • Being overweight

  • Chronic constipation

  • Frequent diarrhea

  • Regularly lifting heavy objects

  • Pregnancy and giving birth

The risk of enlarged hemorrhoids increases with age – probably because the tissue becomes weaker over time. And hemorrhoid problems are thought to run in families too.


Every year, about 4 out of 100 adults in Germany go to a doctor because of hemorrhoid problems. But a lot of people don't seek medical help. It is estimated that more than half of all adults over the age of 30 are affected by hemorrhoids at some point in their lives.

(Video) Life cycle of External Hemorrhoids! From baby to adult. | Dr. Chung explains!


It’s not possible to predict the course of enlarged hemorrhoids.They might get worse and cause more severe symptoms. But they might not get bigger, and the symptoms might improve again. Hemorrhoids that are already enlarged don't get smaller on their own again, though.

Enlarged hemorrhoids can irritate the surrounding tissue too, which increases the risk of anal eczema. In anal eczema, the skin around the anus is red and inflamed, accompanied by itching and weeping. Small blisters and scabs might form as well.


When you go to see a doctor, you will probably first be asked about your symptoms and whether you have other medical conditions. The doctor will then look at your anus to see whether it is inflamed, and whether enlarged hemorrhoids come out of it when you push, or whether they are already outside.

Depending on your symptoms, various examinations might be done. If there’s blood in your stool, the doctor may suggest a colonoscopy (looking inside your bowel with a camera). Some people are afraid of having physical examinations and the possible associated pain. But most of these examinations don't hurt, even if they’re sometimes considered to be unpleasant or embarrassing. They’re a normal part of everyday life for medical professionals.

Doctors typically first feel for anything unusual. Known as a digital rectal examination, this involves gently inserting a finger into the anus, with gloves and a little lubricant. The doctor feels the inside of the anal canal using circular movements. This allows him or her to examine the sphincter muscles and the texture of the membranes lining the anus. Grade 1 hemorrhoids generally can’t be felt in this way. But digital rectal examinations can help rule out other medical conditions. The procedure is usually not painful.

If the doctor thinks you might have enlarged hemorrhoids, a proctoscopy is normally carried out next. Here the membranes lining the rectum are examined using a short tube with a light and lens on it, known as a proctoscope. This allows the doctor to see whether you have enlarged hemorrhoids, and how big they are. The procedure takes a few minutes and is usually not painful. The rectum needs to be emptied before the procedure is carried out. This can be done using a laxative, suppository or enema.


The choice of treatment will mainly depend on the size of the hemorrhoids and the severity of symptoms. If the hemorrhoids are only slightly enlarged, avoiding constipation and changing your behavior during bowel movements might be enough to make a difference. There’s a lot of advice out there about what you can do to relieve hemorrhoid symptoms yourself – like using creams or sitz baths (shallow warm baths), or changing your diet. While some strategies can actually help, many have not been well tested in scientific studies.

It’s a good idea to seek medical advice if the symptoms are unpleasant and distressing. You could contact your family doctor or a proctologist. Proctologists are doctors who are specialized in medical conditions affecting the rectum and anus.

(Video) Hemorrhoids | Piles | How To Get Rid Of Hemorrhoids | Hemorrhoids Treatment

Things you could discuss with a doctor include whether surgery might help, and what other options there are. For instance, sclerotherapy might be considered for the treatment of grade 1 and grade 2 hemorrhoids, and rubber band ligation might be considered for grade 2 and grade 3 hemorrhoids. Sclerotherapy involves injecting a chemical solution to reduce the blood supply to the hemorrhoids. In rubber band ligation, the hemorrhoids are tied off at the base, making them fall off after a while. If someone has grade 3 or grade 4 hemorrhoids, it might be necessary to surgically remove them.

Further information

Some treatments and surgical procedures can only be done in a hospital, such as those for enlarged hemorrhoids. Here you can find information about how to best prepare for treatment in hospital: for example, what sort of routines to expect, what paperwork you will need to take with you and what kind of procedures aren't fully covered by health insurers in Germany.


  • Abramowitz L, Weyandt GH, Havlickova B, Matsuda Y, Didelot JM, Rothhaar A et al. The diagnosis and management of haemorrhoidal disease from a global perspective. Aliment Pharmacol Ther 2010; 31 (Suppl 1): 1-58. [PubMed: 20500735]

  • Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ 2008; 336(7640): 380-383. [PMC free article: PMC2244760] [PubMed: 18276714]

  • Alexander K, Daniel WG, Diener HG, Freund M, Köhler H, Matern S. Thiemes Innere Medizin (TIM). Stuttgart: Thieme; 1999.

  • Alonso-Coello P, Guyatt GH, Heels-Ansdell D, Johanson JF, Lopez-Yarto M, Mills E et al. Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev 2005; (4): CD004649. [PMC free article: PMC9036624] [PubMed: 16235372]

  • Hahn EG, Riemann FJ. Klinische Gastroenterologie. Stuttgart: Thieme; 2000.

    (Video) Is There a Way to Get Rid of Hemorrhoids for Good?

  • Joos AK, Herold A. Hämorrhoidalleiden. Neue konservative und operative Therapien für ein weit verbreitetes Leiden. Der Gastroenterologe 2010; 5: 326-335.

  • Klauber J, Geraedts M, Friedrich J, Wasem J. Krankenhaus-Report 2013. Mengendynamik: mehr Menge, mehr Nutzen? Stuttgart: Schattauer; 2013.

  • Mounsey AL, Halladay J, Sadiq TS. Hemorrhoids. Am Fam Physician 2011; 84(2): 204-210. [PubMed: 21766771]

  • National Institute for Health and Care Excellence (NICE). Haemorrhoids. 2012.

  • IQWiG health information is written with the aim of helpingpeople understand the advantages and disadvantages of the main treatment options and healthcare services.

    Because IQWiG is a German institute, some of the information provided here is specific to theGerman health care system. The suitability of any of the described options in an individualcase can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by ateam ofhealth care professionals, scientists and editors, and reviewed by external experts. You canfind a detailed description of how our health information is produced and updated inour methods.


What is an enlarged hemorrhoid? ›

Swollen hemorrhoids might come out of the anus and can then be seen as soft lumps of tissue. This is called a protruding or prolapsed hemorrhoid. Sometimes hemorrhoids are confused with anal skin tags. These are small flaps of skin that grow around the anus and can cause similar symptoms.

What does a large hemorrhoid look like? ›

A thrombosed hemorrhoid will appear as a lump at the anal verge, protruding from the anus, and will be dark bluish in color because of the blood clot contained inside the swollen blood vessel. Non-thrombosed hemorrhoids will appear as a rubbery lump. Often more than one swollen hemorrhoid appears at the same time.

What is hemorrhoids summary? ›

Hemorrhoids are swollen, inflamed veins around your anus or the lower part of your rectum. There are two types: External hemorrhoids, which form under the skin around your anus. Internal hemorrhoids, which form in the lining of your anus and lower rectum.

Do enlarged hemorrhoids go away? ›

In general, small hemorrhoids can go away on their own in a few days. Larger hemorrhoids, particularly ones that cause a lot of pain, swelling, and itchiness, can't go away on their own and may require treatment from a doctor to heal. Pregnant patients may find that hemorrhoids only go away after they give birth.

How do you get rid of an enlarged hemorrhoid? ›

  1. Eat high-fiber foods. Eat more fruits, vegetables and whole grains. ...
  2. Use topical treatments. Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a numbing agent.
  3. Soak regularly in a warm bath or sitz bath. ...
  4. Take oral pain relievers.
May 12, 2021

What size hemorrhoids need surgery? ›

If someone has grade 3 or grade 4 hemorrhoids, doctors often recommend surgery. A general or local anesthetic is usually needed for this.

When is an external hemorrhoid too big? ›

If you notice a bulge, you may have a prolapsed hemorrhoid.

Many times it will retract on its own but not always. If it can't easily be pushed back in, or it causes pain or bleeding, early hemorrhoid treatment from a doctor is important.

Should I be worried about a large hemorrhoid? ›

Know When to See Your Doctor

If the hemorrhoids are causing you pain or discomfort. If the problems persist despite trying over-the-counter hemorrhoid creams or other remedies. If you're passing stools that look maroon in color or tarry in color, a sign of bleeding.

How long does a large hemorrhoid last? ›

While there is no specific timeline for how long a hemorrhoid lasts, most people find relief from symptoms in a few days. In instances where pain persists for more than a week, consult your physician. 1.

What are the four stages of hemorrhoids? ›

All internal hemorrhoids are classified on a scale of Grade 1 – 4:
  • Grade 1 – No prolapse.
  • Grade 2 – Prolapse under pressure such as straining during a bowel movement but return on their own.
  • Grade 3 – Prolapse that can be pushed back in by the patient.
  • Grade 4 – Prolapse that is too painful to be pushed back in.
Mar 17, 2020

What exactly causes hemorrhoids? ›

What causes hemorrhoids? Traditionally, hemorrhoids are associated with chronic constipation, straining during bowel movements, and prolonged sitting on the toilet — all of which interfere with blood flow to and from the area, causing it to pool and enlarge the vessels.

What is the clinical presentation of hemorrhoids? ›

The cardinal features of hemorrhoidal disease include bleeding, anal pruritus, prolapse, and pain due to thrombosis.

How do you poop with an enlarged hemorrhoid? ›

Putting off bowel movements can worsen constipation, which then aggravates hemorrhoids. Try elevation. Elevating your feet a bit with a step stool as you sit on the toilet changes the position of the rectum in a way that may allow for easier passage of stools.

When do hemorrhoids need surgery? ›

Often hemorrhoids do not cause problems. But if hemorrhoids bleed a lot, cause pain, or become swollen, hard, and painful, surgery can remove them.

Can large hemorrhoids go away with home treatment? ›

Hemorrhoids can be uncomfortable or painful, but they often go away on their own in a couple weeks with home remedies and treatments that are typically easy to find at a drugstore. See a doctor if your hemorrhoid pain or other symptoms, such as rectal bleeding, become more severe even with treatment.

How long do you stay in hospital after hemorrhoid surgery? ›

You will most likely go home the same day (outpatient). There is a procedure that uses a circular stapling device to remove hemorrhoidal tissue and close the wound.

What is a Stage 3 hemorrhoid? ›

Grade III hemorrhoids protrude outside the anal canal and usually require manual reduction. Grade IV hemorrhoids are irreducible and constantly prolapsed. Acutely thrombosed hemorrhoids and those involving rectal mucosal prolapse are also grade IV.

How do you poop after hemorrhoid surgery? ›

Support your feet with a small step stool when you sit on the toilet. This helps flex your hips and places your pelvis in a squatting position. This can make bowel movements easier after surgery. Use baby wipes or medicated pads, such as Tucks, instead of toilet paper after a bowel movement.

Can you shrink a large hemorrhoid? ›

Over-the-counter products are available for hemorrhoids, such as pads infused with witch hazel (Tucks), as well as soothing creams that contain lidocaine, hydrocortisone, or other ingredients like phenylephrine (Preparation H). These substances help shrink the inflamed tissue and provide relief from itching.

How do doctors treat large hemorrhoids? ›

Rubber band ligation is a procedure that doctors use to treat bleeding or prolapsing internal hemorrhoids. A doctor places a special rubber band around the base of the hemorrhoid. The band cuts off the blood supply. The banded part of the hemorrhoid shrivels and falls off, most often within a week.

What happens if hemorrhoids go untreated? ›

Though your hemorrhoids may retract back inside on their own, or with a little help from you, prolapsed hemorrhoids tend to worsen over time. When left untreated, your internal prolapsed hemorrhoid may get trapped outside the anus and cause significant irritation, itching, bleeding, and pain.

Can hemorrhoids be cancerous? ›

Hemorrhoids do not lead to cancer. However, the primary indication to many people that they may be suffering from hemorrhoids is blood in the stool, on the toilet paper, or in the toilet bowl after a bowel movement.

When do hemorrhoids become an emergency? ›

If the hemorrhoid bursts, an emergency care must be sought. The serious complication that's caused by excess blood loss are dizziness, faintness or even hypotension/shock. However, per rectal bleeding can also be a particular sign of other disease conditions, such as colorectal and anal canal cancer.

Does Preparation H work on external hemorrhoids? ›

Description. Preparation H Ointment relieves both internal and external hemorrhoidal symptoms. It shrinks swollen hemorrhoidal tissue and relieves pain, itching, and discomfort. Regular application with Preparation H Ointment provides continual therapy for relief of hemorrhoidal symptoms.

How long does it take for Preparation H to work on hemorrhoids? ›

Preparation H® can provide relief as quickly as just a few hours. Generally, Recticare and other lidocaine creams take around 30-60 minutes to start working and may last for 1-3 hours depending on how long the cream stays on the skin.

Does stress cause hemorrhoids? ›

When people are stressed, they tighten their sphincter muscle and put pressure on the rectum. This pressure can cause hemorrhoid flare-ups. What's more, stress can lead to poor food choices and, therefore, constipation. Chronic constipation can cause pressure in the anal and rectal area, which can cause hemorrhoids.

Why can hemorrhoids go away? ›

Often, you need to resolve the underlying cause of your hemorrhoids to eliminate them. For example, adding more fiber to your diet can improve constipation and help you strain less when defecating. As a result, you get less irritation of the veins in the anus and rectum, and the hemorrhoids heal.

Can hemorrhoids block poop? ›

Complications. If a prolapsed hemorrhoid swells, it can wind up blocking your anus and obstructing your bowel, preventing you from having bowel movements. Some prolapsed hemorrhoids bleed heavily, increasing the risk of life-threatening blood loss.

What are the common complications of hemorrhoids? ›

The most common and serious complications of haemorrhoids include perianal thrombosis and incarcerated prolapsed internal haemorrhoids with subsequent thrombosis. They are characterised by severe pain in the perianal region possibly with bleeding.

What should you assess for hemorrhoids? ›

To diagnose hemorrhoids, your clinician will examine your rectum and anus and may insert a gloved finger into the rectum. If there is bleeding, testing should include a procedure that allows your healthcare provider to look inside the anus (called anoscopy) or colon (sigmoidoscopy or colonoscopy).

What is grade 3 or grade 4 hemorrhoids? ›

Grade 3 - Hemorrhoid protrudes through the anus during straining or evacuation but needs to be manually returned to position. Grade 4 - Hemorrhoid remains prolapsed outside of the anus. Grade 3 hemorrhoids are internal hemorrhoids which prolapse, but do not go back inside the anus until the patient pushes them back in.

How do I know if my hemorrhoid is serious? ›

When is it time to seek medical care for hemorrhoids?
  1. If you notice bleeding before, during, or after bowel movements. ...
  2. If discomfort from hemorrhoids isn't resolved within a week. ...
  3. If your symptoms continue worsening. ...
  4. If you notice a bulge, you may have a prolapsed hemorrhoid.
Mar 19, 2021

When should I be worried about hemorrhoids? ›

If you're experiencing any of the following situations related to your hemorrhoids, make an appointment to see your doctor: You experience rectal bleeding or see bright red blood on your toilet paper. You have pain and discomfort in your rectum or anus.

How long is too long to have hemorrhoids? ›

While there is no specific timeline for how long a hemorrhoid lasts, most people find relief from symptoms in a few days. In instances where pain persists for more than a week, consult your physician. 1.

What would a doctor prescribe for hemorrhoids? ›

Prescription products to treat hemorrhoids include stronger steroid creams, nifedipine, and nitroglycerin. Surgery may be recommended if your hemorrhoids are more severe. Talk to your healthcare provider if you experience bleeding or have bothersome symptoms for more than 7 days.

Do large hemorrhoids require surgery? ›

Surgery for hemorrhoids is usually only performed for severe cases, such as when home remedies aren't working, emergencies (such as extreme bleeding), or when they become so bothersome or painful that they impact your lifestyle.

Why do I have a large external hemorrhoid? ›

The most common cause of external hemorrhoids is repeated straining while having a bowel movement. This is often caused by severe cases of constipation or diarrhea. Straining makes blood pool in the area. Sitting on the toilet for a long time.

How can you tell if a hemorrhoid is cancerous? ›

The main warning signs of anal cancer are rectal pain, itching and bleeding, as well as changes in bowel movements, such as unusually narrow stools. Hemorrhoids, which are painful clusters of inflamed veins in the rectum and anus, can produce many of the same symptoms as anal cancer.

What is a Grade 4 hemorrhoid? ›

Grade 4 hemorrhoids are the most severe — when internal hemorrhoids become too severe and large, push out through the anal canal, and cannot be reduced. There's no need to worry, even if you have grade 4 hemorrhoids. Various treatment options are available for hemorrhoids, no matter how severe.

Can ibuprofen help shrink hemorrhoids? ›

Nonsteroidal anti-inflammatory medicines, like ibuprofen, can help decrease swelling, too. Just remember, if your hemorrhoids are bleeding, pain relievers like aspirin could make the bleeding heavier.

Does witch hazel shrink hemorrhoids fast? ›

It is an astringent, which is one of the main properties that makes it ideal for treating hemorrhoids. Witch hazel's astringent properties reduce the swelling in hemorrhoid tissue, which causes shrinkage and relief of associated pain and itching.


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