Why Do Hemorrhoids Itch? Causes and Treatment Options

Hemorrhoids are a common and often uncomfortable condition that can cause a range of symptoms, one of the most bothersome being itching. If you've ever wondered why hemorrhoids itch, especially at night or during healing, you're not alone. In this article, we’ll break down the causes of hemorrhoid-related itching and explore ways to find lasting relief.

What Are Hemorrhoids?

Hemorrhoids or piles are swollen veins in the lower rectum and anus (similar to varicose veins in the legs). They can be triggered by straining during bowel movements, prolonged sitting on the toilet, eating a low-fiber diet, and regularly lifting heavy items. 

Common hemorrhoid symptoms include pain, swelling, bleeding, irritation, and itching around the anus. Of these, itching is one of the most frequent and often most uncomfortable complaints.

Do Hemorrhoids Itch?

Yes, itching is a common symptom of hemorrhoids.

Hemorrhoids are of two main types: 

1. Internal hemorrhoids that develop inside the rectum. 

2. External hemorrhoids that develop around the anus. 

External hemorrhoids commonly cause anal itching. Internal hemorrhoids typically cause painless bleeding during bowel movements, but can cause itching if an internal hemorrhoid prolapses (protrudes through the anal opening).

Other Hemorrhoid Symptoms

Hemorrhoid symptoms can vary depending on the type and can include the following:

• Internal hemorrhoids:

  • Bright red blood in the toilet bowl after bowel movements

  • Pain and swelling (prolapsed internal hemorrhoids)

  • Possible itching if prolapsed

• External hemorrhoids:

  • Discomfort or pain

  • Swelling or a visible lump

  • Bleeding

  • Irritation

  • Anal itching

• Thrombosed hemorrhoids (external hemorrhoids with blood clots):

  • A hard lump near the anus

  • Severe pain

  • Swelling 

  • Inflammation

Why Do Hemorrhoids Itch?

Pressure On The Anal Tissues and Skin

Swollen blood vessels in hemorrhoid tissue put pressure on the tissues and skin around the anus, which causes itching.

Poor Anal Hygiene

Pain from external hemorrhoids may cause some people to avoid wiping thoroughly, leading to residual stool in the anal area, causing skin irritation and persistent itching.

Buildup of Mucus 

A prolapsed internal hemorrhoid can lead to mucus leakage and excess moisture in the anal region, which can cause skin irritation and itching.

Excessive Wiping

While proper hygiene is important, excessive wiping can lead to a disruption of the skin barrier. This can make the skin around the anus dry and sensitive. Dry skin can be itchy.

Why Do Hemorrhoids Itch More At Night?

• Fewer distractions: One of the main reasons that hemorrhoids itch more at night is that there are fewer distractions, and you become more aware of the uncomfortable symptoms.

• Increased blood flow: Lying down at night can increase blood flow to the rectal area, causing the veins to swell further, which can increase discomfort and itching.

• Nighttime sweating: If your bedroom is too warm, excessive sweating at night can make hemorrhoid itching worse.

Do Hemorrhoids Itch When They Are Healing?

Yes, itching can be a sign of healing hemorrhoids. 

Similar to how cuts can itch when they heal, hemorrhoid itching might be due to the regeneration of anal tissues. However, anal itching associated with hemorrhoids is mainly due to skin irritation and inflammation and should subside with time as the hemorrhoids heal. 

It’s crucial to resist the urge to scratch the skin around the anus. Scratching can worsen the irritation and even lead to a bacterial infection. Instead, consider using topical medications (anti-itch creams) to relieve itching and prevent scratching.

How To Relieve Hemorrhoid Itching

OTC Treatments

Over-the-counter (OTC) topical treatments for hemorrhoids can significantly reduce symptoms. These include hemorrhoid creams, ointments, and suppositories that contain anti-inflammatory medicines such as hydrocortisone. 

They can provide immediate relief from itching and other hemorrhoidal symptoms. However, it's important to consult your doctor if you plan to use OTC hydrocortisone creams for more than a week.

Hemorrhoid pads are also available. They contain witch hazel and numbing medicine (lidocaine) to relieve the itching and burning caused by hemorrhoids. However, while these products can relieve hemorrhoids, they do not treat them.

Warm Sitz Baths

Soaking the anal region in a shallow, warm water bath (Sitz bath) can help to soothe irritated and inflamed tissues. 

Doing this for 10-15 minutes three times a day can help to relieve pain and inflammation and promote healing. A Sitz bath before bedtime can alleviate symptoms and help you sleep better.

Cold Compresses

A cold compress or ice pack can also provide hemorrhoid relief. The cold temperature can help to reduce swelling, discomfort, and itching by constricting blood vessels and reducing blood supply to the area. 

Anal Hygiene

Gently clean the anal area and keep it dry. Avoid excessive wiping. Also, avoid using scented soaps or rough toilet paper, which can cause further irritation of sensitive skin. 

Comfortable Clothing

Wear cotton underwear and loose-fitting clothing to help keep the anal area dry.

How Do Doctors Treat Hemorrhoids?

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), treatment options for hemorrhoids include:

• Lifestyle changes such as:

  • Eating a high-fiber diet.

  • Taking fiber supplements.

• Topical treatments such as creams, ointments, and suppositories (see above).

• Minimally invasive procedures such as:

  • External hemorrhoid thrombectomy.

  • Rubber band ligation.

  • Sclerotherapy.

  • Infrared coagulation.

• Surgical procedures such as:

  • Hemorrhoidectomy.

  • Hemorrhoid stapling.

The choice of hemorrhoid treatment depends on the grade, type, and presentation of the hemorrhoids. 

Treatments vary with the kind of hemorrhoid. Some cases can be managed conservatively with lifestyle changes and topical therapy. 

Others, especially more severe or complicated cases, may require minimally invasive or surgical procedures.

When To See A Doctor

Severe or Persistent Symptoms

If you have severe or persistent itching and other hemorrhoid symptoms that don’t improve after a week of OTC hemorrhoid treatment, it's crucial to make an appointment to see your doctor. Taking this step can lead to a proper diagnosis and appropriate treatment. 

Seek emergency medical attention if you have severe rectal bleeding, dizziness, lightheadedness, or fainting. 

These symptoms may result from a thrombosed hemorrhoid, a condition in which a blood clot forms inside an external hemorrhoid. This can lead to intense pain and swelling and may require urgent surgical treatment to relieve pressure and remove the clot.

Rule Out Other Conditions

Your anal itching may be due to other causes, such as yeast infections, bacterial infections, or some other skin condition that causes pruritus ani (intense itching in the anal region). Your healthcare provider can make a proper diagnosis and recommend appropriate treatment.

Seek medical care if you have anal itching accompanied by bleeding during bowel movements, especially if there are changes in the color or consistency of your stool or changes in your bowel habits. These could be signs of more serious conditions, such as anal fissures or colorectal/anal cancer.

Frequently Asked Questions

How Do I Know If It Is a Hemorrhoid or Something Else?

Many conditions can cause symptoms similar to hemorrhoids. Only a doctor can rule out other causes for your symptoms.

How Do I Know If I Have Pinworms or Hemorrhoids?

Pinworms are intestinal parasites that lay eggs around the anus at night, causing nighttime itching in the skin around the anus. Hemorrhoids are swollen veins that can also cause itching in the anal region, which can be worse at night. 

You cannot tell the difference between pinworms and hemorrhoids based on symptoms alone. Your doctor can make a proper diagnosis.

How Long Until Hemorrhoid Itching Goes Away?

In most cases, hemorrhoids improve in a few days with self-care and home remedies. However, sometimes hemorrhoid symptoms, including itching, can last for two to three weeks. Consult a doctor if your symptoms do not improve after a week of home treatments.

Do Hemorrhoids Ever Go Away?

Yes, small hemorrhoids may go away with lifestyle changes (high-fiber diet, better toilet habits) and home remedies (hemorrhoid creams, stool softeners). However, larger or persistent hemorrhoids may require medical procedures, such as rubber band ligation, sclerotherapy, or surgical removal by a colorectal specialist.