Hemorrhoids in Children: Symptoms, Causes, and Treatment

Hemorrhoids in children aren't frequent; nevertheless, they're annoying conditions that alter the quality of life. Learn more.
Hemorrhoids in Children: Symptoms, Causes, and Treatment
Maria del Carmen Hernandez

Written and verified by the dermatologist Maria del Carmen Hernandez.

Last update: 28 August, 2023

Although hemorrhoids tend to occur more frequently in adults, it’s a condition that can also occur in children. In addition, the symptoms and signs can significantly alter little ones’ quality of life. Therefore, it must be diagnosed and resolved early. Here’s everything you need to know about it.

What are hemorrhoids?

Hemorrhoids are vascular formations of the submucosa located in the anal canal. They’re also called corpus cavernosum recti, and one of their functions is to assist in defecation and prevent the leakage of stool. The hemorrhoidal vessels dilate and thrombose as a consequence of the distension of the connective tissues and protrude from the anal canal. As a result, they become symptomatic and generate hemorrhoidal disease.

The classification of hemorrhoids in children

There are different types of hemorrhoids characterized by different symptoms and signs:

  1. External hemorrhoids: These are those located in the middle area of the anus and are covered by skin.
  2. Internal hemorrhoids: They are located in the upper region of the anal canal and are covered by epithelium. They’re further subdivided into grade I (mild and with moderate inflammation, without protrusion) to grade IV (with severe inflammation, protruding, and outside the anus), according to a publication in the American Family Physician.

The manifestations of external and internal hemorrhoids in children are similar to those of adults.

A child standing in the bathroom in their underwear, holding their hands over their buttox.
Although hemorrhoids are painful, they’re not life-threatening and often go away on their own without treatment.

What causes hemorrhoids in children?

Hemorrhoids in children occur more frequently from the age of 2, which is when they begin to go to the bathroom. Some of the risk factors that are usually related to their manifestation include the following:

  • Constipation: Related to the type of diet, age, and bowel movement complications
  • Type of toilet: Habitual sitting on a toilet for prolonged periods of time
  • Family history 
  • Obesity and diseases: The most common cause of hemorrhoids in children is chronic liver failure

Relaxation of the structures with aging increases the incidence of hemorrhoidal disease. This explains why it doesn’t occur as frequently in children under 10 years of age.

Clinical manifestations of hemorrhoids in children

Symptomatic hemorrhoids are called external or internal according to their location. Some of the symptoms and signs they present are the following:

  • Perianal swelling or lumpiness 
  • Rectal pain or difficulty sitting
  • Mucus discharge
  • Bleeding
  • Itching

The signals coming from children’s bodies are fundamental to making an accurate and quick diagnosis of hemorrhoidal disease. In other words, minors can’t or don’t know how to express their discomfort regarding the clinical picture, so they manifest it with crying in moments that are associated with going to the bathroom.

You may be interested in: What to Do With Postpartum Hemorrhoids?

Therapeutic options for hemorrhoids in children

Conservative treatment is sufficient to manage external hemorrhoids in children due to their low recurrence rate. In fact, management is based on two fundamental pillars:

  1. Recognize and treat the triggering cause.
  2. Provide conservative, non-surgical management initially, including dietary care measures.

Adequate nutrition and hydration

It’s essential that children have a diet high in fiber, vegetables, and water. Even though fruits and vegetables aren’t to their liking, their incorporation is essential for the digestive system to function properly, according to the recommendations of the American Academy of Pediatrics. In addition, physical exercise helps to keep the intestine healthy and can prevent the appearance of hemorrhoids.

A toddler girl eating a plate of vegetables.
The consumption of fruits and vegetables helps the digestive system to function properly and helps to prevent hemorrhoids.

Oral medication

In children under 12 years of age, a diet that doesn’t favor constipation, plenty of water, local analgesics, and warm sitz baths are recommended. In patients older than 12 years, venotonic drugs can be added for 14 days, when indicated by a doctor.

Care measures and topical creams

Sometimes, topical therapeutic options with corticosteroid-based creams can be very useful. However, their use is only recommended for short courses of less than 7 days. Even lidocaine anesthetic creams are often indicated, which only temporarily relieve the signs and symptoms of hemorrhoidal disease.

Surgical intervention

Thrombosed hemorrhoids require hospitalization and surgical treatment within the first 72 hours. In fact, when referring to internal hemorrhoids, either ligation, cryotherapy or sclerotherapy, or electrocoagulation can be performed. As for hemorrhoidectomy or surgical removal of hemorrhoids, it’s painful for adults and is usually much less tolerated in pediatric patients.

Hemorrhoids in children and quality of life

Hemorrhoids aren’t as common in children, but their presence may be linked to other diseases. In most cases, there are no other symptoms, so they don’t require any measures other than changing the diet and avoiding constipation. You should know that children with hemorrhoids have a lower quality of life, so it’s crucial that they receive the correct treatment.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Grossmann O, Soccorso G, Murthi G. LigaSure Hemorrhoidectomy for Symptomatic Hemorrhoids: First Pediatric Experience. Eur J Pediatr Surg. 2015 Aug;25(4):377-80. doi: 10.1055/s-0034-1382258. Epub 2014 Jun 11. PMID: 24918403.
  • Jacobs DO. Hemorrhoids: what are the options in 2018? Curr Opin Gastroenterol. 2018 Jan;34(1):46-49. doi: 10.1097/MOG.0000000000000408. PMID: 29076869.
  • Watanabe T, Ohno M, Tahara K, Tomonaga K, Ogawa K, Takezoe T, Fuchimoto Y, Fujino A, Kanamori Y. Efficacy and safety of sclerotherapy with polidocanol in children with internal hemorrhoids. Pediatr Int. 2021 Jul;63(7):813-817. doi: 10.1111/ped.14506. Epub 2021 May 26. PMID: 33045763.
  • https://www.researchgate.net/publication/326711016_HEMORRHOIDS_IN_CHILDHOOD_A_WELL-KNOWN_AND_OFT-NEGLECTED_PATHOLOGY
  • Mott T, Latimer K, Edwards C. Hemorrhoids: Diagnosis and Treatment Options. Am Fam Physician. 2018 Feb 1;97(3):172-179. PMID: 29431977.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.