Hemorrhoids are a condition in which the veins in the lower part of the anus and rectum become swollen and enlarged. These veins normally serve a supportive function in the anal canal during defecation and at other times. However, when pressure on these veins increases for various reasons, they can become varicose and lead to the condition known as hemorrhoids. Hemorrhoids are classified based on their location and can present with different symptoms. This is a common health issue that can negatively impact quality of life.

Types of Hemorrhoids

Hemorrhoids are mainly classified into two types based on their location:

Internal Hemorrhoids:
Located inside the rectum, above the dentate line. Because the nerve endings in this area are less sensitive, they are usually painless. However, they may protrude during straining (prolapse) and cause bleeding. Internal hemorrhoids are graded as follows:

Grade 1: No prolapse; only bleeding may be observed.
Grade 2: Prolapses during bowel movements but retracts spontaneously.
Grade 3: Prolapses during defecation and must be manually pushed back.
Grade 4: Permanently prolapsed and cannot be manually retracted.

External Hemorrhoids:
Located under the dentate line, on the outer part of the anus. Since this area has more nerve endings, swelling or the formation of a clot (thrombosed hemorrhoid) can cause severe pain. External hemorrhoids may be palpable and sometimes appear as a purplish swelling under the skin.

Causes of Hemorrhoids

Many factors may contribute to the development of hemorrhoids. The primary cause is increased pressure on the veins in the anal area. Situations that may lead to this pressure include:

Chronic Constipation: Hard and dry stools cause excessive straining, putting pressure on anal veins.
Chronic Diarrhea: Frequent and watery bowel movements can irritate the anal area and compress the veins.
Prolonged Sitting on the Toilet: This habit increases sustained pressure on the anal veins.
Heavy Lifting: Regular heavy lifting increases intra-abdominal pressure and stresses the anal veins.
Pregnancy: A growing uterus and hormonal changes can pressure the pelvic veins.
Obesity: Excess weight puts additional pressure on the anal veins.
Aging: Supporting tissues in the anal area may weaken with age, increasing hemorrhoid risk.
Genetic Predisposition: Those with a family history of hemorrhoids may be more susceptible.
Low-Fiber Diet: A fiber-deficient diet can lead to constipation.

Symptoms of Hemorrhoids

Symptoms vary depending on the type and severity of the hemorrhoids. Common symptoms include:

Rectal Bleeding: Bright red blood may appear on toilet paper, in the toilet bowl, or on the stool.
Anal Itching: An irritating itching sensation in the anal area.
Anal Pain or Discomfort: Severe pain is especially common in external or thrombosed hemorrhoids. Internal hemorrhoids are usually painless unless prolapsed.
Swelling or Lump Around the Anus: A palpable lump or swelling, more common with external hemorrhoids.
Mucus Discharge: A slimy discharge from the anal area.
Difficulty Cleaning After Bowel Movements: Swollen hemorrhoids can make cleaning difficult.
Feeling of Fullness in the Anus: Particularly in advanced internal or thrombosed external hemorrhoids.
Pain During Defecation: Common in inflamed or thrombosed hemorrhoids.

How Are Hemorrhoids Diagnosed?

A diagnosis is usually made by a doctor through physical examination and medical history. Diagnostic methods include:

Medical History: The doctor will ask about symptoms, duration, bowel habits, and family history.
Physical Examination: The anal area is visually examined for external or prolapsed hemorrhoids.
Digital Rectal Exam: A gloved, lubricated finger is gently inserted into the anus to assess internal hemorrhoids, abnormalities, or muscle tone.
Anoscopy: A short, lighted tube (anoscope) is inserted into the anus for a clearer view of the anal canal and lower rectum.
Sigmoidoscopy or Colonoscopy: If further evaluation is needed, particularly in cases of bleeding or suspected bowel disease, these procedures help visualize the inner surface of the intestines and rule out other conditions.

What Helps with Hemorrhoids?

There are several home remedies to alleviate symptoms and provide relief:

Sitz Bath: Sitting in warm water for 10–15 minutes a few times daily can relax anal muscles and reduce pain and swelling.
Cold Compress: Applying an ice pack to the area intermittently can help reduce swelling and pain.
Topical Creams and Ointments: Over-the-counter creams and ointments may relieve itching and discomfort but should be used under medical supervision if long-term use is needed.
Pain Relievers: Over-the-counter painkillers like paracetamol or ibuprofen may help relieve pain when used as directed by a doctor.
Hydration: Drinking enough water helps keep stools soft.
High-Fiber Diet: Consuming fiber-rich foods like fruits, vegetables, whole grains, and legumes prevents constipation and eases bowel movements.
Proper Toilet Habits: Avoid delaying bowel movements and prolonged sitting. Straining should be minimized.
Moist Wipes: Use alcohol- and fragrance-free wipes instead of rough toilet paper to reduce irritation.

Do Hemorrhoids Go Away?

Whether hemorrhoids go away on their own depends on their type, stage, and underlying causes. Mild cases may resolve with lifestyle changes and home care. However, advanced hemorrhoids or those with severe symptoms often require medical intervention.

Conservative methods (dietary fiber, hydration, sitz baths, etc.) can help manage symptoms and slow progression. In some cases, medical or surgical treatment is necessary for full resolution.

What Should Hemorrhoid Patients Be Careful About?

Important considerations for patients with hemorrhoids include:

Diet: Consume fiber-rich foods, stay well-hydrated, and limit processed foods, spicy meals, and alcohol.
Toilet Habits: Avoid delaying bowel movements and sitting too long; minimize straining.
Hygiene: Gently clean the area, use moist wipes instead of rough toilet paper, and avoid irritating soaps.
Clothing: Choose loose, cotton underwear instead of tight or synthetic garments.
Activity: Avoid prolonged sitting or standing and engage in regular physical activity. Avoid lifting heavy objects.
Weight Management: Maintaining a healthy weight reduces pressure on anal veins.
Regular Check-ups: See a doctor if symptoms persist or worsen.

Complications of Hemorrhoids

While hemorrhoids are not usually serious, they can lead to complications:

Bleeding: Chronic or recurrent bleeding may cause iron deficiency anemia.
Thrombosis: Clot formation in external hemorrhoids can cause severe pain and swelling.
Strangulation: Prolapsed internal hemorrhoids may get trapped by anal sphincter muscles, impairing blood flow and potentially leading to tissue necrosis—a medical emergency.
Infection: Rarely, infection may occur in the hemorrhoid area.
Skin Irritation: Persistent moisture and discharge may cause skin irritation or eczema.

What Helps with Hemorrhoid-Related Itching?

The following methods can help relieve hemorrhoid-related itching:

Sitz Bath: Soaking in warm water soothes the anal area and reduces itching.
Cold Compress: Reduces swelling and itching.
Moisturizing Creams: Doctor-approved moisturizers can relieve dryness and reduce itching. Corticosteroid creams should not be used long-term without medical supervision.
Cotton Underwear: Helps reduce irritation.
Avoid Irritants: Stay away from perfumed soaps, detergents, and other irritants.
Avoid Scratching: Scratching worsens irritation and can aggravate the condition.
Medical Consultation: Persistent itching requires medical evaluation to determine underlying causes.

How to Prevent Hemorrhoids

You can reduce the risk of developing hemorrhoids by:

High-Fiber Diet: Softens stools and reduces straining.
Staying Hydrated: Drinking enough fluids helps maintain stool consistency.
Regular Exercise: Encourages healthy bowel movements.
Healthy Weight: Reduces pressure on anal veins.
Toilet Habits: Do not delay bowel movements and avoid prolonged toilet use. Minimize straining.
Avoid Heavy Lifting: Use proper techniques and avoid excessive exertion.
Posture Changes: Avoid prolonged sitting or standing; change positions periodically.

How Are Hemorrhoids Treated?

Note: This section outlines general treatment approaches without detailing specific medical or surgical procedures.

Treatment depends on the stage and severity of hemorrhoids and the patient’s overall health. General approaches include:

Lifestyle Changes: Dietary fiber, hydration, exercise, and proper toilet habits help relieve symptoms and prevent worsening.
Medical Treatment: Doctor-prescribed topical creams, ointments, and pain relievers manage symptoms.
Minimally Invasive Procedures: Techniques like rubber band ligation, sclerotherapy, or infrared coagulation may be performed in outpatient settings.
Surgical Treatment: Required for advanced or non-responsive cases. Several surgical techniques exist, and the most appropriate one is selected based on the patient’s condition.

What to Avoid After Hemorrhoid Surgery?

During recovery after hemorrhoid surgery, patients should avoid:

Constipation: Follow a fiber-rich diet and stay hydrated; laxatives may be used as prescribed.
Straining: Avoid excessive pushing during bowel movements.
Prolonged Sitting: Take breaks and move regularly.
Heavy Lifting: Avoid lifting heavy objects during recovery.
Irritating Foods: Refrain from spicy, fatty foods for a while.
Rough Toilet Paper: Use moist wipes or warm water instead.
Medication Compliance: Use all prescribed painkillers and medications regularly.
Early Activity: Engage in light physical activity as advised, but avoid overexertion.
Missing Check-ups: Attend all scheduled follow-up appointments.

Disclaimer:
All content on this site is for informational purposes only and is based on scientific sources valid as of the date of preparation. If you have any symptoms, require diagnosis, or need treatment, please consult your physician or an authorized healthcare provider directly.

Hemorrhoids (Piles)