15120 Hemorrhoids

Overview

Hemorrhoids, also called piles, are swollen veins in the lowest part of the rectum and anus. They can cause itching, discomfort, and sometimes bleeding, especially during or after a bowel movement.

Yes, hemorrhoids are very common. About 3 in 4 adults will have them at some point in their life.

Anyone can get hemorrhoids. They happen more often as people age, during pregnancy, and in people who have long-term constipation or often strain during bowel movements.

Symptoms

Common symptoms

• Bright red blood on toilet paper or in the toilet bowl after a bowel movement
• Itching or irritation around the anus
• Pain or discomfort, especially when sitting
• Swelling or a tender lump near the anus
• A feeling that you still need to have a bowel movement after going

Causes

Main causes

• Increased pressure in the veins around the anus
• Straining during bowel movements
• Sitting for long periods on the toilet
• Long-term constipation or diarrhea
• Pregnancy, because the growing uterus puts pressure on these veins
• Being overweight or lifting heavy objects

Risk factors

• Low-fiber diet
• Chronic constipation or frequent straining
• Pregnancy and childbirth
• Older age
• Spending long periods sitting, especially on the toilet
• Obesity

When to see a doctor

See a doctor urgently if:

• If you see a large amount of blood or blood clots in the toilet
• If you feel faint, dizzy, or very weak
• If you have severe pain that stops you from doing normal activities

Book a routine appointment if:

• If you notice any blood in your stool or on toilet paper for the first time
• If your symptoms do not improve after a week of home care
• If you have a lump near your anus that does not go away
• If you have a change in bowel habits that lasts more than a few weeks

Diagnosis

A doctor will ask about your symptoms and medical history, then examine the area around your anus. They may also gently insert a gloved finger into the rectum to check for internal hemorrhoids or other issues.

Tests that may be done

• Visual inspection of the anus
• Digital rectal exam (doctor inserts a gloved, lubricated finger)
• Anoscopy (a small, lighted tube to look inside the anus)
• Sigmoidoscopy (a longer, flexible tube to check the lower part of the bowel)

What to expect at your appointment

The examination is usually quick. It might feel a little uncomfortable, but it should not be painful. You can ask for a chaperone to be present, and you can let the doctor know if you are anxious.

Treatment

Most hemorrhoids improve with simple self-care. If that is not enough, a doctor can offer procedures to shrink or remove the hemorrhoid. Surgery is reserved for severe cases.

Self-care at home

• Eat more fiber from fruits, vegetables, whole grains, and legumes to soften stools.
• Drink plenty of water throughout the day.
• Go to the toilet as soon as you feel the urge, and try not to strain.
• Take warm baths for 10–15 minutes, a few times a day, to ease pain and itching.
• Use the toilet only when you need to, and avoid sitting on it for long periods.
• Keep the anal area clean and dry. Use soft, unscented toilet paper or moist wipes without alcohol or perfume.
• You can buy soothing creams or pads from a pharmacy for temporary relief, but ask your pharmacist which is suitable for you.

Medical treatments

If self-care is not enough, your doctor may recommend in-office treatments such as rubber band ligation (placing a small band around the hemorrhoid to cut off its blood supply), sclerotherapy (injecting a solution to shrink it), or infrared coagulation (using heat to seal it). These are done by a specialist and usually do not need a hospital stay. Your doctor will explain the risks and benefits of each option.

When is surgery considered?

Surgery may be considered if other treatments have not worked, or if you have a large, painful hemorrhoid that cannot be treated conservatively. Surgery can be done as a day case, and you will get advice on recovery.

Living with this condition

For most people, hemorrhoids get better with simple home care. Keep up your fiber and fluid intake, avoid straining, and continue taking short warm baths during flare-ups. You can live normally while managing symptoms.

Lifestyle tips

• Do not delay bowel movements when you feel the urge.
• Do not sit on the toilet for more than a few minutes.
• Take breaks from sitting for long periods, especially if you work at a desk.
• Avoid heavy lifting or learn proper lifting techniques.
• Maintain a healthy weight to reduce pressure on the veins.

Diet and exercise

A diet rich in fiber helps prevent constipation and softens stools. Include fruits, vegetables, whole grains, and beans. Drink enough water so your stools stay soft. Regular exercise like walking, swimming, or cycling improves circulation and helps you keep a healthy weight.

Mental health and emotional wellbeing

Having hemorrhoids can make you feel embarrassed or stressed, but you are not alone. Many people have them. It is important to talk openly with your doctor so they can help you find relief. Untreated anxiety about symptoms can make you avoid seeking care, which is not helpful. Treatment is usually straightforward and effective.

Prevention

You can lower your risk of developing hemorrhoids by eating a high-fiber diet, drinking enough fluids, exercising regularly, and avoiding straining during bowel movements. Also, try not to sit for long periods on the toilet.

Screening programmes

There is no specific screening test for hemorrhoids, but if you have bleeding or other symptoms, your doctor may recommend checking your lower bowel. This is to rule out other causes, not to screen for hemorrhoids.

Complications

If left untreated

• Ongoing pain, itching, and irritation
• A thrombosed hemorrhoid, which is a painful blood clot inside the hemorrhoid
• A strangulated hemorrhoid, where the blood supply is cut off and it becomes very painful
• Rarely, severe chronic bleeding can lead to anemia (low blood count)

Long-term outlook

The outlook for hemorrhoids is very good. Most people improve with simple home care. Even when treatment is needed, it is usually safe and effective. Bleeding should always be checked, but if you follow your doctor's advice, hemorrhoids should not take over your life.

Find support

Local organisations

• NHS UK ↗ · United Kingdom

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