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Hemorrhoids
Hemorrhoids are swollen, dilated veins in the anus and rectum. They are very common and usually cause bleeding when passing stool, itching, discomfort or a feeling of a lump. In many cases, when they are detected early, they can be treated on an outpatient basis and without surgery, for example with sclerotherapy, which consists of injecting a medication that shrinks the hemorrhoidal tissue. The right technique depends on the grade and on the medical assessment.
In summary
- They are dilated veins of the anus and rectum; the most common symptom is bleeding when passing stool.
- They are classified from grade I to IV; the earlier they are treated, the more options exist without surgery.
- Sclerotherapy is mainly used for grades I and II, on an outpatient basis.
- Any rectal bleeding should be assessed by a doctor before attributing it to hemorrhoids.
What are hemorrhoids?
They are cushions of tissue with blood vessels that everyone has in the anal canal and that help maintain continence. They become a problem when they swell, bleed or move outward (prolapse). This is called hemorrhoidal disease.
They can be internal, inside the rectum, or external, under the skin around the anus.
Symptoms
- Bright red blood when passing stool, on the paper or in the toilet.
- Itching, burning or discomfort in the area.
- A feeling of a lump or of incomplete emptying.
- Tissue coming out of the anus when passing stool, which may go back in on its own or need help.
- Pain, especially if there is a clot in an external hemorrhoid.
Bleeding should never be considered normal or attributed to hemorrhoids without a medical assessment, because other diseases of the colon and rectum can cause similar symptoms.
Causes and risk factors
- Constipation and straining during bowel movements.
- A low-fiber diet and little water intake.
- Spending long periods sitting, including on the toilet.
- Pregnancy and childbirth.
- Excess weight and frequent heavy lifting.
- Weakness of the supporting tissue, which is partly hereditary.
Grades
- Grade I: they bleed, but do not come out of the anus.
- Grade II: they come out when passing stool and go back in on their own.
- Grade III: they come out and have to be pushed back in.
- Grade IV: they stay outside and cannot be pushed back in.
How they are diagnosed
The doctor reviews your symptoms and history and examines the area. Depending on the case, additional tests may be requested to rule out other causes of bleeding. When assessing bleeding, age and family history are important.
Treatment options
Treatment is chosen according to the grade, the symptoms and each person's situation.
General measures
More fiber and water, no straining, not spending long periods in the bathroom and moving regularly. In the early grades, and as support in all of them, these help control symptoms.
Sclerotherapy
A sclerosing medication is injected into the hemorrhoidal tissue. It causes a reaction that shrinks it and reduces bleeding and prolapse. It is an outpatient procedure that lasts a few minutes and is usually used for grade I and II hemorrhoids; in some grade III cases it may be considered. It preserves the tissue needed for continence.
Other techniques and surgery
Advanced hemorrhoids, those with thrombosis or those that do not respond may require other procedures, such as rubber band ligation or surgery. The doctor explains the most suitable option in each case.
What to expect from sclerotherapy
- It is done in the office, with no hospital stay.
- Most people return to their activities the same day, following the doctor's instructions.
- More than one session may be needed; the doctor defines the number according to the response.
- There may be mild discomfort or a small amount of blood in the following days.
- Serious risks are uncommon. The doctor explains them before the procedure.
- Hemorrhoids can come back if the habits that cause them continue, so self-care is part of the treatment.
Care at home
- Eat fiber (fruit, vegetables, whole grains) and drink enough water.
- Do not strain or spend long periods sitting on the toilet.
- Clean gently with water; avoid rough paper and irritating products.
- Exercise regularly, such as walking.
- Do not self-medicate with creams or suppositories for a long time without medical advice.
When to seek urgent care
- Heavy bleeding or bleeding that does not stop, or dizziness and weakness.
- Sudden severe pain, or a very painful lump in the anus.
- Fever, chills, or redness and warmth in the area.
- Inability to pass stool or urine.
- Changes in bowel habits, weight loss or blood mixed with the stool, especially after age 45 or with a family history of colon cancer: ask for an assessment soon.
Frequently asked questions
Is bleeding when passing stool always hemorrhoids?
No. It is the most common symptom of hemorrhoids, but it can also be caused by other diseases. That is why a medical assessment is advisable, rather than assuming it is hemorrhoids on your own.
Does sclerotherapy hurt?
It is a brief procedure that is generally well tolerated. It can cause mild discomfort during or after the injection. The doctor explains what to expect.
How many sessions are needed?
It depends on the grade and on each person's response. Some need a single session and others more than one. The doctor decides.
Do I need surgery?
Not always. Early-grade hemorrhoids are usually treated without surgery. More advanced ones may require it. The assessment defines the best option.
Can they come back?
Yes, if constipation, straining and the other factors that cause them continue. Keeping up self-care helps prevent it.
Would you like an assessment? Message us on WhatsApp.
Book via WhatsAppThe information on this page is general and for guidance only. It does not replace a medical consultation. If you have a warning sign, go to the emergency department. The pages are written for patients in Colombia; consultations are in Spanish.
Last updated: October 15, 2026