Bleeding during bowel movements, itching, and rectal pain are the most common hemorrhoid symptoms.

External hemorrhoids

Rectal pain occurs mainly with external hemorrhoids. Blood may pool under the skin, forming a hard, painful lump. This is called a thrombosed, or clotted, hemorrhoid. You might also notice streaks of blood on the toilet paper after straining to pass a stool.

Internal hemorrhoids

The most common symptom of internal hemorrhoids is rectal bleeding. You may find bright red streaks of blood on the toilet paper or bright red blood in the toilet bowl after having a normal bowel movement. Blood also may be visible on the surface of the stool.

Other symptoms of internal hemorrhoids may include:

• Itching. This is a frequent complaint, because internal hemorrhoids often seep mucus, which can irritate the anal skin and cause itching.
• Skin irritation. Large hemorrhoids that bulge from the anus may secrete mucus, causing mild irritation.
• Discomfort. You may still feel the urge to pass stool right after having a bowel movement. This uncomfortable feeling is caused by the bulging of the hemorrhoid in the end portion of the large intestine (anal canal). In general, the larger the hemorrhoid, the greater the discomfort.
• Pain. Most internal hemorrhoids are not painful. But large hemorrhoids that bulge from the anus may become painful if they swell and are squeezed by the muscles that control the anus. Severe pain may be a sign that the blood supply to the hemorrhoid is being cut off (strangulated hemorrhoid). Emergency treatment is needed.

Rectal bleeding and pain and recent changes in bowel habits are also symptoms of colon, rectal, or anal cancer. People who have these symptoms, especially those age 50 or older or those with a family history of colon cancer, should talk to their health professional.

Other conditions with symptoms similar to hemorrhoids include anal fissures, anal fistulas, colon polyps, rectal prolapse, and inflammatory bowel disease (IBD).

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