From the Guidelines
No, hemorrhoids do not necessarily rupture or bleed. While bleeding is a common symptom of hemorrhoids, many people have hemorrhoids that never bleed or rupture. Hemorrhoids are swollen veins in the lower rectum and anus that can develop internally (inside the rectum) or externally (under the skin around the anus) 1. They often cause discomfort, itching, or pain, but bleeding typically only occurs when the hemorrhoid becomes irritated, usually during bowel movements when hard stool passes and creates friction against the swollen tissue. Internal hemorrhoids are more likely to bleed than external ones, producing bright red blood that may appear on toilet paper, in the toilet bowl, or coating the stool 1.
Some key points to consider:
- Hemorrhoids are found in the subepithelial space of the anal canal and consist of connective tissue cushions surrounding the direct arteriovenous communications between the terminal branches of the superior rectal arteries and the superior, inferior, and middle rectal veins 1.
- Symptoms attributed to hemorrhoids include bleeding, protrusion, itching, and pain, with most hemorrhoidal symptoms arising from enlarged internal hemorrhoids 1.
- The pathogenesis of the enlarged, prolapsing cushions is unknown, but many clinicians believe that inadequate fiber intake, prolonged sitting on the toilet, and chronic straining at stool contribute to the development of symptomatic hemorrhoids 1.
If you have hemorrhoids that aren't bleeding, you can help prevent future bleeding by:
- Maintaining soft stools through adequate fiber intake (25-30g daily)
- Drinking plenty of water
- Avoiding straining during bowel movements
- Not sitting on the toilet for extended periods Over-the-counter treatments like witch hazel pads, hydrocortisone creams, or sitz baths can help manage symptoms and reduce the likelihood of bleeding. According to a recent study, the decision between non-operative management and early surgical excision for thrombosed hemorrhoids should be based on local expertise and patient’s preference 1. However, the majority of hemorrhoids do not require surgical intervention and can be managed conservatively.
From the Research
Hemorrhoid Rupture or Bleeding
- Hemorrhoids do not necessarily rupture or bleed, but they can cause symptoms such as painless rectal bleeding during defecation, especially if they are internal hemorrhoids 2, 3.
- External hemorrhoids can also bleed and cause acute pain if thrombosed 2, 3.
- The severity of symptoms and the presence of bleeding or rupture depend on the grade and location of the hemorrhoids, as well as individual factors such as constipation, increased intra-abdominal pressure, and prolonged straining 2, 4.
- Treatment options for hemorrhoids vary depending on the severity of symptoms and the presence of complications, and may include non-surgical management, office-based procedures such as rubber band ligation, and surgical hemorrhoidectomy 2, 3, 4, 5.
Symptoms and Treatment
- Bright red, painless rectal bleeding during defecation is the most common presentation of internal hemorrhoids 2.
- External hemorrhoids can cause acute pain if thrombosed, and may require excision and evacuation of the clot 2, 4.
- Treatment options for hemorrhoids include increased fiber intake, sitz baths, and drugs, as well as office-based procedures and surgical interventions 2, 3, 4, 5.
- The choice of treatment depends on the severity of symptoms, the presence of complications, and individual patient factors 4, 6.