hemorrhoids at night

Overview

Hemorrhoids, also called piles, are swollen veins in the lower rectum or around the anus. They can cause itching, pain, and bleeding, especially during bowel movements or when lying down at night.

Yes, hemorrhoids affect up to 1 in 3 adults. Many people experience them at some point, especially as they get older.

Anyone can develop hemorrhoids, but they are more common in people who are pregnant, overweight, or have a job that involves sitting for long periods. Constipation and straining on the toilet also increase risk.

Symptoms

Common symptoms

• Itching or irritation around the anus, which can feel worse at night when you are resting.
• Pain or discomfort, especially when sitting or during a bowel movement.
• Bright red blood on toilet paper or in the toilet bowl after a bowel movement.
• A lump or swelling near the anus – this may be a prolapsed hemorrhoid.

Symptoms in children

• Hemorrhoids are rare in children, but symptoms can include pain or bleeding during bowel movements.
• If a child has these symptoms, it is often due to constipation or straining, not hemorrhoids. Always check with a doctor.

Symptoms in older adults

• Older adults may have hemorrhoids that are more stubborn because of weaker tissues and more constipation.
• Bleeding should always be checked, as it can be a sign of other conditions like colorectal issues.

Causes

Main causes

• Increased pressure in the veins around the anus – from straining during bowel movements, chronic constipation, or pregnancy.
• Weakness in the supporting tissues around the anus that happens with age.
• Sitting on the toilet for a long time, or sitting for many hours each day.

Risk factors

• Chronic constipation or diarrhea.
• Pregnancy and childbirth.
• Being overweight or obese.
• A job that involves sitting or standing for long periods without breaks.
• Family history of hemorrhoids.
• Low-fiber diet – not enough fruits, vegetables, and whole grains.

When to see a doctor

See a doctor urgently if:

• If you see blood in your stool or on toilet paper for the first time.
• If you have severe pain or a lump that is very tender.

Book a routine appointment if:

• If symptoms last more than a week despite home care.
• If you have recurrent episodes that affect your quality of life.

Diagnosis

Your doctor will ask about your symptoms and do a physical exam. They may gently examine the anal area with a gloved finger (digital rectal exam) to feel for hemorrhoids or other problems.

Tests that may be done

• Anoscopy: A small, lighted tube is inserted into the anus to look at the lower rectum and see hemorrhoids directly.
• If needed, other tests like a colonoscopy might be done to check for other causes of bleeding, especially if you are over 40 or have risk factors.

What to expect at your appointment

The exam is usually quick and not very painful. Your doctor will explain what they find and discuss treatment options. Some tests, like anoscopy, can be done in the office. Others may require a specialist visit.

Treatment

Treatment focuses on relieving symptoms and preventing more problems. Most people can manage with home care, but doctors may offer additional options for stubborn or severe cases.

Self-care at home

• Soak in a warm bath (sitz bath) for 10–15 minutes a few times a day, especially after bowel movements.
• Apply a cold pack wrapped in cloth to the area for 10 minutes to reduce swelling.
• Use moist toilet wipes or a bidet instead of dry toilet paper.
• Gently clean the area with warm water and pat dry – do not rub.
• Avoid sitting for long periods; stand up and move around every hour.
• Try over-the-counter creams or pads that contain witch hazel or lidocaine – but ask your pharmacist first and do not use for more than a week without talking to a doctor.

Medical treatments

If home care is not enough, a doctor may recommend prescription creams or procedures to shrink hemorrhoids. These can include rubber band ligation (placing a small band around the hemorrhoid to cut off blood flow), sclerotherapy (injecting a solution to shrink it), or infrared coagulation (using heat). These are usually done in a clinic and do not require a hospital stay.

When is surgery considered?

Rarely, for very large or painful hemorrhoids that do not get better with other treatments, surgery (hemorrhoidectomy) may be needed. This is done under anaesthesia and requires recovery time. Your doctor will discuss if this is an option for you.

Living with this condition

Hemorrhoids can be a bother, but with simple changes you can keep symptoms under control. Establishing a gentle bowel routine and avoiding straining can make a big difference.

Lifestyle tips

• Go to the toilet as soon as you feel the urge – do not delay or push.
• Avoid sitting on the toilet for more than 5–10 minutes.
• Use a footstool so your knees are higher than your hips – this changes the angle and makes bowel movements easier.
• Stay active with walking or gentle exercise to keep your bowels regular.

Diet and exercise

Eat plenty of fiber – aim for 25–30 grams a day from fruits, vegetables, whole grains, and legumes. Drink 6–8 glasses of water daily to soften stool. Regular exercise like walking or swimming helps prevent constipation and reduces pressure on the veins.

Mental health and emotional wellbeing

Chronic discomfort or bleeding can make you feel anxious or embarrassed. It may affect sleep if symptoms wake you at night. Remember that hemorrhoids are a very common medical problem, and there is no reason to feel ashamed. Talking to your doctor can help ease worry.

Prevention

You can reduce your risk by keeping stools soft and regular, not straining, and maintaining a healthy weight. A high-fiber diet, plenty of water, and regular exercise are the best prevention.

Screening programmes

There is no specific screening for hemorrhoids. However, if you are 45 or older, you should discuss colorectal cancer screening (like a colonoscopy) with your doctor, even if your symptoms seem like hemorrhoids.

Complications

If left untreated

• Chronic bleeding can lead to anaemia (low red blood cells), causing tiredness and weakness.
• A hemorrhoid can become thrombosed (a blood clot inside) – this is very painful but usually not dangerous and can resolve on its own or with simple treatment.
• Rarely, a large hemorrhoid may become strangulated – cut off from blood supply – causing severe pain and needing urgent care.

Long-term outlook

For the vast majority of people, hemorrhoids are a temporary or manageable condition. With lifestyle changes and simple treatments, most people get relief. Even when symptoms return, they are rarely serious. If you have any concerns, talk to your doctor.

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