Pain Awareness Month: Understanding What Hemorrhoid Pain Means

Pain Awareness Month provides an opportunity to better understand the causes of pain, recognize symptoms that may require medical attention, and learn about available treatment options. For people experiencing hemorrhoids, understanding what the pain means—and what may be causing it—can be an important part of deciding when to seek medical care.

Hemorrhoids are swollen or inflamed veins around the anus or in the lower rectum. They are classified as either internal hemorrhoids, which develop inside the anus or lower rectum, or external hemorrhoids, which develop under the skin around the anus. Hemorrhoids are common, and NIDDK reports that about half of adults older than 50 have hemorrhoids.

Although hemorrhoids can cause pain, pain is not the only symptom associated with hemorrhoidal disease, and the location and type of symptoms can provide clues about what is happening.

What Does Hemorrhoid Pain Feel Like?

Hemorrhoid-related pain can vary depending on the type of hemorrhoid and whether a complication has developed.

External hemorrhoids are more likely to cause pain because they develop beneath the skin around the anus, where there are pain-sensitive nerves. An external hemorrhoid can become particularly painful if a blood clot forms inside it, a condition known as a thrombosed external hemorrhoid.

Internal hemorrhoids are located inside the lower rectum, where there are fewer pain-sensitive nerves. As a result, internal hemorrhoids more commonly cause painless rectal bleeding, particularly during bowel movements. However, an internal hemorrhoid that prolapses or becomes strangulated can cause significant discomfort or pain.

This distinction is important because anal or rectal pain is not automatically caused by hemorrhoids. Other conditions, including anal fissures, can also cause pain and bleeding. A healthcare professional may need to examine the area to determine the cause.

Common Reasons Hemorrhoids Can Hurt

Several changes involving hemorrhoids can contribute to pain or discomfort.

1. A Thrombosed External Hemorrhoid

A blood clot can form within an external hemorrhoid. This can produce a tender lump and significant pain around the anus. A healthcare professional can identify a thrombosed external hemorrhoid during an examination.

2. Prolapsed Internal Hemorrhoids

An internal hemorrhoid can extend through the anal opening, a condition called prolapse. Prolapsed hemorrhoids can cause irritation, discomfort, and difficulty with hygiene. In more severe cases, the blood supply to the prolapsed tissue can become restricted, resulting in a strangulated hemorrhoid.

3. Irritation and Inflammation

Hemorrhoids may also cause itching, irritation, swelling, or discomfort around the anus. Bowel movements, straining, and prolonged time on the toilet can contribute to hemorrhoid symptoms.

4. Another Anorectal Condition

Not every episode of anal pain or rectal bleeding is caused by hemorrhoids. Anal fissures, for example, can cause pain and bleeding and may look or feel similar to other anorectal conditions. This is one reason persistent or unexplained symptoms should be evaluated rather than automatically attributed to hemorrhoids.

Hemorrhoid Pain vs. Hemorrhoid Bleeding

Pain and bleeding are two different hemorrhoid symptoms, and understanding the difference can be helpful.

Bleeding is particularly associated with internal hemorrhoids. Bright red blood may appear on toilet paper, on the surface of stool, or in the toilet after a bowel movement.

Pain is more commonly associated with external hemorrhoids, particularly when a blood clot has formed, or with complications involving prolapsed internal hemorrhoids.

Because rectal bleeding can have causes other than hemorrhoids, recurrent or unexplained bleeding should be discussed with a healthcare professional rather than automatically assumed to be hemorrhoidal bleeding.

When Should Hemorrhoid Pain Be Evaluated?

Mild hemorrhoid symptoms can sometimes improve with conservative measures. Increasing dietary fiber, avoiding straining during bowel movements, limiting time spent on the toilet, and maintaining adequate fluid intake are among the measures recommended for managing hemorrhoids.

Medical evaluation is appropriate when symptoms persist, recur, become severe, or interfere with daily activities.

Severe anal pain accompanied by rectal bleeding requires prompt medical attention, particularly when it occurs with abdominal pain, diarrhea, or fever.

An evaluation can also help determine whether the symptoms are actually being caused by hemorrhoids. Diagnosis may involve a medical history, examination of the anal area, a digital rectal examination, and, when appropriate, anoscopy or another examination of the rectum.

How Are Painful Hemorrhoids Treated?

Treatment depends on the type and severity of the hemorrhoids and the symptoms being experienced.

For mild symptoms, healthcare professionals may recommend dietary and bowel-habit changes, fiber, stool-softening measures, warm sitz baths, or short-term over-the-counter treatments.

For persistent or more significant hemorrhoidal disease, medical procedures may be considered. Treatment options for internal hemorrhoids can include rubber band ligation, sclerotherapy, infrared photocoagulation, and other interventions. More advanced or persistent cases may require surgical treatment.

Another treatment option being studied and used for selected patients with symptomatic internal hemorrhoidal disease is rectal artery embolization, also referred to as hemorrhoid artery embolization or the Emborrhoid technique.

What Is Hemorrhoid Artery Embolization?

Hemorrhoid Artery Embolization (HAE) is a minimally invasive, image-guided procedure that targets arteries supplying the hemorrhoidal vascular network.

During the procedure, an interventional radiologist uses a catheter to access the relevant arteries and places an embolic material, such as microcoils or particles, to reduce blood flow to the hemorrhoidal tissue.

Research has primarily evaluated arterial embolization for internal hemorrhoidal disease, particularly bleeding-predominant disease. A 2022 systematic review and meta-analysis involving 13 studies and 381 patients found improvements in bleeding, pain scores, and quality-of-life measures following rectal artery embolization. However, the researchers also noted that additional research is needed to establish its long-term effectiveness and its role compared with other hemorrhoid treatments.

More recent research continues to evaluate the procedure. A 2025 systematic review of 22 studies involving 810 procedures reported high technical success and clinical success rates ranging from 63% to 94%, while also noting substantial differences among studies and the need for additional comparative and long-term research.

These findings indicate that HAE is an emerging minimally invasive treatment option, but patient selection matters, and it is not appropriate for every type or cause of hemorrhoid pain.

What Hemorrhoid Pain Can Tell You

Pain can provide useful information, but it does not provide a diagnosis by itself.

The location, severity, duration, and accompanying symptoms can help a healthcare professional determine what may be causing the discomfort.

For example:

• A painful lump around the anus may be associated with an external hemorrhoid, particularly if a blood clot has formed.
• Bright red rectal bleeding without significant pain is commonly associated with internal hemorrhoids.
• Pain and bleeding during bowel movements may also occur with an anal fissure.
• Severe pain associated with a prolapsed hemorrhoid can indicate a complication requiring medical evaluation.
• Severe anal pain with rectal bleeding, particularly when accompanied by abdominal pain, diarrhea, or fever, warrants prompt medical attention.

Understanding these differences can help people recognize when symptoms may require professional evaluation.

Pain Awareness Month: Know What Your Symptoms May Mean

Pain Awareness Month is an opportunity to pay attention to persistent or recurring pain rather than assuming that every symptom has the same cause.

For people experiencing hemorrhoid symptoms, understanding the difference between pain, bleeding, itching, swelling, prolapse, and tenderness can provide important context when discussing symptoms with a healthcare professional.

Hemorrhoids are common and treatable, but the appropriate treatment depends on the type of hemorrhoid, the severity of the condition, the symptoms involved, and the individual’s overall health.

If hemorrhoid symptoms are persistent, recurrent, or affecting daily activities, a medical evaluation can help identify the cause and determine whether conservative care, an office-based procedure, surgery, HAE, or another treatment approach is appropriate.

Understanding Your Treatment Options

USA Hemorrhoid Centers provides evaluations for patients experiencing symptomatic hemorrhoidal disease and can determine whether Hemorrhoid Artery Embolization or another treatment approach may be appropriate.

During Pain Awareness Month, understanding what hemorrhoid pain may mean is an important first step toward identifying the cause and finding an appropriate treatment plan.

Medical disclaimer: USA Hemorrhoid Centers content provides medical education only. It is not a diagnosis or treatment recommendation. Consult a hemorrhoid specialist for evaluation.