Due to increased hydrostatic pressure in hemorrhoidal venous plexus (associated with straining at stool, pregnancy). May be external, internal, thrombosed, acute (prolapsed or strangulated), or bleeding. Treat pain with bulk laxative and stool softeners (psyllium extract, dioctyl sodium sulfosuccinate 100–200 mg/d), sitz baths one to four per day, witch hazel compresses, analgesics as needed. Bleeding may require rubber band ligation or injection sclerotherapy. Operative hemorrhoidectomy in severe or refractory cases.