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What Causes Hemorrhoids?

Simon Spichak, M.Sc

Written by: Simon Spichak, M.Sc

Updated: February 2nd, 2023

Hemorrhoids can be a painful and embarrassing condition that affect about two in every five people[1]. While more than half of people who get hemorrhoids don’t report any symptoms, for others it causes severe itching and discomfort.  

Hemorrhoids form when constipation and excessive straining lead to stretching and swelling of the cluster of veins in the rectum and anus [2]. While the exact cause of hemorrhoids is unknown, there are several modifiable lifestyle factors that can help you stay healthy. Fortunately, most hemorrhoids are painless and likely to resolve on their own. 

What causes hemorrhoids? 

There are plenty of factors that make it more likely for hemorrhoids to occur. Some are related to nutrition and the gastrointestinal tract while other factors are closely linked to metabolism and other physiological conditions. These risk factors include[3]

When should I see a doctor? 

If you regularly notice blood in your stool, prolapse, itching, or pain, it might be time to check in with your doctor. The doctor may perform a physical examination of the anus and rectum to look for signs of hemorrhoids or prolapse[3].  In addition to suggesting lifestyle changes and treatments, this initial appointment can rule out more severe conditions like colorectal cancer[3]

What’s the difference between internal and external hemorrhoids?  

There are two types of hemorrhoids, categorized by their location. Internal hemorrhoids occur in the lower rectum, the terminal section of the large intestine and are usually painless. 

External hemorrhoids form under the skin around the anus, causing irritation and damage to the skin. If a blood clot begins forming inside this type of hemorrhoid, it can cause significant pain. Fortunately, the clot typically dissolves and leaves behind a flap of excess skin.   

Common symptoms of hemorrhoids:

When this condition is symptomatic, it may cause[7]

Classifying internal hemorrhoids 

Internal hemorrhoids are further graded based on their appearance and the degree of prolapse[2]. Prolapse is a medical term to describe when internal organs like the blood vessels beneath the anus, push out of their usual position. These grades, known as Goligher’s classification help determine the severity of the hemorrhoid. 

hemorrhoid grades

Treating hemorrhoids 

The initial treatment of hemorrhoids involves lifestyle changes including:  

There are also many over-the-counter remedies that provide temporary relief. These preparations often include two or more of the following[2],[3],[8]

Flavonoids (diosmin for example Hemovel®): These bioactive compounds are used to reduce the pain, swelling and bleeding that come with hemorrhoids.  

These products may not be right for you. Always read and follow the label. 


Hemorrhoids are an extremely common condition characterized by the stretching or swelling of blood vessels in the anus or rectum. While this condition is often asymptomatic, it sometimes causes pain, irritation, and bleeding in the stool. 

A doctor can help rule out more serious conditions and help provide you with a strategy to manage hemorrhoids: eating more fibre, drinking more water, warm baths, and stool softeners. In addition, over-the-counter treatments can provide you with the relief you need. 

Hemovel® is a registered trademark owned by Norwell Consumer Healthcare Inc.  


  1. Riss S, Weiser FA, Schwameis K, et al. The prevalence of hemorrhoids in adults. International Journal of Colorectal Disease. 2011;27(2):215-220. doi:10.1007/s00384-011-1316-3  
  1. Lohsiriwat V. Hemorrhoids: From basic pathophysiology to clinical management. World Journal of Gastroenterology. 2012;18(17):2009. doi:10.3748/wjg.v18.i17.2009  
  1. Mott, T., Latimer, K., & Edwards, C. (2018). Hemorrhoids: diagnosis and treatment options. American family physician, 97(3), 172-179. 
  1. Jacobs D. Hemorrhoids. New England Journal of Medicine. 2014;371(10):944-951. doi:10.1056/nejmcp1204188 5.  
  1. Priyadarshini, Medha, et al. “Role of short chain fatty acid receptors in intestinal physiology and pathophysiology.” Comprehensive Physiology 8.3 (2018): 1091. 
  1. Staroselsky, A., Nava-Ocampo, A. A., Vohra, S., & Koren, G. (2008). Hemorrhoids in pregnancy. Canadian Family Physician, 54(2), 189-190. 
  1. American Gastroenterological Association Medical Position statement: Diagnosis and treatment of hemorrhoids . Gastroenterology. 2004;126(5):1461-1462. doi:10.1053/j.gastro.2004.03.001  
  1. Hemorrhoid cream overview, uses and alternatives – goodrx. Accessed June 21, 2022. 

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