Hemorrhoids are enlarged rectal veins. Enlargement is associated with increased pressure in the veins, as occurs when straining to have a bowel movement (constipation) ,pregnancy, and liver disease. Internal hemorrhoids are enlarged rectal veins in the anal canal. They are usually painless but often bleed following a bowel movement. The most common sign of internal hemorrhoids is blood on toilet paper. Prolapse, or extrution , of an internal hemorrhoids through the anus can be painful. External hemorrhoids are enlarged rectal veins around the anus. The development of a blood clot in an external hemorrhoid can be painful. Treatment for hemorrhoids include increasing the bilk (indigestible fiber) in the diet, taking sitz baths, and using hydrocortisone suppositories. Surgery may be necessary if the condition is extreme and does not respond to other treatments.