Hemorrhoids

Hemorrhoids, also called piles, are swollen blood vessels found inside the back passage (internal) or around the opening of the anus (external). Everyone has cushions of blood vessels in this area; they become hemorrhoids when they swell and cause symptoms.

They are extremely common and are usually not dangerous. Many people have them at some point in life, and symptoms often come and go. While uncomfortable and sometimes worrying because of the bleeding, hemorrhoids are generally a benign condition.

Common symptoms include bright red blood seen on the toilet paper or in the toilet after passing stool, itching or irritation around the anus, discomfort or aching, mucus discharge, and sometimes a feeling that the bowel has not fully emptied. You may feel one or more lumps around the anus.

External hemorrhoids can become more painful, especially if a small clot forms inside them. Internal hemorrhoids are often painless but may bleed or, in some cases, bulge outside the anus.

Hemorrhoids are linked to increased pressure in the lower rectum and anus. This is often related to constipation and straining to pass stool, but can also follow heavy lifting, persistent coughing, pregnancy, and prolonged sitting on the toilet.

Risk increases with age as the supporting tissues weaken, and being overweight can also contribute. Pregnancy is a common trigger because of pressure from the growing baby and changes in the bowel.

A doctor can often diagnose hemorrhoids by asking about your symptoms and examining the area around the anus. They may perform a gentle internal examination with a gloved finger to feel for any abnormalities.

Because rectal bleeding can have other causes, your doctor may sometimes recommend a closer look at the lower bowel using a short scope, particularly if you are older, the bleeding is unusual, or there are other warning symptoms. This helps make sure nothing more serious is being missed.

Most hemorrhoids improve with self-care. Keeping stools soft by drinking plenty of fluids and eating enough fibre reduces straining. Simple measures such as warm baths, cold packs, gentle cleaning, and avoiding sitting on the toilet for long periods can ease discomfort.

A pharmacist can suggest creams, ointments, or suppositories to relieve symptoms, and laxatives if constipation is a problem. If symptoms persist, a doctor may offer office-based procedures such as banding (rubber band ligation), sclerotherapy, or other treatments. Surgery is occasionally needed for larger or persistent hemorrhoids.

See a doctor if your symptoms do not improve with self-care, if you keep having bleeding, or if you are not sure what is causing your symptoms. Always have rectal bleeding assessed rather than assuming it is from hemorrhoids.

Seek urgent care for very heavy bleeding, bleeding that will not stop, severe pain, or signs of infection such as fever or pus. Any change in bowel habit, dark or tarry stools, or unexplained weight loss should be reviewed promptly.

The main way to reduce hemorrhoids is to avoid constipation and straining. This means eating enough fibre, drinking plenty of fluids, staying physically active, and going to the toilet when you feel the urge rather than delaying. Limiting time spent sitting on the toilet also helps.

The outlook is generally very good. Many hemorrhoids settle with simple measures, and treatments are available if they persist. They can return, so keeping up healthy bowel habits is the best way to lower the chance of them coming back.