Symptoms of hemorrhoids usually depend on the type of hemorrhoid.

Internal hemorrhoids

Internal hemorrhoids lie inside the rectum. You usually can't see or feel them, and they rarely cause discomfort. But straining or irritation when passing stool can cause:

• Painless bleeding during bowel movements. You might notice small amounts of bright red blood on your toilet tissue or in the toilet.
• A hemorrhoid to push through the anal opening, called a prolapsed or protruding hemorrhoid. This may result in pain and irritation.

External hemorrhoids

These are under the skin around the anus. Symptoms might include:

• Itching or irritation in the anal region.
• Pain or discomfort.
• Swelling around the anus.
• Bleeding.

Thrombosed hemorrhoids

Blood can pool in an external hemorrhoid and form a clot, called a thrombus. A thrombosed hemorrhoid can result in:

• Severe pain.
• Swelling.
• Inflammation.
• A hard, discolored lump near the anus.

When to see a doctor

If you have bleeding during bowel movements or you have hemorrhoids that don't improve after a week of home care, talk to your health care provider.

Don't assume rectal bleeding is due to hemorrhoids, especially if you have changes in bowel habits or if your stools change in color or consistency. Rectal bleeding can happen with other diseases, including colorectal cancer and anal cancer.

Seek emergency care if you have large amounts of rectal bleeding, lightheadedness, dizziness or faintness.

The veins around the anus tend to stretch under pressure and may bulge or swell. Hemorrhoids can develop from increased pressure in the lower rectum due to:

• Straining during bowel movements.
• Sitting for long periods of time, especially on the toilet.
• Having chronic diarrhea or constipation.
• Being obese.
• Being pregnant.
• Having anal intercourse.
• Eating a low-fiber diet.
• Regularly lifting heavy items.

As people age, the risk of hemorrhoids increases. That's because the tissues that support the veins in the rectum and anus can weaken and stretch. This also can happen during pregnancy because the baby's weight puts pressure on the anal region.

Complications of hemorrhoids are rare but may include:

• Anemia. Rarely, ongoing blood loss from hemorrhoids may cause anemia. Anemia is when there aren't enough healthy red blood cells to carry oxygen to the body's cells.
• Strangulated hemorrhoid. When the blood supply to an internal hemorrhoid is cut off, the hemorrhoid is called strangulated. Strangulated hemorrhoids can cause extreme pain.
• Blood clot. Sometimes a clot can form in a hemorrhoid. This is called a thrombosed hemorrhoid. Although not dangerous, it can be extremely painful and sometimes needs to be drained.

The best way to prevent hemorrhoids is to keep your stools soft so they pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:

• Eat high-fiber foods. Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk. This will help you avoid the straining that can cause hemorrhoids. Add fiber to your diet slowly to avoid problems with gas.
• Drink plenty of fluids. Drink 6 to 8 glasses of water and other liquids each day to help keep stools soft. Avoiding alcohol also may help.

• Consider fiber supplements. Most people don't get enough fiber in their diets. Studies have shown that nonprescription fiber supplements, such as psyllium (Metamucil, Konsyl, others) or methylcellulose (Citrucel), can lessen symptoms and bleeding from hemorrhoids.

  If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause constipation or make it worse.

• Don't strain. Straining and holding your breath when trying to pass stool create greater pressure in the veins in the lower rectum.
• Exercise. Stay active to help prevent constipation and reduce pressure on veins. Exercise also can help you lose excess weight that might be causing your hemorrhoids or making them worse.
• Avoid long periods of sitting. Sitting too long, especially on the toilet, can increase the pressure on the veins in the anus.

Your health care provider might be able to see external hemorrhoids. Diagnosing internal hemorrhoids might include an exam of your anal canal and rectum.

• Digital examination. Your health care provider inserts a gloved, lubricated finger into your rectum. This allows your provider to check for anything unusual, such as growths.
• Visual inspection. Internal hemorrhoids are often too soft to be felt during a rectal exam. Your health care provider might look at the lower part of your colon and rectum with a tool such as an anoscope, a proctoscope or a sigmoidoscope.

Your health care provider might want to look at your entire colon using colonoscopy if:

• Your symptoms suggest you might have another digestive system disease.
• You have risk factors for colorectal cancer.
• You are middle aged and haven't had a recent colonoscopy.

If you have symptoms of hemorrhoids, make an appointment with your primary care provider. If needed, your provider might refer you to one or more specialists for evaluation and treatment. These may include a doctor with expertise in the digestive system, called a gastroenterologist, or a colon and rectal surgeon.

Here are some suggestions to help you get ready for your appointment.

What you can do

Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance.

Make a list of:

• Your symptoms and how long you've noticed them.
• Key personal information, including typical bowel habits and diet, especially your fiber intake.
• All medicines, vitamins or supplements you take, including doses.
• Questions to ask your health care provider.

For hemorrhoids, some questions to ask your provider include:

• What's the likely cause of my symptoms?
• Is my condition likely to be temporary or permanent?
• Am I at risk of complications related to this condition?
• What treatment approach do you recommend?
• If treatments we try first don't work, what will you recommend next?
• Am I a candidate for surgery? Why or why not?
• Are there additional self-care steps that might help?
• I have other medical problems. How can I manage these along with hemorrhoids?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask you questions, including:

• How uncomfortable are your symptoms?
• What are your typical bowel habits?
• How much fiber does your diet contain?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Has anyone in your family had hemorrhoids or cancer of the colon, rectum or anus?
• Have you had a change in your bowel habits?
• During bowel movements, have you noticed blood on your toilet paper, dripping into the toilet or mixed into your stools?

What you can do in the meantime

Before your appointment, take steps to soften your stools. Eat more high-fiber foods, such as fruits, vegetables and whole grains. Consider a nonprescription fiber supplement, such as Metamucil or Citrucel. Drinking 6 to 8 glasses of water a day also might help relieve your symptoms.