Internal Hemorrhoids Causes, Symptoms, and Treatment

Understanding Internal Hemorrhoids

Teenager in pain on the toilet
Getty Images/Peter Dazeley

A hemorrhoid, also known as a bloody pile, is a swollen vein in or around the rectum. If a hemorrhoid is inside the rectal vault – rather than outside the anus where they are visible – it is called an internal hemorrhoid.  

Types of Hemorrhoids

Hemorrhoids are frequently found both internally and externally, or may occur in multiples, at the same time. 

There are internal hemorrhoids and external hemorrhoids.

 External hemorrhoids rest outside of the body and are visible. Some hemorrhoids seem to be both: they are mostly internal but can bulge outside of the body during heavy lifting or other activity that makes the individual bear down, including bowel movements. These hemorrhoids typically return to their internal placement when the activity is over. 

Causes of Internal Hemorrhoids

Internal hemorrhoids can be caused by pregnancy, straining to have a bowel movement, constipation, or other conditions that increase the pressure in the veins of the rectum, such as obesity.

Individuals who have a tendency to sit on the toilet for long periods of time, especially those who strain to have a bowel movement for an extended amount of time, are very prone to hemorrhoids. These individuals should avoid being the person who takes a magazine to the bathroom and reads while having a bowel movement. If necessary, a stool softener can reduce straining and the amount of time necessary to have a bowel movement.


Hemorrhoids can also run in families, an individual with parents who have hemorrhoids is more likely to have this issue than those who do not have relatives with hemorrhoids.

Signs and Symptoms of Internal Hemorrhoids

Internal swollen blood vessels typically don't cause symptoms and are typically first diagnosed when they cause bloody stool.

 This blood is typically "fresh" blood, meaning it is bright red and looks like blood.  You may also see fresh blood in the toilet after having a bowel movement, or notice streaks of blood on toilet tissue after wiping. 

Other types of internal bleeding can cause dark stools that can look similar to tar, and medical attention should be sought with this type of bleeding as it is unlikely to be related to hemorrhoids and may be a sign of a more serious condition. 

Hemorrhoid Treatment

Hemorrhoids can be treated in many ways, including treating the pain with numbing ointments that also reduce the size of the blood vessel, a stool softener/dietary changes to decrease constipation or weight loss. Fortunately, most internal hemorrhoids don't require treatment as they are not painful and cause few, if any, problems.   

Hemorrhoids that are causing significant discomfort or pain are almost always external hemorrhoids. In severe cases, the veins may be scarred to reduce swelling in an outpatient procedure, or they may be surgically treated.