Hemorrhoids in Black Adults: When Rectal Bleeding Needs a Doctor

Hemorrhoids are swollen veins around the anus or in the lower rectum, and they are extremely common. About 1 in 20 Americans have symptomatic hemorrhoids, and roughly half of adults over 50 have them, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Most cases settle with fiber, fluids, and time. The catch is bleeding. Bright red blood after a bowel movement is the classic hemorrhoid sign, and it is also a sign that can come from colon or rectal cancer. For Black adults, who carry the highest colorectal cancer burden of any major group in the United States, that distinction is the whole point.

The two types sit in different places and cause different symptoms. Internal hemorrhoids form inside the lining of the lower rectum, above the point where you feel pain. Per NIDDK, their main sign is bleeding: bright red blood on the stool, on the toilet paper, or in the bowl after a bowel movement. They usually do not hurt unless they prolapse, meaning they slip down through the anal opening, which can cause pain and a feeling of fullness. External hemorrhoids form under the skin around the anus. They cause anal itching, one or more hard tender lumps you can feel, and an ache or pain that is worse when sitting. A clot inside an external hemorrhoid, called a thrombosed hemorrhoid, can produce sudden, sharp pain and a firm bluish bump.

Hemorrhoids come from pressure on the veins of the anus and rectum. NIDDK lists the usual drivers: straining during bowel movements, sitting on the toilet for long stretches, chronic constipation or diarrhea, a low-fiber diet, age-related weakening of the supporting tissue, pregnancy, and regularly lifting heavy objects. A low-fiber diet sits at the center of most of these, because hard stool means more straining, and more straining means more pressure on the veins.

Most hemorrhoids improve with self-care, and the first move is fixing the stool. NIDDK recommends a high-fiber diet, a fiber supplement or stool softener if needed, plenty of water, and not straining or sitting on the toilet longer than necessary. For comfort, a sitz bath, soaking the area in warm water several times a day, eases pain, and over-the-counter pain relievers help. Over-the-counter creams and suppositories can calm external symptoms, but NIDDK advises using them for no more than a week unless a doctor says otherwise. Most flares ease within several days.

When internal hemorrhoids keep bleeding or prolapsing, a doctor can treat them in the office without surgery. Rubber band ligation places a small band around the base of the hemorrhoid to cut off its blood supply so it shrinks and falls off. Sclerotherapy injects a solution that scars the hemorrhoid closed. Infrared photocoagulation and electrocoagulation use heat or current to do the same. These are quick and done while you are awake. For large or stubborn hemorrhoids, surgery to remove them (hemorrhoidectomy) or a stapling procedure is done under anesthesia. None of these are emergencies, and most people never need them.

This is the part that matters most. NIDDK states plainly that bleeding from the rectum can be a sign of bowel diseases including Crohn's disease, ulcerative colitis, and cancer of the colon or rectum. Hemorrhoids and colorectal cancer can produce the same bright red blood. You cannot tell them apart by looking. That is why a doctor evaluating bleeding does not stop at confirming hemorrhoids: a digital rectal exam, an anoscopy to see the lining, and, when warranted, a colonoscopy or sigmoidoscopy are used to check for other causes higher up. Finding hemorrhoids does not rule out a second problem sitting above them.

Black Americans carry the heaviest colorectal cancer burden of any major racial group in the country. The American Cancer Society reports that Black Americans are about 20 percent more likely to be diagnosed with colorectal cancer and about 40 percent more likely to die from it than most other groups. In the society's Colorectal Cancer Statistics 2023 report, incidence among Black Americans was 41.7 per 100,000 versus 35.7 in White Americans, and mortality was 17.6 versus 13.1. Much of the gap traces to lower screening rates and access barriers rather than biology, which means earlier evaluation is a lever Black patients and their clinicians can actually pull.

The risk is also moving younger. Colorectal cancer is rising in adults under 50, and rectal bleeding is one of the strongest early warning signs. A 2025 analysis presented by the American College of Surgeons found that rectal bleeding in adults under 50 was associated with 8.5 times higher odds of an early-onset colorectal cancer diagnosis, and that 39 percent of early-onset cases presented with rectal bleeding. Because most people that age are below the screening start, the bleeding itself is often the only flag, and it is easy to wave off as hemorrhoids. That is exactly the trap to avoid.

For symptoms that point clearly to hemorrhoids and stay mild, a primary care clinician can examine you, confirm the cause, and start treatment. For bleeding, a change in bowel habits, a family history of colorectal cancer, or anything that does not add up, a primary care clinician or gastroenterologist should decide whether you need a colonoscopy. If you are 45 or older and not yet screened, that visit is also the moment to schedule it. You can find a Black primary care clinician or gastroenterologist in our directory who will take your bleeding seriously the first time you describe it. If you want the screening picture in full, our guide to colon cancer screening for Black adults covers when to start and which tests count.