Hemorrhoids are generally not a serious condition. In many cases, they cause no symptoms at all. The appearance of streaks of bright red blood on the toilet paper or stool after a bowel movement is the most common sign of internal hemorrhoids. In some cases, blood may drip from the rectum into the toilet water. This bleeding occurs when swollen veins are broken by straining, rubbing or scratching and is usually painless. There is typically only a small amount of bleeding. Severe blood loss due to bleeding hemorrhoids is very rare, but may cause anemia.

Internal hemorrhoids are not usually painful. This is because the membranes in the rectal area do not possess pain-sensitive nerves. However, internal hemorrhoids that droop down and protrude out of the anus may become painful if they are rubbed raw. Internal protruding hemorrhoids that are strangled by a reduced blood supply, which occurs only in severe cases, may lead to extreme pain. Hemorrhoids that contain a blood clot (thrombus) may also be painful. The pain associated with hemorrhoids may range from slightly tender to severe and burning.

In some cases, hemorrhoids are associated with rectal discharge of mucus. This may result in a feeling that there is still stool in the rectum after a bowel movement. Hemorrhoids may also cause a similar feeling of fullness without a mucus discharge. They can also become inflamed.

Skin tags may develop in patients with external hemorrhoids. These small outgrowths of residual or excess skin around the anus tend to occur after a hemorrhoid with a blood clot has healed. Although they cause no problems directly, they may be difficult to keep clean.

Anal itch (pruritus ani) is often associated with hemorrhoids. However, it is not actually a symptom of the hemorrhoids themselves. Instead, it develops due to poor anal hygiene or habits which often accompany hemorrhoids. Draining mucus that is not properly cleaned off the skin around the anus and particles of stool caught around the anus and hemorrhoids may irritate the skin and cause this itch. However, too much rubbing or aggressive cleaning of the area may also result in anal itch.

Individuals who notice bleeding from their rectum, blood in their stool or blood in the toilet after a bowel movement should consult a physician. Although blood is a common sign of hemorrhoids, it also can indicate other digestive diseases, including colorectal and anal cancers. Physicians can identify the cause of the patient’s bleeding and recommend treatment methods. Patients should also contact a physician if over-the-counter hemorrhoid medications and self-care measures fail to relieve symptoms.