Early signs of haemorrhoids you should not ignore

2026-10-04

• The most common signs of haemorrhoids are bright red blood after a bowel movement, itching, discomfort and soft lumps near the anus.
• Similar symptoms occur with fissures, polyps and other bowel conditions, so you need an examination by a specialist.
• In the early stages, fibre, water, movement and not straining or sitting on the toilet for long all help.
• Heavy bleeding, black stools, fever or severe pain mean you need urgent help.
• An examination by a proctologist takes a few minutes, and there is nothing to be embarrassed about.

A drop of bright red blood on the toilet paper, an unusual itch, or a feeling that 'something is there' after a long drive. Many people notice signals like these, feel embarrassed and decide to wait: it will pass, and it is awkward to talk about, even with family.

Yet a proctologist hears these complaints every day, and for them it is an ordinary medical question, just like a sore throat is for a GP. The sooner you recognise the signs of haemorrhoids, the easier they are to deal with. Here is what to look out for, which symptoms need urgent help and what you can do yourself.

What are haemorrhoids, in simple terms?

Everyone has haemorrhoidal cushions in the anal canal: soft pads full of blood vessels that help keep the bowel contents in. They are a normal part of the body. We talk about haemorrhoids as a condition when these cushions become enlarged, bleed, slip outside or become inflamed.

Haemorrhoids can be internal, lying higher up inside the anal canal, or external, sitting under the skin around the anus. We have explained the difference in more detail in our article on internal and external haemorrhoids. The symptoms of the two types differ a little, so let's go through them one by one.

What are the most common early signs of haemorrhoids?

In the early stages symptoms are usually mild and come and go, especially after constipation, long periods of sitting or a heavy family meal. Pay attention if you notice:

• Bright red blood after a bowel movement: streaks on the paper, drops in the toilet bowl or streaks on the surface of the stool. It is usually painless and typical of internal haemorrhoids.
• Itching, burning and dampness around the anus, caused by mucus and irritated skin.
• Discomfort and a feeling that you have not fully emptied your bowels, as if something were still there.
• Haemorrhoids slipping out when you strain. At first they go back by themselves; later you may have to push them back with your finger.
• Soft lumps at the edge of the anus that you can feel when washing.

Doctors describe prolapse in grades from I to IV, ranging from haemorrhoids that only bleed to those that stay outside all the time. The grade helps to choose treatment, but only a specialist can determine it during an examination.

How can you tell internal from external haemorrhoids by how they feel?

Internal haemorrhoids usually do not hurt, because the lining in that area has few pain receptors. Their main signs are bleeding and prolapse. External haemorrhoids lie under sensitive skin, so they more often cause itching and discomfort when you sit or walk.

A thrombosed external haemorrhoid is a separate situation. A firm, painful, bluish-purple lump suddenly appears, and sitting becomes difficult. It is not life-threatening but it is very unpleasant, and it is best to see a proctologist in the first few days, when it is easiest to help.

Why shouldn't you diagnose yourself?

Bleeding, itching and discomfort are not unique to haemorrhoids. Similar complaints can be caused by an anal fissure, polyps, inflammatory bowel disease, infections and, less often, tumours of the large bowel. Many of these conditions respond well to treatment in the early stages, but only if they are found in time.

That is why both European and American guidelines on haemorrhoids start with an examination: the doctor needs to make sure the blood really is coming from the haemorrhoids. Older people, and anyone whose usual bowel habit has changed or who has relatives with bowel disease, may also be offered a colonoscopy.

What should you do at the first signs of haemorrhoids?

While you wait for your appointment, or once a doctor has confirmed an early stage, the basis of care is being gentle with your bowels. All the specialist guidelines recommend these steps:

1. Add fibre to your diet: vegetables, fruit, fresh herbs, pulses such as mung beans and chickpeas, and wholegrain bread. Increase it gradually to avoid bloating.
2. Drink enough water throughout the day. Tea at the dastarkhan alone is usually not enough to keep stools soft.
3. Don't strain, and don't linger on the toilet. Leave your phone outside: sitting on the toilet for a long time increases blood flow to the haemorrhoids.
4. After using the toilet, wash with cool or lukewarm water and gently pat the skin dry instead of rubbing it with dry paper.
5. Warm sitz baths for 10–15 minutes soothe itching and discomfort well.
6. Move more: walking helps your bowels work and improves circulation in the pelvis.

What happens at a proctologist's appointment, and is it scary?

This is one of the most common worries, so here is a short description of what to expect. The doctor will ask about your symptoms, diet and bowel habits, then look at the area around the anus and do a digital examination with a gloved finger. Often they also do an anoscopy, looking inside the anal canal through a small tube. All of this takes a few minutes and usually does not cause much pain.

Specialists deal with these questions every day, so there is nothing to feel embarrassed about. If you would like to know in advance what doctors say about the most common fears and myths, read our expert interview on haemorrhoids in plain words.

How can you help yourself during a flare-up?

For acute haemorrhoids, a doctor may recommend topical treatments, pain relief and a venotonic medicine. Phlebodia 600 (diosmin 600 mg) is indicated, among other things, for the symptomatic treatment of acute haemorrhoids. According to the instruction leaflet, in this case 2–3 tablets a day are taken with meals. If symptoms persist after several days of treatment, see a doctor.

The medicine is not used under the age of 18 or while breastfeeding; it is contraindicated in the first trimester of pregnancy, and later in pregnancy it may only be taken on a doctor's recommendation. The full list of contraindications is in the official instruction. Before use, read the instruction leaflet and consult a specialist.

The key points

The signs of haemorrhoids are not a reason for shame but a reason to look after yourself. Soft stools, movement and water make a big difference in the early stages, and an examination by a proctologist removes the main worry: whether it really is haemorrhoids and not something else. You will find more useful details in our article on the most important facts about haemorrhoids. Take care of yourself now, and you will most likely prevent a bigger problem.

Sources: 1. van Tol RR, Kleijnen J, Watson AJM, et al. European Society of ColoProctology: guideline for haemorrhoidal disease. Colorectal Dis. 2020;22(6):650–662. 2. Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum. 2018;61(3):284–292. 3. Instructions for medical use of Phlebodia 600 (Republic of Uzbekistan).

• Internal and external haemorrhoids
• The most important facts about haemorrhoids
• Pain relief in the treatment of haemorrhoids