Hemorrhoids: The Annoying Anorectal Swollen Veins

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Hemorrhoids (haemorrhoids), also known as piles, are swollen veins around your anus and rectum. This happens when there is too much pressure in the veins. Learn more about how to keep away from those annoying and embarrassing hemorrhoids!


What are Hemorrhoids?

In the anal canal, there are clusters of small blood vessels and connective tissues that act as cushions. When they become inflamed and swollen, they are called hemorrhoids or piles, which can be located around the anus (external hemorrhoids) or in the upper part of the anal canal (internal hemorrhoids). When blood clots form inside the veins, it is called thrombosed hemorrhoids, which cause severe pain. Hemorrhoids are not life-threatening and usually go away on their own, though they can be itchy, painful and even prolapsed. 

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Signs and Symptoms of Hemorrhoids

Hemorrhoids symptoms vary from person to person, depending on the type of hemorrhoids. Hemorrhoids are classified into 2 categories by their location, namely external hemorrhoids located around the anus and internal hemorrhoids located in the upper part of the anal canal. Generally, the most common complaint signs and symptoms of hemorrhoids include:  


Signs and Symptoms of External hemorrhoids

  • Anal pain and discomfort
  • Anal itching or irritation
  • Bleeding in anus
  • Painful lump or swelling near your anus: Patients often feel pain because the veins of external hemorrhoids are covered by skin with pain fibers.

Signs and Symptoms of Internal hemorrhoids:

  • Painless bleeding from the anal area during bowel movements: You would see some bright red blood on toilet paper or in the toilet bowl.
  • Severe pain if prolapsed: Prolapsed hemorrhoids are hemorrhoids that have fallen through your anal opening. Internal hemorrhoids themselves do not cause pain because there are no pain fibers attached to the veins where they locate. However, if they prolapse or protrude, they can cause pain and irritation. 

Although hemorrhoids can cause rectal bleeding or blood in stool, it is suggested to seek medical advice whenever it happens because bleeding can be caused by other serious conditions other than hemorrhoids, such as inflammatory bowel disease and colorectal cancer.

Causes and Risk Factors of Hemorrhoids

Hemorrhoids are resulted from too much pressure on the veins around your anus, causing them to swell. Causes of hemorrhoids can be due to the following reasons:

  • Straining during bowel movements
  • Sitting on the toilet for long periods of time (e.g. reading)
  • Complications from chronic constipation or diarrhea
  • Low-fiber diet
  • Consistent heavy lifting
  • Anal sex
  • Aging
  • Obesity
  • Family history of hemorrhoids
  • Pregnancy: pregnancy increases the pressure of the enlarged uterus on the rectum and anus, causing the anal region to bulge. 

Complications of Hemorrhoids

Hemorrhoids are not serious and generally go away without treatment, though some complications can rarely happen, including:

  • Anemia: It happens when you have chronic blood loss because of hemorrhoids.
  • Thrombosed hemorrhoids: Sometimes, blood clots form inside the hemorrhoid veins. You can feel a dark bluish lump near your anus. Although it is not dangerous, thrombosed hemorrhoids can cause extreme pain and usually require surgical excision (hemorrhoidectomy). 

Diagnosis of Hemorrhoids

In general, hemorrhoids can be diagnosed by medical history and a simple physical examination, especially external hemorrhoids. To confirm the diagnosis, tests performed by physicians may include: 

  • Physical examination: Your physician would check for abnormal lumps or masses around your anus. External hemorrhoids are usually apparent, particularly if a blood clot has formed (thrombosed hemorrhoids).
  • Digital rectal exam (DRE): Your physician would insert a gloved and lubricated finger into your rectum to check for any abnormal growths. 
  • Proctoscopy: A plastic lighted tube is inserted into your anus to check for internal hemorrhoids and other possible diseases. 
  • Other tests: If your doctor suspects you have other gastrointestinal problems (e.g. colorectal cancer), some tests might be performed, such as colonoscopy (entire large intestine), or sigmoidoscopy (part of the large intestine).

Treatments of Hemorrhoids

Mild hemorrhoids typically go away on their own without treatment within a week, still, you can relieve symptoms through at-home care. If your home treatment does not work effectively, you may need to find a doctor for tests, and possibly surgical procedures. 


Home remedies for hemorrhoids:

  • Fiber-rich diets: Consuming more fiber along with more water can soften the stools and avoid straining during bowel movements, meaning the pressure on your hemorrhoids is reduced. Foods that are rich in fiber include vegetables, beans, whole-grain foods, and fruits.
  • Sitz bath: A sitz bath is a warm water bath that fits over the toilet that can soak your anal area in. Sitting 10-20 minutes several times a day can relieve itching and irritation. A regular bathtub with a few inches of warm water will work too. 
  • Topical treatment: Some hemorrhoids cream or cream containing hydrocortisone can ease the symptoms. There are also pads that contain witch hazel, or numbing agents (e.g. lignocaine) that are also helpful. Consult your doctor or pharmacist on the choice of agents. 
  • Pain relief: You can take paracetamol or ibuprofen if you experience pain, and it is best to consult your doctor or pharmacist.

Minimally invasive procedures for hemorrhoids

If your hemorrhoids can't be managed with at-home care because of persistent symptoms of prolapsed hemorrhoids, procedures may be needed. Your doctor would first consider the need for colonoscopy to rule out other causes of per-rectal bleeding. To relieve the symptoms, some minimally invasive procedures, which can be done in a doctor's office or outpatient setting, are less painful, effective and do not require anesthesia. These include: 

  • Rubber band ligation: Your doctor would place a rubber band around the base of hemorrhoid in order to cut off circulation to the hemorrhoid. The hemorrhoid would shrink within a few days. It can be done as an office procedure or in the same setting during a colonoscopy.
  • Sclerotherapy: The principle of sclerotherapy works the same as rubber band ligation but it is less effective. Sclerotherapy involves injecting a chemical around the blood vessel to shrink the hemorrhoid. 
  • Infrared coagulation: Your doctor would use a device that creates an intense beam of infrared light to cut off the blood supply to the hemorrhoid. It is indicated for internal hemorrhoids only. 

Conservative procedures for hemorrhoids

If you have failed conservative therapy or have large protruding hemorrhoids, surgery may be needed, which includes: 

  • Hemorrhoidectomy: Hemorrhoidectomy involves the incision of the tissue around the hemorrhoid to remove it. This method is very effective and has a low complication rate. The procedure requires anesthesia, but patients can go home on the same day or the day after the surgery.
  • Stapled hemorrhoidopexy (Stapled hemorrhoidectomy): This procedure treats bleeding or prolapsed internal hemorrhoids by returning the hemorrhoid to a normal position. It is more painful than rubber band ligation but less painful than hemorrhoidectomy. The operation usually involves general anesthesia and is regarded as a day case surgery. 

Prevention of Hemorrhoids

Anyone can get hemorrhoids, but the risk can be lowered by the following approaches: 

  • Diet: Consuming fiber-rich foods can soften the stool which makes it easier to pass. These foods include broccoli, beans, nuts, whole-grain foods, berries, and avocados. In addition, adequate water intake can prevent stools from hardening. 
  • Fiber supplements: You can also obtain fiber via supplementation (e.g. Metamucil), which can also help treat constipation. 
  • Regular exercise: Exercising regularly can improve your bowel movement and prevent constipation. However, weight-lifting is not recommended because it would apply a lot of pressure near your rectum and anus.  
  • Avoid sitting for a long period: Sitting for too long can increase the pressure on the anal veins.
  • Avoiding over-straining: Do not strain when using the toilet because it can generate pressure in the veins in the lower rectum.
  • Go to the toilet whenever urged: Do not wait if you are urged to go to the toilet, because the stool can dry out which makes it difficult to pass. 


What is the main cause of hemorrhoids?

Hemorrhoids are caused by too much pressure on the veins around your anus, causing them to swell. It commonly results from prolonged sitting in the toilet, straining during bowel movements, a low-fiber diet and pregnancy.

Can hemorrhoids be treated?
Do hemorrhoids go completely away?

This article was medically reviewed by Dr. Kam Ming Ho Philip 甘明豪醫生. Dr. Kam is a specialist in general surgery in Hong Kong who is currently practicing at the Edinburgh Orthopaedic Spine And Surgery Centre.

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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.

Dr. Kam Ming Ho Philip
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