Living with hemorrhoids

Overview

Hemorrhoids (also called piles) are swollen veins in the lower part of the rectum and around the anus. They are similar to varicose veins that you might see on legs. They can be inside the rectum or on the outside, and they can cause symptoms like itching, pain, and bleeding after a bowel movement.

Yes, hemorrhoids are one of the most common digestive problems. Around three in four adults will have them at some point in their lives.

Hemorrhoids can affect anyone, but they are more common in people over 50, during pregnancy, and in people who have long-term constipation or who strain when passing stool.

Symptoms

Common symptoms

• Bright red blood on the toilet paper, in the toilet bowl, or on the surface of the stool
• Itching or irritation around the anus
• Pain or discomfort, especially when sitting
• Swelling or a tender lump near the anus
• A feeling that you have not completely emptied your bowels

Symptoms in children

• Hemorrhoids are rare in children, but a child can get them after long periods of constipation or frequent straining on the toilet.
• Symptoms in children are similar to adults: pain, itching, and sometimes a small amount of blood on the stool or toilet paper.

Symptoms in older adults

• Older adults are more likely to have hemorrhoids because the tissues that support the veins can weaken with age.
• Age-related constipation and less physical activity also increase the risk.
• Bleeding from the rectum in older adults should always be checked by a doctor to rule out more serious conditions.

Causes

Main causes

• Increased pressure on the veins in the lower rectum and anus
• Straining during bowel movements, often due to constipation
• Sitting on the toilet for a long time
• Pregnancy, because the growing uterus presses on these veins
• Repeated heavy lifting or intense physical strain

Risk factors

• Chronic constipation or diarrhea
• A diet low in fiber and fluids
• Being overweight or obese
• Pregnancy and childbirth
• Being older than 50
• A family history of hemorrhoids

When to see a doctor

See a doctor urgently if:

• You see blood in your stool or on the toilet paper, especially if this is the first time
• You experience persistent rectal pain or a painful lump that does not go away
• You notice a change in your normal bowel habit that lasts more than a few weeks
• You have symptoms that interfere with daily life or cause significant discomfort

Book a routine appointment if:

• You have had hemorrhoid symptoms before, but they are lasting longer than a week despite home care
• You are pregnant and have hemorrhoid symptoms for the first time
• You are unsure whether your symptoms are due to hemorrhoids or something else

Diagnosis

A doctor will ask about your symptoms, your diet, and your bowel habits. They may examine the area around the anus and inside the lower rectum. This is usually quick and routine.

Tests that may be done

• Visual inspection of the anus and surrounding area
• A digital rectal exam, where the doctor gently inserts a gloved finger to feel for problems
• An anoscopy, using a short, lighted tube to look at the lining of the lower rectum
• A sigmoidoscopy or colonoscopy may be recommended if there is bleeding and the doctor wants to rule out other causes, especially in older adults

What to expect at your appointment

Most people do not need any special preparation. The examination may feel slightly uncomfortable but is not usually painful. Your doctor will explain what they are doing and will help you relax. You can ask for a chaperone or a different clinician if you prefer.

Treatment

Treatment for hemorrhoids starts with simple measures you can do at home, like changing your diet and avoiding straining. If these do not help, there are several non-surgical procedures and, for some people, surgery. In most cases, hemorrhoids improve with self-care and lifestyle changes.

Self-care at home

• Eat more fiber — aim for at least 25 to 30 grams a day from fruits, vegetables, whole grains, and beans — and drink plenty of water to soften stool
• Do not delay going to the toilet when you feel the urge, and do not sit on the toilet for more than a few minutes
• Wipe gently with soft, unscented toilet paper, or use moist wipes or a bidet instead
• Take warm (not hot) baths for 10 to 15 minutes a couple of times a day to ease pain and itch
• Use a small pillow or cushion to sit on, to reduce pressure on the anal area
• Apply an over-the-counter soothing cream, ointment, or suppository — ask your pharmacist for advice, and always follow the instructions

Medical treatments

If self-care is not enough, a doctor can offer a range of in-office treatments. These include rubber band ligation (placing a small band around the hemorrhoid to cut off its blood supply), sclerotherapy (injecting a solution that shrinks the hemorrhoid), and infrared or laser coagulation (using heat to seal the blood vessel). These treatments are generally quick and do not require a hospital stay. For some people, prescription medicines are available, but your doctor will discuss the options with you.

When is surgery considered?

Surgery is usually only considered when other treatments have not worked, or if a hemorrhoid is very large, prolapsed, or causing severe discomfort. The most common surgical procedure is a hemorrhoidectomy (removal of the hemorrhoid). Another option is stapled hemorrhoidopexy, which repositions the hemorrhoid. Your surgeon will explain the risks and benefits.

Living with this condition

Living with hemorrhoids often comes down to managing bowel habits. Keep your stools soft by staying hydrated and eating plenty of fiber, and try not to strain or spend too long on the toilet. Regular gentle exercise like walking can help keep your bowels moving. If sitting is painful, use a soft ring cushion and take breaks to stand and move.

Lifestyle tips

• Maintain a healthy weight — extra weight puts pressure on the lower rectum
• Avoid lifting heavy objects or straining during exercise; learn to lift with your legs and breathe
• Do not sit for long periods — stand up and move every hour
• Go when nature calls, but do not push or force a bowel movement
• Treat constipation early with diet and hydration, not by straining

Diet and exercise

A high-fiber diet is the cornerstone of managing and preventing hemorrhoids. Eat plenty of fruits like apples and pears, vegetables like broccoli and carrots, whole grains like oats and brown rice, and legumes like lentils and chickpeas. Drink enough water so your stool stays soft. Regular physical activity, such as walking, helps prevent constipation and improves blood flow.

Mental health and emotional wellbeing

Hemorrhoids can be uncomfortable and sometimes painful, and many people feel embarrassed or anxious about them. It is completely normal to feel this way. Remember that hemorrhoids are a common medical condition and talking to a doctor is nothing to be ashamed of. If anxiety about your symptoms affects your mood or sleep, mention it to your healthcare provider — they can offer support.

Prevention

Yes, you can lower your chance of getting hemorrhoids or having them flare up. The key is to avoid constipation and straining. Eat a high-fiber diet, drink plenty of fluids, exercise regularly, and go to the toilet as soon as you feel the urge.

Complications

If left untreated

• Anemia may develop if hemorrhoids bleed regularly and heavily over time, although this is rare
• A hemorrhoid may become prolapsed, meaning it is pushed out of the anus and cannot easily go back in
• A strangulated hemorrhoid occurs when the blood supply is cut off, causing severe pain and tissue damage
• Skin irritation, itching, or infection around the anus can develop from rubbing or scratching

Long-term outlook

For the vast majority of people, hemorrhoids are not serious and can be managed successfully with lifestyle changes and simple treatment. Even when more advanced treatment is needed, it is usually very effective. With the right care, you can expect symptoms to improve significantly and your daily life to get back on track.

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