Hemorrhoids are swollen, enlarged veins that form inside and outside of your anus and rectum. They can be painful and uncomfortable and cause rectal bleeding. Hemorrhoids are also called piles. We’re all born with hemorrhoids, but at baseline, they don’t bother us. It’s only when they become swollen and enlarged that they produce irritating symptoms

An estimated 1 in 5 has symptomatic hemorrhoids. They affect people of all ages, sexes, races and ethnicities. They’re more common as you age, affecting more than half of people over age 50.

Anyone can get symptomatic hemorrhoids, even teenagers. (But because hemorrhoids take a while to develop, they’re uncommon in children.) You may be more at risk if you:

Have overweight/obesity.
Are pregnant.
Eat a low-fiber diet.
Have chronic constipation or diarrhea.
Regularly lift heavy objects.
Spend a lot of time sitting on the toilet.
Strain while having bowel movements.

Hemorrhoids can happen inside or outside of your rectum. The type depends on where the swollen vein develops. Types include:

External: Swollen veins form underneath the skin around your anus. Your anus is the canal where your poop comes out. External hemorrhoids can be itchy and painful. Occasionally, they bleed. Sometimes, they fill with blood that can clot. This isn’t dangerous, but can result in pain and swelling.
Internal: Swollen veins form inside your rectum. Your rectum is the part of your digestive system that connects your colon (large intestine) to your anus. Internal hemorrhoids may bleed, but they usually aren’t painful.
Prolapsed: Both internal and external hemorrhoids can prolapse, meaning they stretch and bulge outside of your anus. These hemorrhoids may bleed or cause pain.

Different gastrointestinal disorders can cause rectal bleeding and other symptoms similar to hemorrhoids. Some of these disorders are life-threatening. For this reason, it’s important to let a healthcare provider know when you’re having symptoms.

Bowel diseases that can cause bleeding include:

Colon cancer.
Crohn’s disease.
Ulcerative colitis.
Diagnosis and Tests

A healthcare provider diagnoses hemorrhoids based on symptoms and a physical exam. You may also have:

Digital rectal exam: Your provider inserts a gloved, lubricated finger into your rectum to feel for swollen veins.
Anoscopy: Your provider uses an anoscope (lighted tube) to view the lining of your anus and rectum.
Sigmoidoscopy: Your provider uses a sigmoidoscope (lighted tube with a camera) to view inside the lower (sigmoid) part of your colon and rectum. Procedure types include flexible sigmoidoscopy and rigid sigmoidoscopy (proctoscopy).
These tests may be uncomfortable but aren’t painful. They typically take place in a doctor’s office or outpatient center without anesthesia. You go home the same day.

Your provider may perform a colonoscopy to confirm findings from other tests or check for signs of colon cancer. This outpatient procedure requires anesthesia.

Straining puts pressure on veins in your anus or rectum, causing hemorrhoids. You might think of them as varicose veins that affect your bottom.

Any sort of straining that increases pressure on your belly or lower extremities can cause anal and rectal veins to become swollen and inflamed. Hemorrhoids may develop due to:

Pelvic pressure from weight gain, especially during pregnancy.
Pushing hard to have a bowel movement (poop) because of constipation.
Straining to lift heavy objects or weightlifting.

Internal hemorrhoids rarely cause pain (and typically can’t be felt) unless they prolapse. Many people with internal hemorrhoids don’t know they have them because they don’t have symptoms.

If you have symptoms of internal hemorrhoids, you might see blood on toilet paper, in your stool or in the toilet bowl. These are signs of rectal bleeding.

Signs of external hemorrhoids include:

Itchy anus.
Hard lumps near your anus that feel sore or tender.
Pain or ache in your anus, especially when you sit.
Rectal bleeding.
Prolapsed hemorrhoids can be painful and uncomfortable. You may be able to feel them bulging outside of your anus and gently push them back inside.