How do I know whether it is hemorrhoids or a fissure?

The short version is that hemorrhoids usually bleed without much pain, while a fissure hurts sharply during a bowel movement and keeps hurting afterward. Many patients have both at once, which is one reason an exam beats guessing. Our anal fissure treatment page sets the two side by side in detail.

Can hemorrhoids go away on their own?

Mild flares often settle down within a few days with fiber, fluids, and sitz baths. Hemorrhoids that bleed repeatedly or prolapse tend not to resolve on their own, and they generally get harder to treat the longer they are left. Treating them early usually means a simpler procedure.

Is it normal to feel a lump?

A tender lump at the anal opening is usually an external hemorrhoid, and a soft bulge that appears when you go is usually a prolapsing internal hemorrhoid. Any new lump should be examined, though, because skin tags, abscesses, and other conditions can feel similar.

Should I worry if there is only a little blood?

The amount does not tell you the cause. A few drops from a small hemorrhoid and a few drops from an early polyp look the same on the paper. Any rectal bleeding is worth an exam, particularly at age 45 or older or with a family history of colon cancer.

What can I expect at my first appointment?

A conversation about your symptoms, then a brief, private anorectal exam, often including anoscopy, a short look inside the anal canal with a small smooth scope. It takes only a few minutes. From there you will get a clear explanation of what you have, what grade it is, and what your options are. Coverage questions are welcome as well; see our accepted insurance plans.

Hemorrhoid Symptoms & Grades

What hemorrhoid symptoms feel like

The most common signs of hemorrhoids are bright red bleeding with a bowel movement, itching around the anus, a tender lump you can feel, and tissue that bulges out when you go. Which symptoms you get depends on whether your hemorrhoids are internal or external, and how far along they are. Here is what patients most often describe:

Bleeding. Bright red blood on the toilet paper, streaked on the stool, or dripping into the bowl. It is usually painless, which surprises people. Painless bright red bleeding almost always comes from internal hemorrhoids.
Itching and irritation. Persistent itching around the anus, sometimes with mucus or moisture that makes the skin raw. Scratching and repeated wiping make it worse, not better.
Pain, especially when sitting. A sore, tender lump at the anal opening that hurts to sit on. This points to an external hemorrhoid. If a clot forms inside one, called a thrombosed external hemorrhoid, the pain can come on suddenly and be severe.
Prolapse. A soft bulge that pushes out through the anal opening during a bowel movement. It may slide back on its own, or you may have to press it back in.
A feeling of not being finished. Prolapsed tissue can create the sensation that something is still there after you go. One thing worth knowing up front: internal hemorrhoids form above a border called the dentate line, where there are very few pain nerves, so they typically bleed without hurting. External hemorrhoids form below that line under skin full of nerve endings, so they hurt but usually do not bleed much. Many people have both.

The grades of internal hemorrhoids

Doctors grade internal hemorrhoids from 1 to 4 based on how far the tissue comes out. The grade guides the treatment.

Grade 1. The hemorrhoid is swollen inside but does not come out through the anal opening. Bleeding is the usual symptom.
Grade 2. It pushes out during a bowel movement and goes back in on its own afterward.
Grade 3. It pushes out and stays out until you push it back in with your fingers.
Grade 4. It stays outside and cannot be pushed back in. This grade is more likely to need surgery. Grades 1 through 3 are exactly what CRH O'Regan rubber band ligation is designed to treat, and they make up the large majority of cases. Grade 4 hemorrhoids and large, symptomatic external hemorrhoids are the ones more likely to need a surgical referral.

What causes hemorrhoids

Hemorrhoids come from too much pressure in the veins of the lower rectum. Nearly everything on the list below is a form of that pressure:

Constipation and straining on the toilet
Chronic diarrhea
Sitting for long stretches, including long drives, desk work, and extended time on the toilet
Pregnancy and childbirth
Carrying extra weight
Heavy lifting, at work or in the gym
A low-fiber diet They are extremely common. According to the American Society of Colon and Rectal Surgeons, about half of adults in the United States have symptomatic hemorrhoids by around age 50. Having them is not a sign that you did anything wrong.

Home measures that help, and where they stop helping

Simple measures are worth trying first for mild symptoms, and they matter even after treatment because they help keep hemorrhoids from coming back.

Get more fiber. Aim for roughly 25 to 30 grams a day from vegetables, fruit, beans, and whole grains, or add a fiber supplement. Soft stool is the single best thing you can do for hemorrhoids.
Drink water. Fiber without fluid can make constipation worse. Aim for about eight glasses a day unless your doctor has told you otherwise.
Do not strain, and do not linger. If nothing happens within a few minutes, get up and come back later. Leave your phone out of the bathroom.
Move. Regular walking helps keep your bowels regular.
Warm sitz baths. Ten to fifteen minutes in warm water can genuinely soothe soreness and itching.
Over-the-counter creams and wipes. These can relieve burning and itching during a flare. Steroid-containing creams should generally not be used for more than about a week, since they can thin the skin. Here is the honest limit: none of these shrink a hemorrhoid. They calm symptoms while the hemorrhoid stays put. If your bleeding keeps coming back, if tissue prolapses, if the itching never really clears, or if you have been managing this for months with creams, home measures have done what they can. That is the point to be evaluated for non-surgical hemorrhoid treatment rather than buying another tube.

When hemorrhoids become a bigger problem

Most hemorrhoids are uncomfortable rather than dangerous, but a few complications are worth knowing about. Ongoing blood loss, even a small amount at a time over months, can lower your blood count and cause anemia, with fatigue or shortness of breath as the first sign. A prolapsed internal hemorrhoid that gets trapped outside the anal opening and loses its blood supply, called strangulation, can cause severe pain and needs prompt care. A blood clot inside an external hemorrhoid, a thrombosed hemorrhoid, causes sudden, sharp pain and a hard lump, though it is not dangerous and usually improves within a couple of weeks with or without treatment. None of these are common, but they are reasons to be seen rather than to keep waiting.

When rectal bleeding needs a doctor, not a cream

Never assume rectal bleeding is just hemorrhoids. Hemorrhoids and anal fissures are the most common causes of bright red bleeding, but polyps, colitis, diverticular disease, and colon cancer can bleed in ways that look exactly the same to you at home. The only way to be sure is an exam. Contact us promptly if you have any of the following:

Rectal bleeding, especially if you are 45 or older
Black, tarry, or maroon-colored stool, which can mean bleeding higher in the digestive tract
A lasting change in your bowel habits, or stools that have become narrow or pencil-thin
Unexplained weight loss, ongoing fatigue, or a low blood count (anemia)
Abdominal pain along with the bleeding
A personal or family history of colon cancer or polyps
Heavy bleeding, dizziness, or bleeding that will not stop Average-risk adults should begin colon cancer screening in Fort Smith at age 45, not 50. If you have a first-degree relative who had colorectal cancer or polyps, screening usually starts earlier, often ten years before the age at which that relative was diagnosed. Depending on what your exam shows, Dr. Herraka may recommend a colonoscopy, which can find and remove polyps before they ever become cancer. Because Digestive & Liver Center of Arkansas has an on-site endoscopy suite in Fort Smith, that can be arranged with the same physician who examined you.

Get an answer instead of guessing

Bleeding, itching, and discomfort are worth ten minutes of a physician's time, and nothing about this visit is as awkward as you are imagining. Digestive & Liver Center of Arkansas cares for patients from Fort Smith, Van Buren, Greenwood, Alma, Barling, Charleston, and Poteau and Sallisaw in eastern Oklahoma. Call our Main Clinic at (479) 242-2888 to schedule with Dr. Ihab Herraka at 3416 Old Greenwood Rd, Fort Smith, AR 72903, Monday through Friday, 8:00 a.m. to 5:00 p.m.

Hemorrhoid Symptoms and Grades: Bleeding, Itching, Pain and Prolapse