Hemorrhoids: Signs, Symptoms, and Complications

For most people, the signs and symptoms of hemorrhoids—itchiness, swelling, discomfort—will be mild and respond to home remedies. In a minority of cases, however, hemorrhoid signs and symptoms will be severe enough that they require treatment from a physician. Rarely, hemorrhoids that cause significant blood loss or a blood clot can be life-threatening. It's important to note that one of the chief calling cards of hemorrhoids, blood in or on the stool or on toilet paper, should never be considered normal. While the cause could indeed be hemorrhoids, a more serious condition could be afoot.

symptoms of hemorrhoids
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Frequent Symptoms

Hemorrhoids can come with external and/or internal symptoms, depending on how they form.

External Hemorrhoids

Hemorrhoids on the outside of the anus are known as external hemorrhoids. A hard lump might be felt in that area and can often be uncomfortable because it is irritated by bowel movements and by wiping with toilet paper. External hemorrhoids are painful because of the many nerve endings located on the skin around the anus.

If the hemorrhoid becomes inflamed and engorged with blood (thrombosed) it may look bluish-purple and be painful, not only during a bowel movement but even when walking or sitting.

The symptoms of external hemorrhoids can include:

  • Anal pain
  • Bleeding during bowel movements
  • Burning sensation around the anus
  • Itchiness (pruritis ani)
  • Swelling around the anus
  • Tenderness when wiping

Internal Hemorrhoids

Hemorrhoids on the inside of the rectum, called internal hemorrhoids, might not cause symptoms and might only be discovered or diagnosed when they cause bleeding.

Unlike external hemorrhoids, internal hemorrhoids are not painful because of a lack of sensory nerve endings inside the anus. The blood is bright red and could be seen on the stool, in the toilet, or on the toilet tissue after wiping.

However, in some cases, an internal hemorrhoid can become prolapsed and will extend out of the anus. This might happen, for instance, when lifting something heavy or during a bowel movement. A prolapsed hemorrhoid might become painful but usually retracts back inside the anus on its own.

The symptoms of internal hemorrhoids can include:

  • Bleeding during bowel movements 
  • Itchiness (pruritis ani)
  • Pain in the case of prolapse

Rare Symptoms

Hemorrhoids are typically considered a mild and common problem, but in rare circumstances, there can be more troublesome signs and symptoms. In some cases, there may be fecal soiling along with the presence of hemorrhoids, or a feeling that the bowel isn’t completely emptied after going to the bathroom.

External hemorrhoids may rarely have blood pool inside them and sometimes clot, which is called an acutely thrombosed hemorrhoid. This type of hemorrhoid may cause inflammation, and may feel like a hard painful lump the size of a marble on the outside of the anus.

If an internal hemorrhoid prolapses and can’t be pushed back inside, it may be chronically prolapsed. Rarely, the prolapse can lead to complications such as a lack of blood flow to the area and an infection.


Hemorrhoids can be chronic and painful, but they do not usually cause complications. Rarely, a thrombosed hemorrhoid may rupture. This might cause more bleeding and pain, but the site of the rupture usually heals on its own. In some cases, a skin tag might form at the location of a thrombosed hemorrhoid that has healed.

It is rare, but significant blood loss from chronic hemorrhoids has been associated with the development of anemia. Another rare complication is a strangulated hemorrhoid, where the blood flow to an internal hemorrhoid is cut off, which can cause extreme pain. Strangulated hemorrhoids present a risk of infection, so it’s important to seek care in order to prevent this outcome.

When to See a Doctor

Blood in the stool is never normal and should always be discussed with a physician, even when it is thought to be from a hemorrhoid.

Blood in the stool is most often the result of hemorrhoids; bright red blood is characteristic. Stools that have darker red blood or that appear tarry might be related to another condition, particularly one associated with an area higher up in the digestive tract. In the event of these symptoms, it might be necessary to have testing to rule out other conditions.

Hemorrhoids Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man

Profuse rectal bleeding that’s accompanied by feelings of faintness or dizziness is a reason to seek medical attention right away.

This type of bleeding is not typical for hemorrhoids and may be an indication that another problem is occurring. Similarly, mucus or pus from the rectum, fever, chills, nausea, or a rapid heartbeat aren’t common symptoms of a hemorrhoid and are also a reason to seek medical care right away.

Frequently Asked Questions

  • How can I tell if my hemorrhoids are infected?

    Itching, swelling, and pain related to a bowel movement, the typical symptoms of hemorrhoids, are likely to occur with an infection. In addition, you may have a fever and redness around the anus, and the pain will likely get worse even after you’ve treated the area. See a doctor right away to confirm whether your hemorrhoids are infected and to start treatment.

  • Do hemorrhoids cause fever or chills?

    Not usually. Sometimes, hemorrhoids can become infected and cause fever and chills along with typical symptoms such as bleeding.

  • What will happen if I let hemorrhoids go untreated?

    Hemorrhoids will often go away on their own. However, you may want to soak them or use a topical ointment to shrink them so that they are less painful. If you notice more blood or hemorrhoid-related pain gets worse, you should talk to a doctor to ensure you don’t have an infection or other complications.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Harvard Medical School. Hemorrhoids and what to do about them.

  2. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of Hemorrhoids.

  3. Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist's view. World J Gastroenterol. 2015;21(31):9245-52. doi:10.3748/wjg.v21.i31.9245

  4. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts of hemorrhoids.

Additional Reading

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.