Hemorrhoid (internal, external): symptoms, remedies, surgery

Obesity, pregnancy and sedentary life are very different conditions, but they can have one thing in common: be the cause of severe pain and discomfort resulting from hemorrhoids.

Bleeding, itching in the anus region and difficulty in evacuating are recurrent sensations in those who suffer from the problem.

But there are ways to treat and eliminate discomfort.


What is hemorrhoids?

A nuisance every time you need to go to the bathroom starts to appear. The pain and itching in the final region of the anus become constant and very debilitating, affecting the intestinal routine and several other activities in life.

These are classic symptoms of hemorrhoid, a swelling in the veins present in the rectal region , which can be internal (and not visible) or external (and visible).

The intestinal tube is vascularized by several small blood vessels, being called hemorrhoids.

They are normal and act to assist in closing the anus to control bowel movement.

So, anatomically, we all have hemorrhoids.

What is popularly called hemorrhoids are the dysfunctions, swelling and dilation of these vessels, and is also known as hemorrhoidal disease .

When the vessels suffer from excessive pressure or force, their walls can thin and break. What constitutes hemorrhoidal varices, in which the mechanism is quite similar to the appearance of varicose veins in the legs.

Anatomically, most veins have valves that assist in the conduction of blood, keeping the flow in the same direction.

However, hemorrhoidal veins do not have this conductive structure. This makes it easier for blood to concentrate and improperly accumulate in the region.

The dilation of the veins in the rectal region can then dilate, inflame and bleed, characterizing hemorrhoidal disease.

It is estimated that about 5% of the population suffers from any of the 4 degrees of the disease, which is usually accompanied by itching, pain, blood and the appearance of nodules in the anus.

What is external hemorrhoids?

External hemorrhoids are those that appear outside the anus and, therefore, are easily visualized.

Generally, patients have no pain or other symptoms, and are therefore asymptomatic. However, the region is covered by very sensitive skin layers, making it, if there is pain, it can be intense.

What is internal hemorrhoids?

Internal hemorrhoids occur above the sphincter of the anus, a muscle membrane that helps control bowel movement.

Usually, the type causes more acute and intense symptoms compared to the external type, but it is possible that the disease will remain asymptomatic for some period.

However, it is subdivided into 4 stages or degrees, and if left untreated, they can gradually migrate from grades 1 to 4. Therefore, everyone needs medical care.

What types (degrees) of internal hemorrhoids?

Hemorrhoids can be divided into 4 degrees, which affect their size and intensity of symptoms:

However, it is subdivided into 4 stages or degrees, and if left untreated, they can gradually migrate from grades 1 to 4. Therefore, all grades require medical monitoring.

  • Grade 1 : dilated veins are not seen by the patient, as they are inside the anus. The condition may already have pain, itching and bleeding;
  • Grade 2 : it is characterized by a small external manifestation of hemorrhoids. In this phase, they are usually exposed when the patient goes to evacuate (characterizing the prolapse), but they return to the anus afterwards;
  • Grade 3 : marked by the most evident hemorrhoids exit from the rectal canal. Usually, after the patient goes to the bathroom or does some intense physical activity. In general, the patient himself returns or reinserts the hemorrhoids in the anus;
  • Grade 4 : the condition is more aggravated and the patient is unable to return the hemorrhoids to the inner part of the anus. Thus, the dilated veins are constantly exposed and vulnerable to friction and irritation from the external environment. The pain is severe and fecal incontinence (difficulty controlling the bowel movement) may occur, in addition to a thrombosis.

What is inflamed hemorrhoid?

Hemorrhoids are part of the anatomical structure of all people. But sometimes they are tender, swollen and inflamed.

To know when they become inflamed, it is necessary to observe the resulting signs and symptoms, which usually involve pain, bleeding, nodules and bumps in the anal area, in addition to difficulty in evacuating.

These are some aspects that indicate hemorrhoidal inflammation.

What causes hemorrhoids?

The causes of hemorrhoids are still debated and uncertain. In general, the onset of the disease is attributed to the degradation or deterioration of the rectal layers, possibly triggered by factors such as aging, intestinal habits and rectal muscle strain due to constipation.

The cause of dilation and bleeding is the thinning of the blood vessel walls, which can be triggered or favored by factors such as:

  • Aging : although it can occur at any age, hemorrhoids are more frequent in older people, usually from 45 years old;
  • Genetics : people who have cases in the family are more likely to have hemorrhoids;
  • Pregnancy : due to the increase in abdominal pressure that occurs due to the enlargement of the uterus;
  • Obesity : there is constant pressure on the organs and veins due to being overweight;
  • Chronic diarrhea : can cause increased bowel movements;
  • Constipation : due to the intense effort to evacuate.

Food factors are sometimes pointed out as possible causes of hemorrhoids. However, there is a lot of divergence in the information.

Some researchers suggest that a diet with strong and irritating foods (like peppers) could trigger and favor the disease.

But others suggest that the relationship between food and hemorrhoids is due only to a lack of fiber (which would cause constipation).

Risk factors for internal and external hemorrhoids

Considering the probable causes of hemorrhoids, the risk factors most associated with the disease are:

  • People with cases in the family;
  • Obese;
  • Pregnant women;
  • People with chronic difficulty to evacuate;
  • People with intestinal disorders (chronic diarrhea).

Hemorrhoids in pregnancy: what to do and how to treat?

During pregnancy, a series of changes in the body and body can happen, including the appearance of hemorrhoids. This is because there is a growth of the uterus and increased pressure in the pelvic region, causing blood flow compression and favoring constipation .

The condition is frequent and care must be the same for non-pregnant people: adequate food, healthy habits and medical (prenatal) monitoring.

Care must still be reinforced due to the immunological variations that the pregnant woman presents.

In general, the condition shows good improvements after the indicated treatment.

External and internal hemorrhoids: what are the symptoms?

Hemorrhoids do not always cause symptoms, such as pain or itching in the region, in which case, bleeding is usually the first warning sign .

It is important to remember that blood in the stool always needs to be investigated and that there are several conditions that can be associated.

In general, the patient does not feel pain and, therefore, has difficulty in realizing that there is something wrong in the body.

As the anal region is difficult to visualize, even if the hemorrhoid is in grade 2, it can take time to notice it.

Only when there is an injury or rupture of the hemorrhoidal vessel, causing bleeding to occur, does the patient begin to notice changes in the body.

Among patients who manifest symptoms, the most frequent and common signs are:

  • Itching (itching) in the anus region;
  • Irritation;
  • Pain and discomfort when evacuating;
  • Presence of blood after going to the bathroom (usually bright red);
  • Presence of tender or painful nodules in the anus;
  • Difficulty controlling evacuation;
  • Mucus is present in underwear or in bowel movements.

Other conditions that can manifest in hemorrhoids and configure more severe and intense conditions:

Hemorrhoidal thrombosis

The thrombosis hemorrhoidal is characterized by a nodule or protrusion, generally quite painful and differentiated color (possibly with bluish tone).

Usually, the manifestation is not gradual, that is, it starts quickly and abruptly, in which the pain intensifies in the first 48 hours and tends to regress after 4 days.

Thrombosis occurs because the veins are dilated and the blood flow tends to be slower in that part, causing it to accumulate and clot.

Some conditions can favor this clotting, such as dehydration or alcohol consumption.

With coagulation, an extremely painful nodule (hardened mass) is formed, and it is possible for necrosis and ulcerations to occur in the skin covering the hemorrhoid with thrombosis.

Hemorrhoidal crisis

The hemorrhoidal crisis is the manifestation of the symptoms, characterizing the hemorrhoid episodes. The condition is usually very painful and occurs due to prolapse (that is, the exit of the internal hemorrhoids).

What is the difference between hemorrhoids and anal fissures?

Although hemorrhoids and anal fissures may show very similar signs and symptoms, such as pain and bleeding, the conditions are quite different.

Anal fissures are small lesions or cracks that occur in the anal wall.

They are caused by trauma, usually due to hard stools, as the intestinal tissue stretches excessively to allow it to be evacuated.

Some conditions, such as constipation, diseases that affect the intestine (such as celiac disease and Crohn’s disease), trauma due to anal sex and postoperative are among the causes of the fissure.

That is, fissures are small lesions in the anal area, while hemorrhoids are dilations or swelling of the hemorrhoidal veins.

Since pain and the presence of blood are similar symptoms in both conditions, a medical consultation is needed to determine the causes.

How is the diagnosis made?

The professionals best suited to diagnose and / or refer hemorrhoids treatment are the proctologist and the general surgeon . Only an adequate assessment, consisting of physical assessment, the patient’s history and examinations, is able to provide an accurate diagnosis.

Therefore, based on the patient’s symptoms, combining exams to assess the rectum region, it is possible to trace the diagnosis.

Tests for internal and external hemorrhoids

To assist in confirming the diagnosis, especially when there are internal hemorrhoids, the doctor may request that certain tests be performed, such as:

Touch exam

The examination consists of observing the outermost region of the anus, seeking to identify the presence of changes or signs of the disease.

After a more superficial analysis, the doctor will also evaluate the internal region through digital rectal examination.

The goal is to inspect the musculature of the region, to notice if there are nodules or noticeable changes or the presence of blood, for example.


Anuscopy allows for a better assessment of the anus and anal canal. The exam is simple and does not require any preparation to be performed, being generally quite safe.

The anuscope is the instrument used for the evaluation, which is introduced in the anus and, through the emission of light, allows an adequate visualization of the region.


A device called a sigmoidoscope is introduced into the anus to assess the final part of the intestinal tube.

In it, there is a video camera that allows the region to be properly evaluated.

In general, the preparations for the exam involve the use of laxatives to empty the intestine, sedation is not necessary, but the patient may feel a little discomfort or pressure during the procedure.


The test is usually requested only when other complications or illnesses are suspected. In general, it is more suitable for patients over 50 and with a clinical history that indicate the need for further investigation.

colonoscopy requires some specific preparation, such as a particular nutritional uses (indicated by laboratory) on the day prior to the examination, and the use of laxatives for intestinal area is completely clean.

On average, the exam lasts about 30 minutes, in which a probe (colonoscope) is inserted through the anus until it reaches the intestine.

The goal is to visualize the intestinal walls, looking for changes or irregularities.

As the intestine is a hollow tube, it needs to be inflated to allow the professional to be able to assess properly. Therefore, although it does not hurt, the patient may experience some discomfort due to the insertion of carbon dioxide in the site.

Sedation may or may not be necessary, depending mainly on the patient’s sensitivity (tolerance for pain or discomfort) and degree of anxiety .

Is there a cure?

-Yeah . Hemorrhoids can be treated, trying to avoid worsening the condition, solve the symptoms and eliminate the condition.

Some cases may require surgical intervention, but asymptomatic patients often do not even need treatment, according to the medical guidelines for hemorrhoids at the Federal University of Rio Grande do Sul (UFRGS).

Hemorrhoid treatment: what is good?

Hemorrhoid treatment includes home care, in addition to, in some cases, therapies, medication use and surgery.

Homemade or conservative treatment

The conservative method consists of modifying the diet and the habits of life, in order to improve the intestinal functioning.

Hemorrhoid medical guidelines recommend that you include fiber-rich foods that aid intestinal flow (such as leaves, fruits, and seeds).

This includes reducing the consumption of foods that may have a constipating effect (such as flour) and increasing water intake to aid intestinal transit.

In addition, the patient is recommended not to use force to evacuate, always choose to clean with baths instead of using toilet paper.

If necessary, include fiber supplements and faecal cake formers in the routine. The latter will facilitate trips to the bathroom, reducing the effort to evacuate.

Sitz bath

Sitz baths are also very popular techniques to assist in the home treatment of hemorrhoids.

Although the UFGRS Guidelines point out that there is little evidence about sitz baths, they can be quite effective in relieving pain and discomfort.

In general, they are recommended between 2 and 3 baths or always after evacuation, for a maximum of 15 minutes in warm water.

Drug treatment

Medicines, such as anesthetics, anti-inflammatories and astringents, can be prescribed to relieve pain and sensitivity, even though the real efficacy and benefits of chemicals are debated.

In patients with severe conditions, such as hemorrhoidal thrombosis, it is possible to include the use of ointments and creams.

Read more: Remedies for treating internal and external hemorrhoids

Sclerotherapy injection

The technique is recent and consists of the injection into the vein of a sclerosing substance, which promotes intense inflammation and destruction of the region, eliminating the hemorrhoid.

The injection is done through microneedles and it may be necessary to do more than one session.

The method is usually indicated when the other therapies have no effect.

Infrared coagulation

Localized infrared irradiation applications are made, increasing the temperature of the tissue, which can reach up to 100 ºC.

Heat affects the small vessels, promoting clotting that prevents blood from reaching the hemorrhoid.

The result is that the necrosis process in the region begins, that is, causing the hemorrhoid to die.

On average, between 10 and 14 days the organism is able to eliminate the necrotic part and initiate tissue renewal processes.

Read more: How to apply hemorrhoid creams and ointments?

Surgery: how to cure hemorrhoids?

Not every hemorrhoid condition requires surgery, and conservative treatment should preferably be prioritized. However, when there is no improvement in the disease or the doctor deems it necessary, outpatient interventions should be considered.

After surgery, the recommendations to the patient are very similar: avoiding the use of toilet paper, performing sitz baths for hygiene and the use of prescription drugs.

The choice of treatment and recovery time depend on the patient’s condition.

Among the options are:

Transanal Hemorrhoidal Dearterialization (THD)

The method is indicated for grade 2, 3 or 4 hemorrhoids.

It consists of a less invasive procedure, because, instead of the doctor performing a cut or extraction of the hemorrhoid, blocking the veins that carry blood to it.

In a few days, around 14, the region will dry out due to tissue necrosis.

However, as there are no cuts, the resumption of activities by the patient is quite fast (on average, 48 hours after the procedure).

Elastic bandage

Indicated in grade 2 and 3 hemorrhoids, with 85% of patients presenting positive results with the intervention. The technique is simple and consists of placing (or strangling) the hemorrhoids.

For this, the doctor wraps them with an elastic ring that blocks blood flow, causing a process of tissue death to begin.

Without receiving blood, between 1 and 2 weeks the hemorrhoid dries completely and detaches from the body.

Sometimes it takes more than one session, depending on the amount of hemorrhoids.

The procedure is generally well tolerated, but the patient may experience pain and discomfort on subsequent days.


Substances called sclerosing agents (substances capable of closing blood vessels) are injected directly into the hemorrhoid.

In general, it is more recommended in patients with grade 1 or 2 and who use anticoagulant drugs or ASA.


In grade 3 and 4 external or internal hemorrhoids that do not show improvement in treatment, surgery may be recommended.

If the patient has extensive thrombosis or hemorrhoidal crisis, treatment should be considered on an emergency basis.

In general, the technique requires local or general anesthesia of the patient and consists of removing all tissue from the hemorrhoid with the use of scissors, an electric scalpel or specific forceps.

The devices make a cut and, therefore, a spot can be given to accelerate healing and reduce the size of the scar.

However, the stitches usually break after a few days of the procedure.

The recovery process is generally slower, and may take between 2 weeks and 1 month.

Ointment or pill: what is the best medicine?

Medicines that can be indicated for the treatment of hemorrhoids include faecal cake (intestinal regulators), ointments and pain relievers, which can be used together or alone, according to the medical recommendation. Learn more about each one:

Intestinal regulators to treat hemorrhoids

Used to relieve constipation and reduce straining during bowel movements, bowel regulators help to form less hard stools. Among them are:

  • Psyllium;
  • Agiolax;
  • Benefiber ;
  • Flora-5.

In general, the products are well tolerated and assist in fiber supplementation, improving intestinal transit.

Pills to cure hemorrhoids

Treatment with tablets includes the use of diosmin + hesperidin . Among the available options are: Velunid and Daflon .

Ointments indicated for hemorrhoids

To relieve pain, irritation and discomfort, topical medications such as:

  • Cinchocaína + policresuleno: Proctyl;
  • Lidocaine + combinations: Proctosan and Hemovirtus ;
  • Lidocaine + fluocortolone : Ultraproct ;
  • Lidocaine + hydrocortisone : Xyloproct .

Medications can help relieve symptoms, but they should be used for a limited time.

In cases of hemorrhoidal thrombosis, the combination of polycresulene and cinchocaine may also be indicated.

In addition to these, ointments such as Hemofiss , Hemorroydina , Proctan and Proctfis-H can help to relieve symptoms, accelerating the local drying process.

Living with inflamed hemorrhoids

Hemorrhoids are, in general, very uncomfortable and can limit the activities of patients. When symptoms appear, it is important to be attentive to the routine and adopt measures that assist in the recovery of the condition.

It is indicated to maintain a regular and adequate diet, inserting fibers in the meals increasing the consumption of water.

Thus, intestinal transit is facilitated and efforts to evacuate are minimized.

It is important to maintain anal hygiene as well, avoiding possible complications resulting from hemorrhoid exposure.

As there are usually ruptures or microlesions, the region is more susceptible to contamination and infections.

It is also recommended to avoid the use of toilet paper, always using baths as a means of cleaning after evacuation.

In addition, it is indicated to take care of physical activities, maintaining a balance.

Light walks can be very beneficial, especially throughout the day for those who sit for a long time.

However, during the hemorrhoids manifestation, it is indicated to avoid intense activities, such as weight training . This is because they can generate excessive contractions of the rectal musculature.

For the treatment to be effective, it is necessary to follow the medical recommendations, using the medications (if necessary), and maintaining constant monitoring.


After treatment, the prognosis of hemorrhoids is generally good, if they are diagnosed and treated quickly and properly.

The improvement depends a lot on the condition and the adequacy of the treatment. That is, if the patient adopts changes in diet and routine, there is usually a promising improvement.

When surgery is needed, the prognosis will depend on whether the patient also proceeded with conservative treatment.

In some cases, it is possible for symptoms to return within 3 years if there is no effective follow-up.

Complications: what happens if I don’t treat?

The manifestation of strangulation of hemorrhoids and hemorrhoidal thrombosis are considered complications of the disease. In these cases, the surgical options assume an emergency character.

The other complications related to hemorrhoids are generally related to surgery.

About 5% of patients undergoing invasive treatment may have tissue necrosis, manifestation of thrombosis of external or internal hemorrhoids, dysuria (pain or difficulty in urinating), urinary retention and severe pain.

How to prevent external and internal hemorrhoids?

Hemorrhoid prevention occurs with the adoption of healthy habits and adequate nutrition.

As the causes can be diverse and you do not know for sure what is the triggering factor, the ideal is to take care of the health of the organism as a whole.

Some simple measures that can help prevent the disease are:

Have a balanced diet

Caring for food includes adequate consumption of fiber, a reduction in constipating foods and, if there is any food restriction, following the recommended diet.

For this reason, fruits, leaves, seeds and probiotic foods can help in intestinal health, reducing constipation or diarrhea .

Some time ago, it was believed that some foods could cause hemorrhoids, such as peppers or strong spices.

However, there is no evidence that, in fact, there is any relationship.

So, these stronger or peppery foods should only be avoided if there is any discomfort when eating them.

Drink water

Just as the diet must be rich in fiber to assist in the health of the intestine, the consumption of water deserves attention.

Without good hydration, fibers are unable to perform their facilitating function in the intestine, causing an inverse effect (ie, more constipation).

Attention in cases of pregnancy and obesity

The pressure that the pelvis region suffers from high weight – whether due to obesity or pregnancy – can facilitate the appearance of hemorrhoids.

For this reason, overweight people or pregnant women should undergo constant medical monitoring, pay attention to preventive measures in food and be attentive to the body’s signs.

Respect your desire to evacuate

Caring for the health of the intestine depends on the regularity of bowel movements.

Many people do not respect the need to go to the bathroom, which can promote excessive contractions of the rectal muscles. In addition, it helps to trigger changes in bowel function.

Take care of the emotional

Intestinal habits and health are closely associated with emotional conditions.

Situations of stress and tension can cause constipation, which promotes greater chances of hemorrhoids arise. Therefore, emotional health deserves attention.

Look for relaxing and pleasurable physical activities, try to lower the intense rhythm of the routine and learn to deal with emotions better.

Common questions

Can blood in the stool be a sign of hemorrhoids?

-Yeah . Blood during evacuation can be a sign of hemorrhoid due to a rupture of the hemorrhoidal vein during the passage of stool, but a medical evaluation is required.

In general, the presence of blood in the stool is always a warning sign and needs to be investigated. But there are different conditions that can trigger bleeding.

Can hemorrhoids turn into cancer?

No . Even if there are nodules or aggravated conditions, the hemorrhoid is not a cancer of the rectum or anus, nor is there a relationship between the two, although sometimes the symptoms are similar.

But it is worth remembering that in the presence of symptoms and signs (such as bleeding), it is always necessary to investigate the condition. This is because there are cases where the symptoms are confused and more serious conditions can be masked.

Is hemorrhoid serious?

The disease is benign, although it can cause severe pain and discomfort.

There are cases in which surgery is needed as an emergency measure (as in cases of grade 4 hemorrhoids with possible complications).

But, in general, the disease responds well to treatment, provided it is done properly.

What should the diet be like after hemorrhoid surgery?

After surgical procedures or during any hemorrhoid therapy, food is very important to improve the condition.

It is necessary to follow medical recommendations, which may vary according to each patient.

However, in general, it is recommended that the patient consume foods that facilitate intestinal transit. That is, rich in fiber or that do not favor constipation.

The patient must pay attention to water intake to maintain intestinal regularity. If recommended, it can include fiber supplements in the diet.

It may be recommended to decrease the intake of milk products, as these can trap the intestine.

Therefore, the ideal is to opt for fruits, vegetables and natural foods, also avoiding industrialized products, sausages and fast foods .

Can hemorrhoids reappear after surgery?

Hemorrhoid recurrence cases are uncommon. In general, after surgery, there may be excess skin or the appearance of anal fissures, which are mistaken for hemorrhoids.

If the surgery is successful, new manifestations are rare, and complications resulting from the procedure (such as hemorrhoidal thrombosis) are more common.

Can hemorrhoids be emotional?

Conditions related to the emotional state, such as stress and anxiety, can affect the proper functioning of the intestines.

Constipation, for example, can aggravate hemorrhoid conditions, causing even more pain and discomfort, especially when evacuating.

Therefore, hemorrhoids can have an indirect relationship with the emotional.

How long does a hemorrhoid crisis last?

In general, after starting treatments and medication, it takes around 2 days for the condition to show a significant improvement. Some episodes may be more persistent and, in such cases, require specific medical advice.

What is the best medicine to deflate hemorrhoids?

The best medication will depend on the stage of the hemorrhoid. Analgesics, which relieve pain, and anti-inflammatory drugs, may be prescribed to alleviate inflammation. In persistent and recurrent cases, surgery can be considered.

Which tea is good for hemorrhoids?

Teas that help digestion and improve intestinal transit can be good allies in the treatment of hemorrhoids. Some options include chamomile and mint, which improve gastric emptying.

How to relieve the burning of hemorrhoids?

When hemorrhoids attack, pain and burning may appear in the area. One way to relieve symptoms and discomfort is to increase the intake of water and fiber, as well as avoiding cleaning habits that attack the place. For example, the use of toilet paper.

Hemorrhoids are a very uncomfortable condition and can cause limitations to the patient.

Generally, the pain and discomfort are severe and, if there is no treatment, they can get worse.

It is important to be aware of the body’s signs and maintain health care, resorting to medical care whenever there is any change in the body.

The rapid diagnosis of any dysfunction helps to reduce the risks and favors that the treatment is as effective as possible, restoring the patient’s well-being.

Always consult a doctor and read more health tips at Minute Healthy!