Hemorrhoids - Diagnosis and treatment (2024)


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.

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  • Flexible sigmoidoscopy


Home remedies

You can often relieve the mild pain, swelling and inflammation of hemorrhoids with home treatments.

  • Eat high-fiber foods. Eat more foods that are high in fiber. This helps softens the stool and increases its bulk, which will help you avoid straining. Add fiber to your diet slowly to avoid problems with gas.
  • Use topical treatments. Apply a hemorrhoid cream or suppository containing hydrocortisone that you can buy without a prescription. You also can use pads containing witch hazel or a numbing medicine.
  • Soak regularly in a warm bath or sitz bath. Soak your anal area in plain warm water for 10 to 15 minutes two or three times a day. A sitz bath fits over the toilet.
  • Take pain relievers by mouth. You can temporarily use acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin IB, others) to help relieve your discomfort.

With these treatments, hemorrhoid symptoms often go away within a week. See your health care provider within a week if you don't get relief. Contact your provider sooner if you have severe pain or bleeding.


Your hemorrhoids might only produce mild discomfort. In this case, your health care provider may suggest creams, ointments, suppositories or pads that you can buy without a prescription. These products contain ingredients such as witch hazel, or hydrocortisone and lidocaine, which can temporarily relieve pain and itching.

Hydrocortisone is a steroid that can thin your skin when used for more than a week. Ask your health care provider how long you should use it.

External hemorrhoid thrombectomy

If a painful blood clot has formed within an external hemorrhoid, your health care provider can remove the hemorrhoid. Removal can provide relief right away. This procedure, done with a medicine that numbs a part of the body, also called a local anesthetic, works best when done within 72 hours of getting a clot.

Minimally invasive procedures

Rubber band ligation of hemorrhoid

Hemorrhoids - Diagnosis and treatment (1)

Rubber band ligation of hemorrhoid

To remove a hemorrhoid using rubber band ligation, a health care provider inserts a small tool called a ligator through a lighted tube, called a scope, into the anal canal and grasps the hemorrhoid with forceps. Sliding the ligator cylinder upward releases rubber bands around the base of the hemorrhoid. Rubber bands cut off the hemorrhoid's blood supply, causing the hemorrhoid to wither and drop off.

For bleeding that doesn't stop or for painful hemorrhoids, your health care provider might recommend one of the other minimally invasive procedures available. These treatments can be done in your provider's office or another outpatient setting. They don't usually require numbing medicine.

  • Rubber band ligation. Your health care provider places one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its blood flow. The hemorrhoid withers and falls off within a week.

    Hemorrhoid banding can be uncomfortable and cause bleeding. The bleeding might begin 2 to 4 days after the procedure but is rarely severe. Sometimes, more-serious complications can occur.

  • Sclerotherapy. With sclerotherapy, your health care provider injects a chemical solution into the hemorrhoid tissue to shrink it. While the injection causes little or no pain, it might be less effective than rubber band ligation.
  • Coagulation. Coagulation techniques use laser or infrared light or heat. They cause small, bleeding internal hemorrhoids to harden and shrivel. Coagulation has few side effects and usually causes little discomfort.

Surgical procedures

Only a small percentage of people with hemorrhoids need surgery to remove them. However, if other procedures haven't worked or you have large hemorrhoids, your health care provider might recommend one of the following:

  • Hemorrhoid removal, also called a hemorrhoidectomy. Your surgeon removes extra tissue that causes bleeding by using one of various techniques. The surgery can be done with a local anesthetic combined with a medicine to help you feel calm or less anxious, also called a sedative. Spinal anesthesia or general anesthesia also may be used.

    Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. Complications can include temporarily having a hard time urinating, which can lead to urinary tract infections. This complication happens mainly after spinal anesthesia.

    Most people have some pain after the procedure, which medicines can relieve. Soaking in a warm bath also might help.

  • Hemorrhoid stapling. This procedure, called stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. It is typically used only for internal hemorrhoids.

    Stapling generally involves less pain than hemorrhoidectomy and lets you get back to regular activities sooner. Compared with hemorrhoidectomy, however, stapling has been associated with a greater risk of hemorrhoids coming back and rectal prolapse. Rectal prolapse is when part of the rectum pushes through the anus.

    Complications also can include bleeding, troubles emptying the bladder and pain. A rare complication is a life-threatening blood infection called sepsis.

    Talk with your health care provider about the best option for you.

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Preparing for your appointment

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.

By Mayo Clinic Staff

Aug. 25, 2023

Hemorrhoids - Diagnosis and treatment (2024)


What is the best diagnosis for hemorrhoids? ›

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.

What is often misdiagnosed as hemorrhoids? ›

Serious issues often mistaken for hemorrhoids.

Abnormal blood vessels in the colon. These are present from birth in most people who have them. Anal fissures, which are small tears in the tissue of the anus that also can cause bleeding. Colon polyps or even colorectal cancer.

What is the best evidence for treatment of hemorrhoids? ›

Surgery. Although nonsurgical treatments have substantially improved, surgery is the most effective and strongly recommended treatment for patients with high-grade internal hemorrhoids (grades III and IV), external and mixed hemorrhoids, and recurrent hemorrhoids.

What is considered a bad case of hemorrhoids? ›

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.

What is the gold standard for diagnosis of hemorrhoids? ›

Gold-standard of the diagnosis is endoscopic examination of the anorectum. Hemorrhoidal bleeding produces bright-red blood, dark blood points to a more proximal bleeding site.

Do you need a colonoscopy to diagnose hemorrhoids? ›

It's also possible for an internal hemorrhoid to push through the anal opening and cause pain and irritation. A colonoscopy isn't typically recommended for diagnosing or treating hemorrhoids since they're easy to find with a visual or physical exam.

What shrinks hemorrhoids fastest? ›

What shrinks hemorrhoids fast? Using home remedies as soon as you identify a hemorrhoid can help you treat it before it gets irritated or inflamed. Try a combination of warm (or sitz) baths, witch hazel, and OTC hemorrhoid cream to relieve symptoms and treat your hemorrhoid before symptoms get worse.

What is the strongest treatment for hemorrhoids? ›

Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids.

What do stage 4 hemorrhoids look like? ›

Grade 4 hemorrhoids remain prolapsed outside of the anus. They are internal hemorrhoids that protrude but do not go back inside the anus until you push them back in.

How do I know if it's a hemorrhoid or something else? ›

Hemorrhoids tend to flare and then go away, but if the bleeding is constant and progressive or a combination of both pain and bleeding, it could be something more.

What not to do with hemorrhoids? ›

During a flare, avoid foods that are low in fiber like refined flour, processed meats, and dairy. Low-fiber foods make you strain when you're passing stool. This may put pressure on your hemorrhoids and make them bleed. Eating high-fiber foods during a flare may help you recover faster.

How do I know what stage hemorrhoid I have? ›

A second-degree internal hemorrhoid bulges from the anus during bowel movements, then goes back inside by itself. A third-degree hemorrhoid bulges from the anus during bowel movements and must be pushed back in with a finger. A fourth-degree hemorrhoid protrudes from the anus all the time.

What kind of doctor looks at hemorrhoids? ›

Both gastroenterologists and proctologists can provide you treatment for hemorrhoids. Whether you should visit a gastroenterologist or proctologist depends on the type and severity of hemorrhoids you have. Hemorrhoids are of two main types: External hemorrhoids: They form under the skin around the anus.

What is the diagnostic criteria for haemorrhoids? ›

He or she can diagnose external hemorrhoids by checking the area around your anus. To diagnose internal hemorrhoids, your doctor will perform a digital rectal exam and may perform procedures to look inside your anus and rectum.

What is the investigation of choice for hemorrhoids? ›

A digital rectal examination can detect masses, tenderness, and fluctuance, but internal hemorrhoids are less likely to be palpable unless they are large or prolapsed.

How does a gastroenterologist check for hemorrhoids? ›

Hemorrhoids diagnosis

Your gastroenterologist may use one or more of the following diagnostic tools to diagnose your hemorrhoids: Digital examination. In this test, your doctor inserts a gloved, lubricated finger into your rectum. Your doctor then uses their finger to feel for any unusual growths or abnormalities.

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