Hemorrhoids (piles) are swollen veins in the anus and lower rectum. Signs and symptoms of hemorrhoids include small amounts of bright red blood on the toilet paper after having a bowel movement; itching, irritation, pain or discomfort of the anus; swollen skin protruding from the anus; swelling around the anus; a sensitive or painful lump near the anus; or leakage of feces.

They are a normal part of the anatomy and are located at the junction where small arteries merge into veins. They are cushioned by smooth muscles and connective tissue and are classified by where they are located in relationship to the pectinate line, the dividing point between the upper 2/3 and lower 1/3 of the anus. This is an important anatomic distinction because of the type of cells that line the hemorrhoid, and the nerves that provide sensation.

Internal hemorrhoids are located above the pectinate line and are covered with cells that are the same as those that line the rest of the intestines. External hemorrhoids arise below the line and are covered with cells that resemble skin.


Experts are not sure what causes hemorrhoids to develop. Several factors could be to blame, including:

  • straining during a bowel movement
  • complications from chronic constipation
  • sitting on the toilet for a long time
  • pregnancy (when the uterus enlarges it presses on the vein in the colon causing it to bulge)
  • Aging can also stretch and weaken the veins at the rectum


If the blood supply to an internal hemorrhoid is cut off, the hemorrhoid can become “strangulated,” causing extreme pain and tissue death, which can lead to gangrene.

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