How to Identify the Causes of Hemorrhoids?

Types of hemorrhoids

Did you know hemorrhoids are the most widespread anorectal disease in the U.S population? It affects all age groups and genders. Have you been experiencing itching or pain around the anal region? Are you worried you might be suffering from hemorrhoidal disease? Don't worry, we'll help you understand the causes of hemorrhoids.

Read on to learn more about the different types of hemorrhoids.

Note: Although this article can help you identify the causes of hemorrhoids, consulting a medical healthcare professional is still your best bet for an accurate diagnosis. Doctors can also help tailor a suitable treatment plan according to the symptoms exhibited by a patient.


Hemorrhoids are clusters of connective tissue, hemorrhoidal veins, and smooth muscle that form the anal cushion protecting the anal sphincter; the sphincter is a ring of muscle around the anus that helps you control bowel movements.

Inflammation and swelling of hemorrhoidal veins give rise to hemorrhoidal disease. Commonly known as Piles, it is a prevalent anorectal disease that usually does not require treatment. Hemorrhoids do not always cause any symptoms and resolve on their own.

In some cases, they cause severe pain and discomfort. They are caused by trauma to hemorrhoidal structures. We will get into the details of the causes of hemorrhoids later in this article.

It is easy to accurately diagnose hemorrhoids through an anorectal exam like an Anoscopy. There are three types of hemorrhoids based on their location in the anal region. Let’s learn more about them.

Internal Hemorrhoids

Internal hemorrhoids arise from the swelling of hemorrhoidal structures inside the rectum. Hemorrhoids of this class occur in the back of the anal cavity and generally do not exhibit any symptoms. They are rarely painful and may only be indicated by the presence of blood during bowel movements. Bleeding occurs when the hemorrhoids inside the rectum rupture.

Based on severity, internal hemorrhoids are classified into 4 grades. Besides blood, prolapse is a vital symptom of internal hemorrhoids.

  • Grades I and II of internal hemorrhoids exhibit minimal symptoms and can be treated at home with painkillers. 
  • Grade II prolapse can go back inside on its own upon reduction in swelling.
  • Grades III and IV cause severe pain. These hemorrhoids tend to protrude outside the anus and require immediate medical attention. Prolapsed Class IV hemorrhoids cannot be pushed back inside the anus and require surgical removal.

External Hemorrhoids

Receptors underneath our skin help our body identify stimuli. The skin on the external anal region has numerous pain receptors that make swelling feel severely painful. Swollen hemorrhoids occurring on the outer anal area are classified as external hemorrhoids. They can immediately be identified from the pain and discomfort they cause to a person.

External hemorrhoids can also cause tears in the skin and tend to develop pockets of pus. Torn skin is visible to a colorectal doctor in the form of skin tags. Skin tags develop when an external hemorrhoid reduces in size, but the skin remains stretched.

Thrombosed Hemorrhoids

Sometimes, the hemorrhoidal veins develop blood clots and cause thrombosed hemorrhoids. Blood clots elevate the pressure in swollen hemorrhoids, which causes constant and severe pain. The clots can also tear the overlying skin and cause blood to leak out of the hemorrhoids.

Thrombosed hemorrhoids form from chronic internal and external hemorrhoids. The clots are benign, so there's no need to worry, but surgery is often recommended to manage pain and complications. Perianal abscesses are a common complication of thrombosed external hemorrhoids.

Symptoms of Hemorrhoids

Hemorrhoids generally do not cause any symptoms. When symptoms do occur, they can include itching and irritation of the anal region. Rectal bleeding is an important indicator of hemorrhoids. It should be noted that rectal bleeding is also an important sign of colorectal cancer. Immediately consult your doctor if you experience rectal bleeding.

In the case of hemorrhoidal disease, the blood is bright red and visible in the stool. Bleeding can happen without any bowel movements as well. As discussed before, prolapse is a unique symptom of hemorrhoids. It can also indicate that internal hemorrhoids have been thrombosed.

Other common symptoms include painful bowel movements and the inability to pass stool. Visual symptoms include the presence of swollen rubber-like lumps that are either red or dark blue in color. Thrombosed external hemorrhoids can also cause skin tags to develop, among other complications. These are visible as tears in the swollen skin of hemorrhoids. Doctors have also noted the presence of pus-filled perianal abscesses and fistulas in extreme cases of hemorrhoids.

Causes of Hemorrhoids

Different types of hemorrhoids can have different triggers, but they are primarily caused by trauma or pressure on the rectal cavity. Increased abdominal pressure can cause hemorrhoids to become inflamed. Hemorrhoids develop from a combination of these factors and the progressive weakening of the walls of the anus. Our muscles start losing their elasticity as we age; old age increases the risk of developing hemorrhoidal disease.

You could be engaged in several activities and lifestyle habits that contribute to the risks of developing hemorrhoids.

The following factors increase abdominal pressure:

  • Sitting on the toilet for long periods which puts pressure on the anus
  • Forced and strenuous bowel movements that damage the walls of the rectal cavity
  • Anal intercourse
  • History of previous hemorrhoidal disease, chronic constipation, and diarrhea.
  • A low-fiber diet as it can make stool hard and dry.
  • Severe dehydration
  • Heavyweight lifting and physical strain on the abdomen
  • Pregnancy and childbirth

Some of the rare causes also include obesity, irregular bowel movements, and liver cirrhosis due to alcoholism.

We hope this article helped you learn more about hemorrhoids. Experiencing any of the aforementioned symptoms? Make sure to consult a doctor!