Hemorrhoids often sneak up on their victims unannounced with very little in the way of warning. Because hemorrhoid tissue already exists in the anal canal, inflammation is all it takes for the lumps to enlarge and, if further irritated, to bleed. Hemorrhoids may or may not cause pain, depending entirely upon where they appear and whether they occur under skin with nerves that sense pain or only pressure.

Hemorrhoids inside the anal canal usually do not hurt, but those just outside generally do. Bleeding may occur when a bowel movement passes through the anal canal and ruptures the hemorrhoid in the process. This means bleeding and, possibly, pain. Some hemorrhoids protrude from the anus even if they are inside the anal canal. Most can be pushed back in with a finger, but they will most likely reappear with the next bowel movement.

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